Valley Children's Hospital 7/1/2024 version "Madera, CA" "9300 Valley Children's Place, Madera, CA 93636" 040000160 "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." 2.0.0 Description Code Code Type Default CPT/HCPCS Modifier Setting NDC Pharmacy Unit Pharmacy Unit Type Charge De-Identified Negotiated Min De-Identified Negotiated Max Cash Price UHC Local Negotiated Dollar UHC Local Negotiated Percentage UHC Local Negotiated Algorithm UHC Local Estimated Amount UHC Local Payment Methodology UHC National Negotiated Dollar UHC National Negotiated Percentage UHC Local Negotiated Algorithm UHC National Estimated Amount UHC National Payment Methodology Blue Cross Negotiated Dollar Blue Cross Negotiated Percentage Blue Cross Negotiated Algorithm Blue Cross Estimated Amount Blue Cross Payment Methodology Blue Shield Negotiated Dollar Blue Shield Negotiated Percentage Blue Shield Negotiated Algorithm Blue Shield Estimated Amount Blue Shield Payment Methodology Blue Shield Covered CA Negotiated Dollar Blue Shield Covered CA Negotiated Percentage Blue Shield Covered CA Negotiated Algorithm Blue Shield Covered CA Estimated Amount Blue Shield Covered CA Payment Methodology Kaiser Negotiated Rate Kaiser Negotiated Percentage Kaiser Negotiated Algorithm Kaiser Estimated Amount Kaiser Payment Methodology Aetna Negotiated Rate Aetna Negotiated Percentage Aetna Negotiated Algorithm Aetna Estimated Amount Aetna Payment Methodology NBD Negotiated Rate NBD Negotiated Percentage NBD Negotiated Algorithm NBD Negotiated Rate NBD Methodology Community Care Health Plan Negotiated Rate Community Care Health Plan Negotiated Percentage Community Care Health Plan Negotiated Algorithm Community Care Health Plan Negotiated Rate Community Care Health Plan Methodology Community Health Networks Negotiated Rate Community Health Networks Negotiated Percentage Community Health Networks Negotiated Algorithm Community Health Networks Estimated Amount Community Health Networks Methodology Dignity Health Negotiated Rate Dignity Health Negotiated Percentage Dignity Health Negotiated Algorithm Dignity Health Estimated Amount Dignity Health Methodology Incentive Health Negotiated Rate Incentive Health Negotiated Percentage Incentive Health Negotiated Algorithm Incentive Health Estimated Amount Incentive Health Methodology Kaweah Delta Healthcare Negotiated Rate Kaweah Delta Healthcare Negotiated Percentage Kaweah Delta Healthcare Negotiated Algorithm Kaweah Delta Healthcare Estimated Amount Kaweah Delta Healthcare Methodology HealthSmart Negotiated Rate HealthSmart Negotiated Percentage HealthSmart Negotiated Algorithm HealthSmart Estimated Amount HealthSmart Methodology First Health (Coventry) Negotiated Rate First Health (Coventry) Negotiated Percentage First Health (Coventry) Negotiated Algorithm First Health (Coventry) Estimated Amount First Health (Coventry) Methodology Multiplan (PHCS) Negotiated Rate Multiplan (PHCS) Negotiated Percentage Multiplan (PHCS) Negotiated Algorithm Multiplan (PHCS) Estimated Amount Multiplan (PHCS) Methodology Stanislaus Partners in Health Negotiated Rate Stanislaus Partners in Health Negotiated Percentage Stanislaus Partners in Health Negotiated Algorithm Stanislaus Partners in Health Estimated Amount Stanislaus Partners in Health Methodology Sutter Hospitals (EPO) Negotiated Rate Sutter Hospitals (EPO) Negotiated Percentage Sutter Hospitals (EPO) Negotiated Algorithm Sutter Hospitals (EPO) Negotiated Rate Sutter Hospitals (EPO) Methodology Manage Care Systems (Gemcare) Negotiated Rate Manage Care Systems (Gemcare) Negotiated Percentage Manage Care Systems (Gemcare) Negotiated Algorithm Manage Care Systems (Gemcare) Estimated Amount Manage Care Systems (Gemcare) Methodology Managed Care Systems (DRMG) Negotiated Rate Managed Care Systems (DRMG) Negotiated Percentage Managed Care Systems (DRMG) Negotiated Algorithm Managed Care Systems (DRMG) Estimated Amount Managed Care Systems (DRMG) Methodology Bakersfield Family Medical Center (LOA) Negotiated Rate Bakersfield Family Medical Center (LOA) Negotiated Percentage Bakersfield Family Medical Center (LOA) Negotiated Algorithm Bakersfield Family Medical Center (LOA) Estimated Amount Bakersfield Family Medical Center (LOA) Methodology Health Net Negotiated Rate Health Net Negotiated Percentage Health Net Negotiated Algorithm Health Net Estimated Amount Health Net Methodology Health Net Medi-Cal Negotiated Rate Health Net Medi-Cal Negotiated Percentage Health Net Medi-Cal Negotiated Algorithm Health Net Medi-Cal Estimated Amount Health Net Medi-Cal Payment Methodology Blue Cross Medi-Cal Negotiated Rate Blue Cross Medi-Cal Negotiated Percentage Blue Cross Medi-Cal Negotiated Algorithm Blue Cross Medi-Cal Estimated Amount Blue Cross Medi-Cal Payment Methodology CenCal Negotiated Rate CenCal Negotiated Percentage CenCal Negotiated Algorithm CenCal Estimated Amount CenCal Payment Methodology CCAH Negotiated Rate CCAH Negotiated Percentage CCAH Negotiated Algorithm CCAH Estimated Amount CCAH Payment Methodology Kern Family Negotiated Rate Kern Family Negotiated Percentage Kern Family Negotiated Algorithm Kern Family Negotiated Rate Kern Family Payment Methodology Adventist Negotiated Rate Adventist Negotiated Percentage Adventist Negotiated Algorithm Adventist Estimated Amount Adventist Payment Methodology Kaiser Medi-Cal Negotiated Rate Kaiser Medi-Cal Negotiated Percentage Kaiser Medi-Cal Negotiated Algorithm Kaiser Medi-Cal Estimated Amount Kaiser Medi-Cal Payment Methodology Health Plan of San Joaquin Negotiated Rate Health Plan of San Joaquin Negotiated Percentage Health Plan of San Joaquin Negotiated Algorithm Health Plan of San Joaquin Negotiated Rate Health Plan of San Joaquin Payment Methodology HC SEMI-PRIVATE PED ROOM DAILY I 123 Revenue Inpatient " $8,314.00 " " $2,100.00 " " $11,830.00 " " $8,314.00 " " $7,256.00 " " $7,256.00 " Per-Diem " $8,811.00 " " $8,811.00 " Per-Diem " $7,954.00 " " $7,954.00 " Per-Diem " $8,373.00 " " $8,373.00 " Per Diem " $7,371.00 " " $7,371.00 " Per Diem " $5,956.00 " " $5,956.00 " Per Diem 67.00% " $5,570.38 " Percent of Billed Charges " $11,830.00 " " $11,830.00 " Per-Diem " $8,959.00 " " $8,959.00 " Per Diem 55.00% " $4,572.70 " Percent of Billed Charges " $7,875.00 " " $7,875.00 " Per-Diem " $8,076.00 " Per-Diem 55.00% " $4,572.70 " Percent of Billed Charges " $9,821.00 " " $9,821.00 " Per-Diem " $4,968.00 " " $4,968.00 " Per-Diem " $11,072.00 " " $11,072.00 " Per-Diem 55.00% " $4,572.70 " Percent of Billed Charges " $2,100.00 " " $2,100.00 " Per-Diem " $4,840.00 " " $4,840.00 " Per-Diem " $3,213.00 " " $3,213.00 " Per-Diem 75.00% " $6,235.50 " Percent of Billed Charges " $7,852.00 " " $7,852.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $2,400.00 " " $2,400.00 " Per-Diem HC ONCOLOGY I 127 Revenue Inpatient " $8,314.00 " " $2,400.00 " " $13,450.00 " " $8,314.00 " " $7,256.00 " " $7,256.00 " Per-Diem " $8,811.00 " " $8,811.00 " Per-Diem " $7,954.00 " " $7,954.00 " Per-Diem " $8,373.00 " " $8,373.00 " Per Diem " $7,371.00 " " $7,371.00 " Per Diem " $5,956.00 " " $5,956.00 " Per Diem 67.00% " $5,570.38 " Percent of Billed Charges " $13,450.00 " " $13,450.00 " Per-Diem " $8,959.00 " " $8,959.00 " Per Diem 55.00% " $4,572.70 " Percent of Billed Charges " $7,875.00 " " $7,875.00 " Per-Diem " $8,076.00 " Per-Diem 55.00% " $4,572.70 " Percent of Billed Charges " $11,070.00 " " $11,070.00 " Per-Diem " $4,968.00 " " $4,968.00 " Per-Diem " $11,072.00 " " $11,072.00 " Per-Diem 55.00% " $4,572.70 " Percent of Billed Charges " $2,400.00 " " $2,400.00 " Per-Diem " $4,840.00 " " $4,840.00 " Per-Diem " $3,476.00 " " $3,476.00 " Per-Diem 75.00% " $6,235.50 " Percent of Billed Charges " $8,459.00 " " $8,459.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $2,400.00 " " $2,400.00 " Per-Diem HC REHABILITATION I 128 Revenue Inpatient " $8,314.00 " " $2,080.00 " " $11,830.00 " " $8,314.00 " " $7,256.00 " " $7,256.00 " Per-Diem " $8,811.00 " " $8,811.00 " Per-Diem " $7,954.00 " " $7,954.00 " Per-Diem " $8,373.00 " " $8,373.00 " Per Diem " $7,371.00 " " $7,371.00 " Per Diem " $5,956.00 " " $5,956.00 " Per Diem 67.00% " $5,570.38 " Percent of Billed Charges " $11,830.00 " " $11,830.00 " Per-Diem " $8,959.00 " " $8,959.00 " Per Diem 55.00% " $4,572.70 " Percent of Billed Charges " $7,875.00 " " $7,875.00 " Per-Diem " $8,076.00 " Per-Diem 55.00% " $4,572.70 " Percent of Billed Charges " $9,821.00 " " $9,821.00 " Per-Diem " $4,968.00 " " $4,968.00 " Per-Diem " $10,252.00 " " $10,252.00 " Per-Diem 55.00% " $4,572.70 " Percent of Billed Charges " $2,100.00 " " $2,100.00 " Per-Diem " $4,840.00 " " $4,840.00 " Per-Diem " $3,476.00 " " $3,476.00 " Per-Diem 75.00% " $6,235.50 " Percent of Billed Charges " $7,974.00 " " $7,974.00 " Per-Diem " $3,617.00 " " $3,617.00 " Per-Diem " $3,919.87 " " $3,919.87 " Per-Diem " $3,010.00 " " $3,010.00 " Per-Diem " $3,205.00 " " $3,205.00 " Per-Diem " $5,078.00 " " $5,078.00 " Per-Diem " $3,320.00 " " $3,320.00 " Per-Diem " $2,080.00 " " $2,080.00 " Per-Diem " $2,400.00 " " $2,400.00 " Per-Diem HC NURSERY 2 ROOM DAILY I 172 Revenue Inpatient " $10,988.00 " " $2,100.00 " " $17,203.00 " " $10,988.00 " " $8,180.00 " " $8,180.00 " Per-Diem " $9,932.00 " " $9,932.00 " Per-Diem " $9,600.00 " " $9,600.00 " Per-Diem " $8,876.00 " " $8,876.00 " Per Diem " $7,816.00 " " $7,816.00 " Per Diem " $9,649.00 " " $9,649.00 " Per Diem 67.00% " $7,361.96 " Percent of Billed Charges " $13,510.00 " " $13,510.00 " Per-Diem " $9,497.00 " " $9,497.00 " Per Diem 55.00% " $6,043.40 " Percent of Billed Charges " $8,867.00 " " $8,867.00 " Per-Diem " $8,545.00 " Per-Diem 55.00% " $6,043.40 " Percent of Billed Charges " $11,436.00 " " $11,436.00 " Per-Diem " $5,400.00 " " $5,400.00 " Per-Diem " $17,203.00 " " $17,203.00 " Per-Diem 55.00% " $6,043.40 " Percent of Billed Charges " $2,100.00 " " $2,100.00 " Per-Diem " $5,100.00 " " $5,100.00 " Per-Diem " $5,574.00 " " $5,574.00 " Per-Diem 75.00% " $8,241.00 " Percent of Billed Charges " $8,341.00 " " $8,341.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $3,200.00 " " $3,200.00 " Per-Diem HC NURSERY 3 ROOM DAILY I 173 Revenue Inpatient " $14,745.00 " " $3,200.00 " " $20,079.00 " " $14,745.00 " " $11,526.00 " " $11,526.00 " Per-Diem " $13,996.00 " " $13,996.00 " Per-Diem " $11,457.00 " " $11,457.00 " Per-Diem " $12,690.00 " " $12,690.00 " Per Diem " $11,171.00 " " $11,171.00 " Per Diem " $9,649.00 " " $9,649.00 " Per Diem 67.00% " $9,879.15 " Percent of Billed Charges " $20,079.00 " " $20,079.00 " Per-Diem " $13,578.00 " " $13,578.00 " Per Diem 55.00% " $8,109.75 " Percent of Billed Charges " $10,541.00 " " $10,541.00 " Per-Diem " $12,210.00 " Per-Diem 55.00% " $8,109.75 " Percent of Billed Charges " $16,528.00 " " $16,528.00 " Per-Diem " $7,560.00 " " $7,560.00 " Per-Diem " $17,203.00 " " $17,203.00 " Per-Diem 55.00% " $8,109.75 " Percent of Billed Charges " $3,600.00 " " $3,600.00 " Per-Diem " $7,300.00 " " $7,300.00 " Per-Diem " $5,574.00 " " $5,574.00 " Per-Diem 75.00% " $11,058.75 " Percent of Billed Charges " $12,538.00 " " $12,538.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $3,200.00 " " $3,200.00 " Per-Diem HC NURSERY 4 ROOM DAILY I 174 Revenue Inpatient " $17,624.00 " " $3,200.00 " " $20,079.00 " " $17,624.00 " " $11,526.00 " " $11,526.00 " Per-Diem " $13,996.00 " " $13,996.00 " Per-Diem " $11,457.00 " " $11,457.00 " Per-Diem " $12,690.00 " " $12,690.00 " Per Diem " $11,171.00 " " $11,171.00 " Per Diem " $9,649.00 " " $9,649.00 " Per Diem 67.00% " $11,808.08 " Percent of Billed Charges " $20,079.00 " " $20,079.00 " Per-Diem " $13,578.00 " " $13,578.00 " Per Diem 55.00% " $9,693.20 " Percent of Billed Charges " $11,904.00 " " $11,905.00 " Per-Diem " $12,210.00 " Per-Diem 55.00% " $9,693.20 " Percent of Billed Charges " $16,528.00 " " $16,528.00 " Per-Diem " $7,560.00 " " $7,560.00 " Per-Diem " $17,203.00 " " $17,203.00 " Per-Diem 55.00% " $9,693.20 " Percent of Billed Charges " $3,600.00 " " $3,600.00 " Per-Diem " $7,300.00 " " $7,300.00 " Per-Diem " $5,574.00 " " $5,574.00 " Per-Diem 75.00% " $13,218.00 " Percent of Billed Charges " $12,538.00 " " $12,538.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $3,200.00 " " $3,200.00 " Per-Diem HC ICU PED ROOM DAILY I 203 Revenue Inpatient " $15,873.00 " " $3,200.00 " " $21,263.00 " " $15,873.00 " " $12,753.00 " " $12,753.00 " Per-Diem " $15,891.00 " " $15,891.00 " Per-Diem " $14,085.00 " " $14,085.00 " Per-Diem " $14,230.00 " " $14,230.00 " Per Diem " $12,529.00 " " $12,529.00 " Per Diem " $10,750.00 " " $10,750.00 " Per Diem 67.00% " $10,634.91 " Percent of Billed Charges " $21,263.00 " " $21,263.00 " Per-Diem " $15,226.00 " " $15,226.00 " Per Diem 55.00% " $8,730.15 " Percent of Billed Charges " $13,395.00 " " $13,395.00 " Per-Diem " $13,698.00 " Per-Diem 55.00% " $8,730.15 " Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $8,600.00 " " $8,600.00 " Per-Diem " $19,693.00 " " $19,693.00 " Per-Diem 55.00% " $8,730.15 " Percent of Billed Charges " $3,800.00 " " $3,800.00 " Per-Diem " $8,220.00 " " $8,220.00 " Per-Diem " $5,661.00 " " $5,661.00 " Per-Diem 75.00% " $11,904.75 " Percent of Billed Charges " $13,840.00 " " $13,840.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $3,200.00 " " $3,200.00 " Per-Diem HC NICU ECMO 174 Revenue Inpatient " $26,632.00 " " $3,200.00 " " $31,074.00 " " $26,632.00 " " $17,618.00 " " $17,618.00 " Per-Diem " $21,394.00 " " $21,394.00 " Per-Diem " $22,072.00 " " $22,072.00 " Per-Diem " $24,097.00 " " $24,097.00 " Per-Diem " $24,097.00 " " $24,097.00 " Per-Diem " $9,649.00 " " $9,649.00 " Per-Diem 67.00% " $17,843.44 " Percent of Billed Charges " $29,450.00 " " $29,450.00 " Per-Diem " $25,784.00 " " $25,784.00 " Per-Diem 55.00% " $14,647.60 " Percent of Billed Charges " $20,463.00 " " $20,463.00 " Per-Diem " $23,180.00 " Per-Diem 55.00% " $14,647.60 " Percent of Billed Charges " $25,436.00 " " $25,436.00 " Per-Diem " $7,560.00 " " $7,560.00 " Per-Diem " $31,074.00 " " $31,074.00 " Per-Diem 55.00% " $14,647.60 " Percent of Billed Charges " $3,600.00 " " $3,600.00 " Per-Diem " $7,300.00 " " $7,300.00 " Per-Diem " $5,574.00 " " $5,574.00 " Per-Diem 75.00% " $19,974.00 " Percent of Billed Charges " $21,720.00 " " $21,720.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $3,200.00 " " $3,200.00 " Per-Diem HC PEDIATRIC ICU ECMO 203 Revenue Inpatient " $26,006.00 " " $3,200.00 " " $31,074.00 " " $26,006.00 " " $17,618.00 " " $17,618.00 " Per-Diem " $21,394.00 " " $21,394.00 " Per-Diem " $22,072.00 " " $22,072.00 " Per-Diem " $24,097.00 " " $24,097.00 " Per-Diem " $24,097.00 " " $24,097.00 " Per-Diem " $10,750.00 " " $10,750.00 " Per-Diem 67.00% " $17,424.02 " Percent of Billed Charges " $29,450.00 " " $29,450.00 " Per-Diem " $25,784.00 " " $25,784.00 " Per-Diem 55.00% " $14,303.30 " Percent of Billed Charges " $20,463.00 " " $20,463.00 " Per-Diem " $23,180.00 " Per-Diem 55.00% " $14,303.30 " Percent of Billed Charges " $25,436.00 " " $25,436.00 " Per-Diem " $8,600.00 " " $8,600.00 " Per-Diem " $31,074.00 " " $31,074.00 " Per-Diem 55.00% " $14,303.30 " Percent of Billed Charges " $3,800.00 " " $3,800.00 " Per-Diem " $8,220.00 " " $8,220.00 " Per-Diem " $5,661.00 " " $5,661.00 " Per-Diem 75.00% " $19,504.50 " Percent of Billed Charges " $21,720.00 " " $21,720.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A " $3,200.00 " " $3,200.00 " Per-Diem Extracorporeal Membrane Oxygenation (ECMO) 3 MS-DRG Inpatient Non-Chargemaster Item " $17,618.00 " " $31,074.00 " Non-Chargemaster Item " $17,618.00 " " $17,618.00 " Per-Diem " $21,394.00 " " $21,394.00 " Per-Diem " $22,072.00 " " $22,072.00 " Per-Diem " $24,097.00 " " $24,097.00 " Per-Diem " $24,097.00 " " $24,097.00 " Per-Diem N/A N/A N/A 67.00% Non-Chargemaster Item Percent of Billed Charges " $29,450.00 " " $29,450.00 " Per-Diem " $25,784.00 " " $25,784.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $20,463.00 " " $20,463.00 " Per-Diem " $23,180.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $25,436.00 " " $25,436.00 " Per-Diem N/A Per-Diem " $31,074.00 " " $31,074.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem Varies Varies Per-Diem Varies Varies Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $21,720.00 " " $21,720.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A HC TRAUMA ACTIVATION-LEVEL 1 682 Revenue Inpatient " $31,875.00 " " $8,750.00 " " $26,558.25 " " $31,875.00 " 64.54% " $20,572.13 " Percent of Billed Charges 73.05% " $23,284.69 " Percent of Billed Charges " $22,072.00 " " $22,072.00 " Per-Diem " $15,223.00 " " $15,223.00 " Per-Diem " $14,005.00 " " $14,005.00 " Per-Diem " $14,934.00 " " $14,934.00 " Per-Diem 67.00% " $21,356.25 " Percent of Billed Charges 77.00% " $24,543.75 " Percent of Billed Charges " $16,289.00 " " $16,289.00 " Per-Diem 55.00% " $17,531.25 " Percent of Billed Charges " $13,395.00 " " $13,395.00 " Per-Diem " $14,663.00 " Per-Diem 55.00% " $17,531.25 " Percent of Billed Charges 83.32% " $26,558.25 " Percent of Billed Charges 65.00% " $20,718.75 " Percent of Billed Charges 75.18% " $23,963.63 " Percent of Billed Charges 55.00% " $17,531.25 " Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $8,750.00 " " $8,750.00 " Per-Diem 75.00% " $23,906.25 " Percent of Billed Charges 75.00% " $23,906.25 " Percent of Billed Charges 66.24% " $21,114.00 " Percent of Billed Charges % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A HC TRAUMA ACTIVATION-LEVEL 2 682 Revenue Inpatient " $16,846.00 " " $8,750.00 " " $22,072.00 " " $16,846.00 " 64.54% " $10,872.41 " Percent of Billed Charges 73.05% " $12,306.00 " Percent of Billed Charges " $22,072.00 " " $22,072.00 " Per-Diem " $15,223.00 " " $15,223.00 " Per-Diem " $14,005.00 " " $14,005.00 " Per-Diem " $14,934.00 " " $14,934.00 " Per-Diem 67.00% " $11,286.82 " Percent of Billed Charges 77.00% " $12,971.42 " Percent of Billed Charges " $16,289.00 " " $16,289.00 " Per-Diem 55.00% " $9,265.30 " Percent of Billed Charges " $13,395.00 " " $13,395.00 " Per-Diem " $14,663.00 " Per-Diem 55.00% " $9,265.30 " Percent of Billed Charges 83.32% " $14,036.09 " Percent of Billed Charges 65.00% " $10,949.90 " Percent of Billed Charges 75.18% " $12,664.82 " Percent of Billed Charges 55.00% " $9,265.30 " Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $8,750.00 " " $8,750.00 " Per-Diem 75.00% " $12,634.50 " Percent of Billed Charges 75.00% " $12,634.50 " Percent of Billed Charges 66.24% " $11,158.79 " Percent of Billed Charges % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 216 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 217 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 218 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 219 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 220 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 221 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 222 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 223 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 224 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 225 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 226 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 227 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 228 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Cardiac valve and other major cardiothoracic procedures 229 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Coronary Bypass 231 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Coronary Bypass 232 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Coronary Bypass 233 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Coronary Bypass 234 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Coronary Bypass 236 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Permanent cardiac pacemaker implant 242 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Percutaneous cardiovascular procedures without intraluminal device 250 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Percutaneous cardiovascular procedures without intraluminal device 251 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Aortic and heart assist procedures except pulsation balloon 268 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Aortic and heart assist procedures except pulsation balloon 269 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Other major cardiovascular procedures 270 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Other major cardiovascular procedures 271 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Other major cardiovascular procedures 272 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Percutaneous intracardiac procedures 273 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A Percutaneous intracardiac procedures 274 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A "Circulatory disorders except AMI, with cardiac catheterization" 286 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A "Circulatory disorders except AMI, with cardiac catheterization" 287 MS-DRG Inpatient Non-Chargemaster Item " $8,002.00 " " $20,065.00 " Non-Chargemaster Item N/A N/A N/A N/A N/A N/A " $17,899.00 " " $17,899.00 " Per-Diem " $15,770.00 " " $15,770.00 " Per-Diem " $14,507.00 " " $14,507.00 " Per-Diem " $14,476.00 " " $14,476.00 " Per-Diem 67.00% Non-Chargemaster Item Percent of Billed Charges " $20,065.00 " " $20,065.00 " Per-Diem " $16,874.00 " " $16,874.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $16,866.00 " " $16,866.00 " Per-Diem " $15,187.00 " Per-Diem 55.00% Non-Chargemaster Item Percent of Billed Charges " $18,089.00 " " $18,089.00 " Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem 84.17% Varies Percent of Billed Charges 55.00% Non-Chargemaster Item Percent of Billed Charges Non-Chargemaster Item Non-Chargemaster Item Per-Diem " $9,100.00 " " $9,100.00 " Per-Diem " $8,002.00 " " $8,002.00 " Per-Diem 75.00% Non-Chargemaster Item Percent of Billed Charges " $15,439.00 " " $15,439.00 " Per-Diem % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A % of APR-DRG N/A N/A N/A N/A N/A HC INJECTION IM OR SQ 260 CPT 96372 Outpatient $61.00 $- $96.99 $61.00 61.04% $37.23 Percent of Billed Charges 69.29% $42.27 Percent of Billed Charges " $1,480.00 " $61.00 Case Rate 74.74% $45.59 Percent of Billed Charges 68.24% $41.63 Percent of Billed Charges 65.00% $39.65 Percent of Billed Charges 67.00% $40.87 Percent of Billed Charges 77.50% $47.28 Percent of Billed Charges 79.97% $48.78 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 49.55% $30.23 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 78.94% $48.15 Percent of Billed Charges 74.00% $45.14 Percent of Billed Charges 92.50% $56.43 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 85.00% $51.85 Percent of Billed Charges 63.00% $38.43 Percent of Billed Charges 63.00% $38.43 Percent of Billed Charges 75.00% $45.75 Percent of Billed Charges 66.24% $40.41 Percent of Billed Charges 35.00% $21.35 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $96.99 Fee Schedule 145.00% $- Fee Schedule 60.00% $36.60 Percent of Billed Charges "HC IV INFUSION, HYDRATION, 31-60 MIN" 260 CPT 96360 Outpatient $657.00 $- " $1,044.63 " $657.00 61.04% $401.03 Percent of Billed Charges 69.29% $455.24 Percent of Billed Charges " $1,480.00 " $657.00 Case Rate 74.74% $491.04 Percent of Billed Charges 68.24% $448.34 Percent of Billed Charges 65.00% $427.05 Percent of Billed Charges 67.00% $440.19 Percent of Billed Charges 77.50% $509.18 Percent of Billed Charges 79.97% $525.40 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 49.55% $325.54 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 78.94% $518.64 Percent of Billed Charges 74.00% $486.18 Percent of Billed Charges 92.50% $607.73 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 85.00% $558.45 Percent of Billed Charges 63.00% $413.91 Percent of Billed Charges 63.00% $413.91 Percent of Billed Charges 75.00% $492.75 Percent of Billed Charges 66.24% $435.20 Percent of Billed Charges 35.00% $229.95 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,044.63 " Fee Schedule 145.00% $- Fee Schedule 60.00% $394.20 Percent of Billed Charges "HC IV INFUSION, HYDRATION, EA ADD HR" 260 CPT 96361 Outpatient $193.00 $- $306.87 $193.00 61.04% $117.81 Percent of Billed Charges 69.29% $133.73 Percent of Billed Charges " $1,480.00 " $193.00 Case Rate 74.74% $144.25 Percent of Billed Charges 68.24% $131.70 Percent of Billed Charges 65.00% $125.45 Percent of Billed Charges 67.00% $129.31 Percent of Billed Charges 77.50% $149.58 Percent of Billed Charges 79.97% $154.34 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 49.55% $95.63 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 78.94% $152.35 Percent of Billed Charges 74.00% $142.82 Percent of Billed Charges 92.50% $178.53 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 85.00% $164.05 Percent of Billed Charges 63.00% $121.59 Percent of Billed Charges 63.00% $121.59 Percent of Billed Charges 75.00% $144.75 Percent of Billed Charges 66.24% $127.84 Percent of Billed Charges 35.00% $67.55 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $306.87 Fee Schedule 145.00% $- Fee Schedule 60.00% $115.80 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAG,INITIAL,1ST HR" 260 CPT 96365 Outpatient $986.00 $- " $1,567.74 " $986.00 61.04% $601.85 Percent of Billed Charges 69.29% $683.20 Percent of Billed Charges " $1,480.00 " $986.00 Case Rate 74.74% $736.94 Percent of Billed Charges 68.24% $672.85 Percent of Billed Charges 65.00% $640.90 Percent of Billed Charges 67.00% $660.62 Percent of Billed Charges 77.50% $764.15 Percent of Billed Charges 79.97% $788.50 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 49.55% $488.56 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 78.94% $778.35 Percent of Billed Charges 74.00% $729.64 Percent of Billed Charges 92.50% $912.05 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 85.00% $838.10 Percent of Billed Charges 63.00% $621.18 Percent of Billed Charges 63.00% $621.18 Percent of Billed Charges 75.00% $739.50 Percent of Billed Charges 66.24% $653.13 Percent of Billed Charges 35.00% $345.10 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,567.74 " Fee Schedule 145.00% $- Fee Schedule 60.00% $591.60 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR" 260 CPT 96366 Outpatient $246.00 $- $391.14 $246.00 61.04% $150.16 Percent of Billed Charges 69.29% $170.45 Percent of Billed Charges " $1,480.00 " $246.00 Case Rate 74.74% $183.86 Percent of Billed Charges 68.24% $167.87 Percent of Billed Charges 65.00% $159.90 Percent of Billed Charges 67.00% $164.82 Percent of Billed Charges 77.50% $190.65 Percent of Billed Charges 79.97% $196.73 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 49.55% $121.89 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 78.94% $194.19 Percent of Billed Charges 74.00% $182.04 Percent of Billed Charges 92.50% $227.55 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 85.00% $209.10 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 75.00% $184.50 Percent of Billed Charges 66.24% $162.95 Percent of Billed Charges 35.00% $86.10 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $391.14 Fee Schedule 145.00% $- Fee Schedule 60.00% $147.60 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR" 260 CPT 96367 Outpatient $373.00 $- $593.07 $373.00 61.04% $227.68 Percent of Billed Charges 69.29% $258.45 Percent of Billed Charges " $1,480.00 " $373.00 Case Rate 74.74% $278.78 Percent of Billed Charges 68.24% $254.54 Percent of Billed Charges 65.00% $242.45 Percent of Billed Charges 67.00% $249.91 Percent of Billed Charges 77.50% $289.08 Percent of Billed Charges 79.97% $298.29 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 49.55% $184.82 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 78.94% $294.45 Percent of Billed Charges 74.00% $276.02 Percent of Billed Charges 92.50% $345.03 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 85.00% $317.05 Percent of Billed Charges 63.00% $234.99 Percent of Billed Charges 63.00% $234.99 Percent of Billed Charges 75.00% $279.75 Percent of Billed Charges 66.24% $247.08 Percent of Billed Charges 35.00% $130.55 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $593.07 Fee Schedule 145.00% $- Fee Schedule 60.00% $223.80 Percent of Billed Charges "HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG" 260 CPT 96375 Outpatient $259.00 $- $411.81 $259.00 61.04% $158.09 Percent of Billed Charges 69.29% $179.46 Percent of Billed Charges " $1,480.00 " $259.00 Case Rate 74.74% $193.58 Percent of Billed Charges 68.24% $176.74 Percent of Billed Charges 65.00% $168.35 Percent of Billed Charges 67.00% $173.53 Percent of Billed Charges 77.50% $200.73 Percent of Billed Charges 79.97% $207.12 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 49.55% $128.33 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 78.94% $204.45 Percent of Billed Charges 74.00% $191.66 Percent of Billed Charges 92.50% $239.58 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 85.00% $220.15 Percent of Billed Charges 63.00% $163.17 Percent of Billed Charges 63.00% $163.17 Percent of Billed Charges 75.00% $194.25 Percent of Billed Charges 66.24% $171.56 Percent of Billed Charges 35.00% $90.65 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $411.81 Fee Schedule 145.00% $- Fee Schedule 60.00% $155.40 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION" 260 CPT 96368 Outpatient $205.00 $- $325.95 $205.00 61.04% $125.13 Percent of Billed Charges 69.29% $142.04 Percent of Billed Charges " $1,480.00 " $205.00 Case Rate 74.74% $153.22 Percent of Billed Charges 68.24% $139.89 Percent of Billed Charges 65.00% $133.25 Percent of Billed Charges 67.00% $137.35 Percent of Billed Charges 77.50% $158.88 Percent of Billed Charges 79.97% $163.94 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 49.55% $101.58 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 78.94% $161.83 Percent of Billed Charges 74.00% $151.70 Percent of Billed Charges 92.50% $189.63 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 85.00% $174.25 Percent of Billed Charges 63.00% $129.15 Percent of Billed Charges 63.00% $129.15 Percent of Billed Charges 75.00% $153.75 Percent of Billed Charges 66.24% $135.79 Percent of Billed Charges 35.00% $71.75 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $325.95 Fee Schedule 145.00% $- Fee Schedule 60.00% $123.00 Percent of Billed Charges "HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR" 260 CPT 96369 Outpatient " $1,241.00 " $- " $1,973.19 " " $1,241.00 " 61.04% $757.51 Percent of Billed Charges 69.29% $859.89 Percent of Billed Charges " $1,480.00 " " $1,241.00 " Case Rate 74.74% $927.52 Percent of Billed Charges 68.24% $846.86 Percent of Billed Charges 65.00% $806.65 Percent of Billed Charges 67.00% $831.47 Percent of Billed Charges 77.50% $961.78 Percent of Billed Charges 79.97% $992.43 Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 49.55% $614.92 Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 78.94% $979.65 Percent of Billed Charges 74.00% $918.34 Percent of Billed Charges 92.50% " $1,147.93 " Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 85.00% " $1,054.85 " Percent of Billed Charges 63.00% $781.83 Percent of Billed Charges 63.00% $781.83 Percent of Billed Charges 75.00% $930.75 Percent of Billed Charges 66.24% $822.04 Percent of Billed Charges 35.00% $434.35 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,973.19 " Fee Schedule 145.00% $- Fee Schedule 60.00% $744.60 Percent of Billed Charges "HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR" 260 CPT 96370 Outpatient $345.00 $- $548.55 $345.00 61.04% $210.59 Percent of Billed Charges 69.29% $239.05 Percent of Billed Charges " $1,480.00 " $345.00 Case Rate 74.74% $257.85 Percent of Billed Charges 68.24% $235.43 Percent of Billed Charges 65.00% $224.25 Percent of Billed Charges 67.00% $231.15 Percent of Billed Charges 77.50% $267.38 Percent of Billed Charges 79.97% $275.90 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 49.55% $170.95 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 78.94% $272.34 Percent of Billed Charges 74.00% $255.30 Percent of Billed Charges 92.50% $319.13 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 85.00% $293.25 Percent of Billed Charges 63.00% $217.35 Percent of Billed Charges 63.00% $217.35 Percent of Billed Charges 75.00% $258.75 Percent of Billed Charges 66.24% $228.53 Percent of Billed Charges 35.00% $120.75 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $548.55 Fee Schedule 145.00% $- Fee Schedule 60.00% $207.00 Percent of Billed Charges HC SC THER INFUSION RESET PUMP 260 CPT 96371 Outpatient $332.00 $- $527.88 $332.00 61.04% $202.65 Percent of Billed Charges 69.29% $230.04 Percent of Billed Charges " $1,480.00 " $332.00 Case Rate 74.74% $248.14 Percent of Billed Charges 68.24% $226.56 Percent of Billed Charges 65.00% $215.80 Percent of Billed Charges 67.00% $222.44 Percent of Billed Charges 77.50% $257.30 Percent of Billed Charges 79.97% $265.50 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 49.55% $164.51 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 78.94% $262.08 Percent of Billed Charges 74.00% $245.68 Percent of Billed Charges 92.50% $307.10 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 85.00% $282.20 Percent of Billed Charges 63.00% $209.16 Percent of Billed Charges 63.00% $209.16 Percent of Billed Charges 75.00% $249.00 Percent of Billed Charges 66.24% $219.92 Percent of Billed Charges 35.00% $116.20 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $527.88 Fee Schedule 145.00% $- Fee Schedule 60.00% $199.20 Percent of Billed Charges "HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG" 260 CPT 96376 Outpatient $305.00 $- $484.95 $305.00 61.04% $186.17 Percent of Billed Charges 69.29% $211.33 Percent of Billed Charges " $1,480.00 " $305.00 Case Rate 74.74% $227.96 Percent of Billed Charges 68.24% $208.13 Percent of Billed Charges 65.00% $198.25 Percent of Billed Charges 67.00% $204.35 Percent of Billed Charges 77.50% $236.38 Percent of Billed Charges 79.97% $243.91 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 49.55% $151.13 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 78.94% $240.77 Percent of Billed Charges 74.00% $225.70 Percent of Billed Charges 92.50% $282.13 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 85.00% $259.25 Percent of Billed Charges 63.00% $192.15 Percent of Billed Charges 63.00% $192.15 Percent of Billed Charges 75.00% $228.75 Percent of Billed Charges 66.24% $202.03 Percent of Billed Charges 35.00% $106.75 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $484.95 Fee Schedule 145.00% $- Fee Schedule 60.00% $183.00 Percent of Billed Charges "HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG" 260 CPT 96374 Outpatient $643.00 $- " $1,022.37 " $643.00 61.04% $392.49 Percent of Billed Charges 69.29% $445.53 Percent of Billed Charges " $1,480.00 " $643.00 Case Rate 74.74% $480.58 Percent of Billed Charges 68.24% $438.78 Percent of Billed Charges 65.00% $417.95 Percent of Billed Charges 67.00% $430.81 Percent of Billed Charges 77.50% $498.33 Percent of Billed Charges 79.97% $514.21 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 49.55% $318.61 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 78.94% $507.58 Percent of Billed Charges 74.00% $475.82 Percent of Billed Charges 92.50% $594.78 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 85.00% $546.55 Percent of Billed Charges 63.00% $405.09 Percent of Billed Charges 63.00% $405.09 Percent of Billed Charges 75.00% $482.25 Percent of Billed Charges 66.24% $425.92 Percent of Billed Charges 35.00% $225.05 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,022.37 " Fee Schedule 145.00% $- Fee Schedule 60.00% $385.80 Percent of Billed Charges HC IRRIG IMPLANTED DRUG DELIVERY DEVICE 260 CPT 96523 Outpatient $320.00 $- $508.80 $320.00 61.04% $195.33 Percent of Billed Charges 69.29% $221.73 Percent of Billed Charges " $1,480.00 " $320.00 Case Rate 74.74% $239.17 Percent of Billed Charges 68.24% $218.37 Percent of Billed Charges 65.00% $208.00 Percent of Billed Charges 67.00% $214.40 Percent of Billed Charges 77.50% $248.00 Percent of Billed Charges 79.97% $255.90 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 49.55% $158.56 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 78.94% $252.61 Percent of Billed Charges 74.00% $236.80 Percent of Billed Charges 92.50% $296.00 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 85.00% $272.00 Percent of Billed Charges 63.00% $201.60 Percent of Billed Charges 63.00% $201.60 Percent of Billed Charges 75.00% $240.00 Percent of Billed Charges 66.24% $211.97 Percent of Billed Charges 35.00% $112.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $508.80 Fee Schedule 145.00% $- Fee Schedule 60.00% $192.00 Percent of Billed Charges HC TRIALNET SEMI-ANN MONITORING 260 Revenue Outpatient $175.00 $- $278.25 $175.00 61.04% $106.82 Percent of Billed Charges 69.29% $121.26 Percent of Billed Charges " $1,480.00 " $175.00 Case Rate 74.74% $130.80 Percent of Billed Charges 68.24% $119.42 Percent of Billed Charges 65.00% $113.75 Percent of Billed Charges 67.00% $117.25 Percent of Billed Charges 77.50% $135.63 Percent of Billed Charges 79.97% $139.95 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 49.55% $86.71 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 78.94% $138.15 Percent of Billed Charges 74.00% $129.50 Percent of Billed Charges 92.50% $161.88 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 85.00% $148.75 Percent of Billed Charges 63.00% $110.25 Percent of Billed Charges 63.00% $110.25 Percent of Billed Charges 75.00% $131.25 Percent of Billed Charges 66.24% $115.92 Percent of Billed Charges 35.00% $61.25 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $278.25 Fee Schedule 145.00% $- Fee Schedule 60.00% $105.00 Percent of Billed Charges HC TRIALNET REPEAT OGTT 260 Revenue Outpatient $95.00 $- $151.05 $95.00 61.04% $57.99 Percent of Billed Charges 69.29% $65.83 Percent of Billed Charges " $1,480.00 " $95.00 Case Rate 74.74% $71.00 Percent of Billed Charges 68.24% $64.83 Percent of Billed Charges 65.00% $61.75 Percent of Billed Charges 67.00% $63.65 Percent of Billed Charges 77.50% $73.63 Percent of Billed Charges 79.97% $75.97 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 49.55% $47.07 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 78.94% $74.99 Percent of Billed Charges 74.00% $70.30 Percent of Billed Charges 92.50% $87.88 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 85.00% $80.75 Percent of Billed Charges 63.00% $59.85 Percent of Billed Charges 63.00% $59.85 Percent of Billed Charges 75.00% $71.25 Percent of Billed Charges 66.24% $62.93 Percent of Billed Charges 35.00% $33.25 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $151.05 Fee Schedule 145.00% $- Fee Schedule 60.00% $57.00 Percent of Billed Charges HC TRIALNET BASELINE MONITORING 260 Revenue Outpatient $184.00 $- $292.56 $184.00 61.04% $112.31 Percent of Billed Charges 69.29% $127.49 Percent of Billed Charges " $1,480.00 " $184.00 Case Rate 74.74% $137.52 Percent of Billed Charges 68.24% $125.56 Percent of Billed Charges 65.00% $119.60 Percent of Billed Charges 67.00% $123.28 Percent of Billed Charges 77.50% $142.60 Percent of Billed Charges 79.97% $147.14 Percent of Billed Charges 55.00% $101.20 Percent of Billed Charges 49.55% $91.17 Percent of Billed Charges 55.00% $101.20 Percent of Billed Charges 55.00% $101.20 Percent of Billed Charges 78.94% $145.25 Percent of Billed Charges 74.00% $136.16 Percent of Billed Charges 92.50% $170.20 Percent of Billed Charges 55.00% $101.20 Percent of Billed Charges 85.00% $156.40 Percent of Billed Charges 63.00% $115.92 Percent of Billed Charges 63.00% $115.92 Percent of Billed Charges 75.00% $138.00 Percent of Billed Charges 66.24% $121.88 Percent of Billed Charges 35.00% $64.40 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $292.56 Fee Schedule 145.00% $- Fee Schedule 60.00% $110.40 Percent of Billed Charges "HC IV INFUSION, HYDRATION, 31-60 MIN" 260 Revenue Outpatient $210.00 $- $333.90 $210.00 61.04% $128.18 Percent of Billed Charges 69.29% $145.51 Percent of Billed Charges " $1,480.00 " $210.00 Case Rate 74.74% $156.95 Percent of Billed Charges 68.24% $143.30 Percent of Billed Charges 65.00% $136.50 Percent of Billed Charges 67.00% $140.70 Percent of Billed Charges 77.50% $162.75 Percent of Billed Charges 79.97% $167.94 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 49.55% $104.06 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 78.94% $165.77 Percent of Billed Charges 74.00% $155.40 Percent of Billed Charges 92.50% $194.25 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 85.00% $178.50 Percent of Billed Charges 63.00% $132.30 Percent of Billed Charges 63.00% $132.30 Percent of Billed Charges 75.00% $157.50 Percent of Billed Charges 66.24% $139.10 Percent of Billed Charges 35.00% $73.50 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $333.90 Fee Schedule 145.00% $- Fee Schedule 60.00% $126.00 Percent of Billed Charges "HC IV INFUSION, HYDRATION, 31-60 MIN OBS" 260 CPT 96360 Outpatient $657.00 $81.16 " $1,044.63 " $657.00 61.04% $401.03 Percent of Billed Charges 69.29% $455.24 Percent of Billed Charges " $1,480.00 " $657.00 Case Rate 74.74% $491.04 Percent of Billed Charges 68.24% $448.34 Percent of Billed Charges 65.00% $427.05 Percent of Billed Charges 67.00% $440.19 Percent of Billed Charges 77.50% $509.18 Percent of Billed Charges 79.97% $525.40 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 49.55% $325.54 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 78.94% $518.64 Percent of Billed Charges 74.00% $486.18 Percent of Billed Charges 92.50% $607.73 Percent of Billed Charges 55.00% $361.35 Percent of Billed Charges 85.00% $558.45 Percent of Billed Charges 63.00% $413.91 Percent of Billed Charges 63.00% $413.91 Percent of Billed Charges 75.00% $492.75 Percent of Billed Charges 66.24% $435.20 Percent of Billed Charges 165.81% $92.80 Fee Schedule 166.07% $92.95 Fee Schedule 176.26% $98.65 Fee Schedule 191.75% $107.32 Fee Schedule 191.24% $107.04 Fee Schedule 159.00% " $1,044.63 " Fee Schedule 145.00% $81.16 Fee Schedule 60.00% $394.20 Percent of Billed Charges "HC IV INFUSION, HYDRATION, EA ADD HR OBS" 260 CPT 96361 Outpatient $193.00 $23.10 $306.87 $193.00 61.04% $117.81 Percent of Billed Charges 69.29% $133.73 Percent of Billed Charges " $1,480.00 " $193.00 Case Rate 74.74% $144.25 Percent of Billed Charges 68.24% $131.70 Percent of Billed Charges 65.00% $125.45 Percent of Billed Charges 67.00% $129.31 Percent of Billed Charges 77.50% $149.58 Percent of Billed Charges 79.97% $154.34 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 49.55% $95.63 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 78.94% $152.35 Percent of Billed Charges 74.00% $142.82 Percent of Billed Charges 92.50% $178.53 Percent of Billed Charges 55.00% $106.15 Percent of Billed Charges 85.00% $164.05 Percent of Billed Charges 63.00% $121.59 Percent of Billed Charges 63.00% $121.59 Percent of Billed Charges 75.00% $144.75 Percent of Billed Charges 66.24% $127.84 Percent of Billed Charges 165.81% $26.41 Fee Schedule 166.07% $26.45 Fee Schedule 176.26% $28.08 Fee Schedule 191.75% $30.55 Fee Schedule 191.24% $30.46 Fee Schedule 159.00% $306.87 Fee Schedule 145.00% $23.10 Fee Schedule 60.00% $115.80 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAG,INITIAL,1ST HR OBS" 260 CPT 96365 Outpatient $986.00 $90.77 " $1,567.74 " $986.00 61.04% $601.85 Percent of Billed Charges 69.29% $683.20 Percent of Billed Charges " $1,480.00 " $986.00 Case Rate 74.74% $736.94 Percent of Billed Charges 68.24% $672.85 Percent of Billed Charges 65.00% $640.90 Percent of Billed Charges 67.00% $660.62 Percent of Billed Charges 77.50% $764.15 Percent of Billed Charges 79.97% $788.50 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 49.55% $488.56 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 78.94% $778.35 Percent of Billed Charges 74.00% $729.64 Percent of Billed Charges 92.50% $912.05 Percent of Billed Charges 55.00% $542.30 Percent of Billed Charges 85.00% $838.10 Percent of Billed Charges 63.00% $621.18 Percent of Billed Charges 63.00% $621.18 Percent of Billed Charges 75.00% $739.50 Percent of Billed Charges 66.24% $653.13 Percent of Billed Charges 165.81% $103.80 Fee Schedule 166.07% $103.96 Fee Schedule 176.26% $110.34 Fee Schedule 191.75% $120.04 Fee Schedule 191.24% $119.72 Fee Schedule 159.00% " $1,567.74 " Fee Schedule 145.00% $90.77 Fee Schedule 60.00% $591.60 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,EA ADD HOUR OBS" 260 CPT 96366 Outpatient $246.00 $27.94 $391.14 $246.00 61.04% $150.16 Percent of Billed Charges 69.29% $170.45 Percent of Billed Charges " $1,480.00 " $246.00 Case Rate 74.74% $183.86 Percent of Billed Charges 68.24% $167.87 Percent of Billed Charges 65.00% $159.90 Percent of Billed Charges 67.00% $164.82 Percent of Billed Charges 77.50% $190.65 Percent of Billed Charges 79.97% $196.73 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 49.55% $121.89 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 78.94% $194.19 Percent of Billed Charges 74.00% $182.04 Percent of Billed Charges 92.50% $227.55 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 85.00% $209.10 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 75.00% $184.50 Percent of Billed Charges 66.24% $162.95 Percent of Billed Charges 165.81% $31.95 Fee Schedule 166.07% $32.00 Fee Schedule 176.26% $33.97 Fee Schedule 191.75% $36.95 Fee Schedule 191.24% $36.85 Fee Schedule 159.00% $391.14 Fee Schedule 145.00% $27.94 Fee Schedule 60.00% $147.60 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAGNOST,ADD INFUSION,1ST HOUR OBS" 260 CPT 96367 Outpatient $373.00 $45.02 $593.07 $373.00 61.04% $227.68 Percent of Billed Charges 69.29% $258.45 Percent of Billed Charges " $1,480.00 " $373.00 Case Rate 74.74% $278.78 Percent of Billed Charges 68.24% $254.54 Percent of Billed Charges 65.00% $242.45 Percent of Billed Charges 67.00% $249.91 Percent of Billed Charges 77.50% $289.08 Percent of Billed Charges 79.97% $298.29 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 49.55% $184.82 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 78.94% $294.45 Percent of Billed Charges 74.00% $276.02 Percent of Billed Charges 92.50% $345.03 Percent of Billed Charges 55.00% $205.15 Percent of Billed Charges 85.00% $317.05 Percent of Billed Charges 63.00% $234.99 Percent of Billed Charges 63.00% $234.99 Percent of Billed Charges 75.00% $279.75 Percent of Billed Charges 66.24% $247.08 Percent of Billed Charges 165.81% $51.48 Fee Schedule 166.07% $51.56 Fee Schedule 176.26% $54.73 Fee Schedule 191.75% $59.54 Fee Schedule 191.24% $59.38 Fee Schedule 159.00% $593.07 Fee Schedule 145.00% $45.02 Fee Schedule 60.00% $223.80 Percent of Billed Charges "HC IV INFUSION, THERAP/PROPH/DIAGNOST,CONCURRENT INFUSION OBS" 260 CPT 96368 Outpatient $205.00 $26.04 $325.95 $205.00 61.04% $125.13 Percent of Billed Charges 69.29% $142.04 Percent of Billed Charges " $1,480.00 " $205.00 Case Rate 74.74% $153.22 Percent of Billed Charges 68.24% $139.89 Percent of Billed Charges 65.00% $133.25 Percent of Billed Charges 67.00% $137.35 Percent of Billed Charges 77.50% $158.88 Percent of Billed Charges 79.97% $163.94 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 49.55% $101.58 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 78.94% $161.83 Percent of Billed Charges 74.00% $151.70 Percent of Billed Charges 92.50% $189.63 Percent of Billed Charges 55.00% $112.75 Percent of Billed Charges 85.00% $174.25 Percent of Billed Charges 63.00% $129.15 Percent of Billed Charges 63.00% $129.15 Percent of Billed Charges 75.00% $153.75 Percent of Billed Charges 66.24% $135.79 Percent of Billed Charges 165.81% $29.78 Fee Schedule 166.07% $29.83 Fee Schedule 176.26% $31.66 Fee Schedule 191.75% $34.44 Fee Schedule 191.24% $34.35 Fee Schedule 159.00% $325.95 Fee Schedule 145.00% $26.04 Fee Schedule 60.00% $123.00 Percent of Billed Charges HC INJECTION IM OR SQ OBS 260 CPT 96372 Outpatient $61.00 $27.19 $96.99 $61.00 61.04% $37.23 Percent of Billed Charges 69.29% $42.27 Percent of Billed Charges " $1,480.00 " $61.00 Case Rate 74.74% $45.59 Percent of Billed Charges 68.24% $41.63 Percent of Billed Charges 65.00% $39.65 Percent of Billed Charges 67.00% $40.87 Percent of Billed Charges 77.50% $47.28 Percent of Billed Charges 79.97% $48.78 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 49.55% $30.23 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 78.94% $48.15 Percent of Billed Charges 74.00% $45.14 Percent of Billed Charges 92.50% $56.43 Percent of Billed Charges 55.00% $33.55 Percent of Billed Charges 85.00% $51.85 Percent of Billed Charges 63.00% $38.43 Percent of Billed Charges 63.00% $38.43 Percent of Billed Charges 75.00% $45.75 Percent of Billed Charges 66.24% $40.41 Percent of Billed Charges 165.81% $31.09 Fee Schedule 166.07% $31.14 Fee Schedule 176.26% $33.05 Fee Schedule 191.75% $35.95 Fee Schedule 191.24% $35.86 Fee Schedule 159.00% $96.99 Fee Schedule 145.00% $27.19 Fee Schedule 60.00% $36.60 Percent of Billed Charges "HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG OBS" 260 CPT 96374 Outpatient $643.00 $72.24 " $1,022.37 " $643.00 61.04% $392.49 Percent of Billed Charges 69.29% $445.53 Percent of Billed Charges " $1,480.00 " $643.00 Case Rate 74.74% $480.58 Percent of Billed Charges 68.24% $438.78 Percent of Billed Charges 65.00% $417.95 Percent of Billed Charges 67.00% $430.81 Percent of Billed Charges 77.50% $498.33 Percent of Billed Charges 79.97% $514.21 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 49.55% $318.61 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 78.94% $507.58 Percent of Billed Charges 74.00% $475.82 Percent of Billed Charges 92.50% $594.78 Percent of Billed Charges 55.00% $353.65 Percent of Billed Charges 85.00% $546.55 Percent of Billed Charges 63.00% $405.09 Percent of Billed Charges 63.00% $405.09 Percent of Billed Charges 75.00% $482.25 Percent of Billed Charges 66.24% $425.92 Percent of Billed Charges 165.81% $82.61 Fee Schedule 166.07% $82.74 Fee Schedule 176.26% $87.81 Fee Schedule 191.75% $95.53 Fee Schedule 191.24% $95.28 Fee Schedule 159.00% " $1,022.37 " Fee Schedule 145.00% $72.24 Fee Schedule 60.00% $385.80 Percent of Billed Charges "HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG OBS" 260 CPT 96375 Outpatient $259.00 $30.87 $411.81 $259.00 61.04% $158.09 Percent of Billed Charges 69.29% $179.46 Percent of Billed Charges " $1,480.00 " $259.00 Case Rate 74.74% $193.58 Percent of Billed Charges 68.24% $176.74 Percent of Billed Charges 65.00% $168.35 Percent of Billed Charges 67.00% $173.53 Percent of Billed Charges 77.50% $200.73 Percent of Billed Charges 79.97% $207.12 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 49.55% $128.33 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 78.94% $204.45 Percent of Billed Charges 74.00% $191.66 Percent of Billed Charges 92.50% $239.58 Percent of Billed Charges 55.00% $142.45 Percent of Billed Charges 85.00% $220.15 Percent of Billed Charges 63.00% $163.17 Percent of Billed Charges 63.00% $163.17 Percent of Billed Charges 75.00% $194.25 Percent of Billed Charges 66.24% $171.56 Percent of Billed Charges 165.81% $35.30 Fee Schedule 166.07% $35.36 Fee Schedule 176.26% $37.53 Fee Schedule 191.75% $40.82 Fee Schedule 191.24% $40.71 Fee Schedule 159.00% $411.81 Fee Schedule 145.00% $30.87 Fee Schedule 60.00% $155.40 Percent of Billed Charges "HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG OBS" 260 CPT 96376 Outpatient $305.00 $- $484.95 $305.00 61.04% $186.17 Percent of Billed Charges 69.29% $211.33 Percent of Billed Charges " $1,480.00 " $305.00 Case Rate 74.74% $227.96 Percent of Billed Charges 68.24% $208.13 Percent of Billed Charges 65.00% $198.25 Percent of Billed Charges 67.00% $204.35 Percent of Billed Charges 77.50% $236.38 Percent of Billed Charges 79.97% $243.91 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 49.55% $151.13 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 78.94% $240.77 Percent of Billed Charges 74.00% $225.70 Percent of Billed Charges 92.50% $282.13 Percent of Billed Charges 55.00% $167.75 Percent of Billed Charges 85.00% $259.25 Percent of Billed Charges 63.00% $192.15 Percent of Billed Charges 63.00% $192.15 Percent of Billed Charges 75.00% $228.75 Percent of Billed Charges 66.24% $202.03 Percent of Billed Charges 35.00% $106.75 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $484.95 Fee Schedule 145.00% $- Fee Schedule 60.00% $183.00 Percent of Billed Charges HC IRRIG IMPLANTED DRUG DELIVERY DEVICE OBS 260 CPT 96523 Outpatient $320.00 $- $508.80 $320.00 61.04% $195.33 Percent of Billed Charges 69.29% $221.73 Percent of Billed Charges " $1,480.00 " $320.00 Case Rate 74.74% $239.17 Percent of Billed Charges 68.24% $218.37 Percent of Billed Charges 65.00% $208.00 Percent of Billed Charges 67.00% $214.40 Percent of Billed Charges 77.50% $248.00 Percent of Billed Charges 79.97% $255.90 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 49.55% $158.56 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 78.94% $252.61 Percent of Billed Charges 74.00% $236.80 Percent of Billed Charges 92.50% $296.00 Percent of Billed Charges 55.00% $176.00 Percent of Billed Charges 85.00% $272.00 Percent of Billed Charges 63.00% $201.60 Percent of Billed Charges 63.00% $201.60 Percent of Billed Charges 75.00% $240.00 Percent of Billed Charges 66.24% $211.97 Percent of Billed Charges 35.00% $112.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $508.80 Fee Schedule 145.00% $- Fee Schedule 60.00% $192.00 Percent of Billed Charges "HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR OBS" 260 CPT 96369 Outpatient " $1,241.00 " $200.69 " $1,973.19 " " $1,241.00 " 61.04% $757.51 Percent of Billed Charges 69.29% $859.89 Percent of Billed Charges " $1,480.00 " " $1,241.00 " Case Rate 74.74% $927.52 Percent of Billed Charges 68.24% $846.86 Percent of Billed Charges 65.00% $806.65 Percent of Billed Charges 67.00% $831.47 Percent of Billed Charges 77.50% $961.78 Percent of Billed Charges 79.97% $992.43 Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 49.55% $614.92 Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 78.94% $979.65 Percent of Billed Charges 74.00% $918.34 Percent of Billed Charges 92.50% " $1,147.93 " Percent of Billed Charges 55.00% $682.55 Percent of Billed Charges 85.00% " $1,054.85 " Percent of Billed Charges 63.00% $781.83 Percent of Billed Charges 63.00% $781.83 Percent of Billed Charges 75.00% $930.75 Percent of Billed Charges 66.24% $822.04 Percent of Billed Charges 165.81% $229.50 Fee Schedule 166.07% $229.86 Fee Schedule 176.26% $243.96 Fee Schedule 191.75% $265.40 Fee Schedule 191.24% $264.70 Fee Schedule 159.00% " $1,973.19 " Fee Schedule 145.00% $200.69 Fee Schedule 60.00% $744.60 Percent of Billed Charges "HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR OBS" 260 CPT 96370 Outpatient $345.00 $19.62 $548.55 $345.00 61.04% $210.59 Percent of Billed Charges 69.29% $239.05 Percent of Billed Charges " $1,480.00 " $345.00 Case Rate 74.74% $257.85 Percent of Billed Charges 68.24% $235.43 Percent of Billed Charges 65.00% $224.25 Percent of Billed Charges 67.00% $231.15 Percent of Billed Charges 77.50% $267.38 Percent of Billed Charges 79.97% $275.90 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 49.55% $170.95 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 78.94% $272.34 Percent of Billed Charges 74.00% $255.30 Percent of Billed Charges 92.50% $319.13 Percent of Billed Charges 55.00% $189.75 Percent of Billed Charges 85.00% $293.25 Percent of Billed Charges 63.00% $217.35 Percent of Billed Charges 63.00% $217.35 Percent of Billed Charges 75.00% $258.75 Percent of Billed Charges 66.24% $228.53 Percent of Billed Charges 165.81% $22.43 Fee Schedule 166.07% $22.47 Fee Schedule 176.26% $23.85 Fee Schedule 191.75% $25.94 Fee Schedule 191.24% $25.87 Fee Schedule 159.00% $548.55 Fee Schedule 145.00% $19.62 Fee Schedule 60.00% $207.00 Percent of Billed Charges HC SC THER INFUSION RESET PUMP OBS 260 CPT 96371 Outpatient $332.00 $98.21 $527.88 $332.00 61.04% $202.65 Percent of Billed Charges 69.29% $230.04 Percent of Billed Charges " $1,480.00 " $332.00 Case Rate 74.74% $248.14 Percent of Billed Charges 68.24% $226.56 Percent of Billed Charges 65.00% $215.80 Percent of Billed Charges 67.00% $222.44 Percent of Billed Charges 77.50% $257.30 Percent of Billed Charges 79.97% $265.50 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 49.55% $164.51 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 78.94% $262.08 Percent of Billed Charges 74.00% $245.68 Percent of Billed Charges 92.50% $307.10 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 85.00% $282.20 Percent of Billed Charges 63.00% $209.16 Percent of Billed Charges 63.00% $209.16 Percent of Billed Charges 75.00% $249.00 Percent of Billed Charges 66.24% $219.92 Percent of Billed Charges 165.81% $112.30 Fee Schedule 166.07% $112.48 Fee Schedule 176.26% $119.38 Fee Schedule 191.75% $129.87 Fee Schedule 191.24% $129.53 Fee Schedule 159.00% $527.88 Fee Schedule 145.00% $98.21 Fee Schedule 60.00% $199.20 Percent of Billed Charges HC CASIRIVMAB OR IMDEVIMAB INF ADMIN AND POST ADMIN MONITORING 260 CPT M0243 Outpatient " $1,536.00 " $- " $2,442.24 " " $1,536.00 " 61.04% $937.57 Percent of Billed Charges 69.29% " $1,064.29 " Percent of Billed Charges " $1,480.00 " " $1,480.00 " Case Rate 74.74% " $1,148.01 " Percent of Billed Charges 68.24% " $1,048.17 " Percent of Billed Charges 65.00% $998.40 Percent of Billed Charges 67.00% " $1,029.12 " Percent of Billed Charges 77.50% " $1,190.40 " Percent of Billed Charges 79.97% " $1,228.34 " Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 49.55% $761.09 Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 78.94% " $1,212.52 " Percent of Billed Charges 74.00% " $1,136.64 " Percent of Billed Charges 92.50% " $1,420.80 " Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 85.00% " $1,305.60 " Percent of Billed Charges 63.00% $967.68 Percent of Billed Charges 63.00% $967.68 Percent of Billed Charges 75.00% " $1,152.00 " Percent of Billed Charges 66.24% " $1,017.45 " Percent of Billed Charges 35.00% $537.60 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $2,442.24 " Fee Schedule 145.00% $- Fee Schedule 60.00% $921.60 Percent of Billed Charges HC SOTROVIMAB INF ADMIN AND POST ADMIN MONITORING 260 CPT M0247 Outpatient " $1,536.00 " $- " $2,442.24 " " $1,536.00 " 61.04% $937.57 Percent of Billed Charges 69.29% " $1,064.29 " Percent of Billed Charges " $1,480.00 " " $1,480.00 " Case Rate 74.74% " $1,148.01 " Percent of Billed Charges 68.24% " $1,048.17 " Percent of Billed Charges 65.00% $998.40 Percent of Billed Charges 67.00% " $1,029.12 " Percent of Billed Charges 77.50% " $1,190.40 " Percent of Billed Charges 79.97% " $1,228.34 " Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 49.55% $761.09 Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 78.94% " $1,212.52 " Percent of Billed Charges 74.00% " $1,136.64 " Percent of Billed Charges 92.50% " $1,420.80 " Percent of Billed Charges 55.00% $844.80 Percent of Billed Charges 85.00% " $1,305.60 " Percent of Billed Charges 63.00% $967.68 Percent of Billed Charges 63.00% $967.68 Percent of Billed Charges 75.00% " $1,152.00 " Percent of Billed Charges 66.24% " $1,017.45 " Percent of Billed Charges 35.00% $537.60 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 191.75% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $2,442.24 " Fee Schedule 145.00% $- Fee Schedule 60.00% $921.60 Percent of Billed Charges HC TIXAGEVIMAB AND CILGAVIMAB INJ AND POST ADMIN MONITORING 260 CPT M0220 Outpatient $270.00 $133.79 $429.30 $270.00 61.04% $164.81 Percent of Billed Charges 69.29% $187.08 Percent of Billed Charges " $1,480.00 " $270.00 Case Rate 74.74% $201.80 Percent of Billed Charges 68.24% $184.25 Percent of Billed Charges 65.00% $175.50 Percent of Billed Charges 67.00% $180.90 Percent of Billed Charges 77.50% $209.25 Percent of Billed Charges 79.97% $215.92 Percent of Billed Charges 55.00% $148.50 Percent of Billed Charges 49.55% $133.79 Percent of Billed Charges 55.00% $148.50 Percent of Billed Charges 55.00% $148.50 Percent of Billed Charges 78.94% $213.14 Percent of Billed Charges 74.00% $199.80 Percent of Billed Charges 92.50% $249.75 Percent of Billed Charges 55.00% $148.50 Percent of Billed Charges 85.00% $229.50 Percent of Billed Charges 63.00% $170.10 Percent of Billed Charges 63.00% $170.10 Percent of Billed Charges 75.00% $202.50 Percent of Billed Charges 66.24% $178.85 Percent of Billed Charges 165.81% $249.54 Fee Schedule 166.07% $249.94 Fee Schedule 176.26% $265.27 Fee Schedule 191.75% $288.58 Fee Schedule 191.24% $287.82 Fee Schedule 159.00% $429.30 Fee Schedule 145.00% $218.23 Fee Schedule 60.00% $162.00 Percent of Billed Charges HC PHONAK M50 M 260 CPT V5298 Outpatient " $1,759.92 " $615.97 " $1,627.93 " " $1,759.92 " 61.04% " $1,074.26 " Percent of Billed Charges 69.29% " $1,219.45 " Percent of Billed Charges 56.78% $999.28 Percent of Billed Charges 74.74% " $1,315.36 " Percent of Billed Charges 68.24% " $1,200.97 " Percent of Billed Charges 65.00% " $1,143.95 " Percent of Billed Charges 67.00% " $1,179.15 " Percent of Billed Charges 77.50% " $1,363.94 " Percent of Billed Charges 79.97% " $1,407.41 " Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 49.55% $872.04 Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 78.94% " $1,389.28 " Percent of Billed Charges 74.00% " $1,302.34 " Percent of Billed Charges 92.50% " $1,627.93 " Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 85.00% " $1,495.93 " Percent of Billed Charges 63.00% " $1,108.75 " Percent of Billed Charges 63.00% " $1,108.75 " Percent of Billed Charges 75.00% " $1,319.94 " Percent of Billed Charges 66.24% " $1,165.77 " Percent of Billed Charges 35.00% $615.97 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,055.95 " Percent of Billed Charges HC PHONAK M30-R 270 CPT V5298 Outpatient " $1,508.00 " $527.80 " $1,394.90 " " $1,508.00 " 61.04% $920.48 Percent of Billed Charges 69.29% " $1,044.89 " Percent of Billed Charges 56.78% $856.24 Percent of Billed Charges 74.74% " $1,127.08 " Percent of Billed Charges 68.24% " $1,029.06 " Percent of Billed Charges 65.00% $980.20 Percent of Billed Charges 67.00% " $1,010.36 " Percent of Billed Charges 77.50% " $1,168.70 " Percent of Billed Charges 79.97% " $1,205.95 " Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 49.55% $747.21 Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 78.94% " $1,190.42 " Percent of Billed Charges 74.00% " $1,115.92 " Percent of Billed Charges 92.50% " $1,394.90 " Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 85.00% " $1,281.80 " Percent of Billed Charges 63.00% $950.04 Percent of Billed Charges 63.00% $950.04 Percent of Billed Charges 75.00% " $1,131.00 " Percent of Billed Charges 66.24% $998.90 Percent of Billed Charges 35.00% $527.80 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $904.80 Percent of Billed Charges HC PHONAK M90-R 270 CPT V5298 Outpatient " $3,597.78 " " $1,259.22 " " $3,327.95 " " $3,597.78 " 61.04% " $2,196.08 " Percent of Billed Charges 69.29% " $2,492.90 " Percent of Billed Charges 56.78% " $2,042.82 " Percent of Billed Charges 74.74% " $2,688.98 " Percent of Billed Charges 68.24% " $2,455.13 " Percent of Billed Charges 65.00% " $2,338.56 " Percent of Billed Charges 67.00% " $2,410.51 " Percent of Billed Charges 77.50% " $2,788.28 " Percent of Billed Charges 79.97% " $2,877.14 " Percent of Billed Charges 55.00% " $1,978.78 " Percent of Billed Charges 49.55% " $1,782.70 " Percent of Billed Charges 55.00% " $1,978.78 " Percent of Billed Charges 55.00% " $1,978.78 " Percent of Billed Charges 78.94% " $2,840.09 " Percent of Billed Charges 74.00% " $2,662.36 " Percent of Billed Charges 92.50% " $3,327.95 " Percent of Billed Charges 55.00% " $1,978.78 " Percent of Billed Charges 85.00% " $3,058.11 " Percent of Billed Charges 63.00% " $2,266.60 " Percent of Billed Charges 63.00% " $2,266.60 " Percent of Billed Charges 75.00% " $2,698.34 " Percent of Billed Charges 66.24% " $2,383.17 " Percent of Billed Charges 35.00% " $1,259.22 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,158.67 " Percent of Billed Charges " HC BATTERY HEARING AID SIZE 10, 13, 312" 270 CPT V5266 Outpatient $0.88 $0.31 $0.81 $0.88 61.04% $0.54 Percent of Billed Charges 69.29% $0.61 Percent of Billed Charges 56.78% $0.50 Percent of Billed Charges 74.74% $0.66 Percent of Billed Charges 68.24% $0.60 Percent of Billed Charges 65.00% $0.57 Percent of Billed Charges 67.00% $0.59 Percent of Billed Charges 77.50% $0.68 Percent of Billed Charges 79.97% $0.70 Percent of Billed Charges 55.00% $0.48 Percent of Billed Charges 49.55% $0.44 Percent of Billed Charges 55.00% $0.48 Percent of Billed Charges 55.00% $0.48 Percent of Billed Charges 78.94% $0.69 Percent of Billed Charges 74.00% $0.65 Percent of Billed Charges 92.50% $0.81 Percent of Billed Charges 55.00% $0.48 Percent of Billed Charges 85.00% $0.75 Percent of Billed Charges 63.00% $0.55 Percent of Billed Charges 63.00% $0.55 Percent of Billed Charges 75.00% $0.66 Percent of Billed Charges 66.24% $0.58 Percent of Billed Charges 35.00% $0.31 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $0.53 Percent of Billed Charges HC Battery Hearing Aid Size 675 270 CPT V5266 Outpatient $1.18 $0.41 $1.09 $1.18 61.04% $0.72 Percent of Billed Charges 69.29% $0.82 Percent of Billed Charges 56.78% $0.67 Percent of Billed Charges 74.74% $0.88 Percent of Billed Charges 68.24% $0.81 Percent of Billed Charges 65.00% $0.77 Percent of Billed Charges 67.00% $0.79 Percent of Billed Charges 77.50% $0.91 Percent of Billed Charges 79.97% $0.94 Percent of Billed Charges 55.00% $0.65 Percent of Billed Charges 49.55% $0.58 Percent of Billed Charges 55.00% $0.65 Percent of Billed Charges 55.00% $0.65 Percent of Billed Charges 78.94% $0.93 Percent of Billed Charges 74.00% $0.87 Percent of Billed Charges 92.50% $1.09 Percent of Billed Charges 55.00% $0.65 Percent of Billed Charges 85.00% $1.00 Percent of Billed Charges 63.00% $0.74 Percent of Billed Charges 63.00% $0.74 Percent of Billed Charges 75.00% $0.89 Percent of Billed Charges 66.24% $0.78 Percent of Billed Charges 35.00% $0.41 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $0.71 Percent of Billed Charges HC CLEANING BRUSH 270 CPT V5267 Outpatient $2.00 $0.70 $1.85 $2.00 61.04% $1.22 Percent of Billed Charges 69.29% $1.39 Percent of Billed Charges 56.78% $1.14 Percent of Billed Charges 74.74% $1.49 Percent of Billed Charges 68.24% $1.36 Percent of Billed Charges 65.00% $1.30 Percent of Billed Charges 67.00% $1.34 Percent of Billed Charges 77.50% $1.55 Percent of Billed Charges 79.97% $1.60 Percent of Billed Charges 55.00% $1.10 Percent of Billed Charges 49.55% $0.99 Percent of Billed Charges 55.00% $1.10 Percent of Billed Charges 55.00% $1.10 Percent of Billed Charges 78.94% $1.58 Percent of Billed Charges 74.00% $1.48 Percent of Billed Charges 92.50% $1.85 Percent of Billed Charges 55.00% $1.10 Percent of Billed Charges 85.00% $1.70 Percent of Billed Charges 63.00% $1.26 Percent of Billed Charges 63.00% $1.26 Percent of Billed Charges 75.00% $1.50 Percent of Billed Charges 66.24% $1.32 Percent of Billed Charges 35.00% $0.70 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $1.20 Percent of Billed Charges HC COCHLEAR BAHA ATTRACT SP MAGNET 270 CPT V5267 Outpatient $294.00 $102.90 $271.95 $294.00 61.04% $179.46 Percent of Billed Charges 69.29% $203.71 Percent of Billed Charges 56.78% $166.93 Percent of Billed Charges 74.74% $219.74 Percent of Billed Charges 68.24% $200.63 Percent of Billed Charges 65.00% $191.10 Percent of Billed Charges 67.00% $196.98 Percent of Billed Charges 77.50% $227.85 Percent of Billed Charges 79.97% $235.11 Percent of Billed Charges 55.00% $161.70 Percent of Billed Charges 49.55% $145.68 Percent of Billed Charges 55.00% $161.70 Percent of Billed Charges 55.00% $161.70 Percent of Billed Charges 78.94% $232.08 Percent of Billed Charges 74.00% $217.56 Percent of Billed Charges 92.50% $271.95 Percent of Billed Charges 55.00% $161.70 Percent of Billed Charges 85.00% $249.90 Percent of Billed Charges 63.00% $185.22 Percent of Billed Charges 63.00% $185.22 Percent of Billed Charges 75.00% $220.50 Percent of Billed Charges 66.24% $194.75 Percent of Billed Charges 35.00% $102.90 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $176.40 Percent of Billed Charges HC COCHLEAR BAHA ATTRACT SP MAGNET KIT 270 CPT V5267 Outpatient $362.60 $126.91 $335.41 $362.60 61.04% $221.33 Percent of Billed Charges 69.29% $251.25 Percent of Billed Charges 56.78% $205.88 Percent of Billed Charges 74.74% $271.01 Percent of Billed Charges 68.24% $247.44 Percent of Billed Charges 65.00% $235.69 Percent of Billed Charges 67.00% $242.94 Percent of Billed Charges 77.50% $281.02 Percent of Billed Charges 79.97% $289.97 Percent of Billed Charges 55.00% $199.43 Percent of Billed Charges 49.55% $179.67 Percent of Billed Charges 55.00% $199.43 Percent of Billed Charges 55.00% $199.43 Percent of Billed Charges 78.94% $286.24 Percent of Billed Charges 74.00% $268.32 Percent of Billed Charges 92.50% $335.41 Percent of Billed Charges 55.00% $199.43 Percent of Billed Charges 85.00% $308.21 Percent of Billed Charges 63.00% $228.44 Percent of Billed Charges 63.00% $228.44 Percent of Billed Charges 75.00% $271.95 Percent of Billed Charges 66.24% $240.19 Percent of Billed Charges 35.00% $126.91 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $217.56 Percent of Billed Charges HC COCHLEAR BAHA BILATERAL SOFTBAND 270 CPT V5267 Outpatient $156.80 $54.88 $145.04 $156.80 61.04% $95.71 Percent of Billed Charges 69.29% $108.65 Percent of Billed Charges 56.78% $89.03 Percent of Billed Charges 74.74% $117.19 Percent of Billed Charges 68.24% $107.00 Percent of Billed Charges 65.00% $101.92 Percent of Billed Charges 67.00% $105.06 Percent of Billed Charges 77.50% $121.52 Percent of Billed Charges 79.97% $125.39 Percent of Billed Charges 55.00% $86.24 Percent of Billed Charges 49.55% $77.69 Percent of Billed Charges 55.00% $86.24 Percent of Billed Charges 55.00% $86.24 Percent of Billed Charges 78.94% $123.78 Percent of Billed Charges 74.00% $116.03 Percent of Billed Charges 92.50% $145.04 Percent of Billed Charges 55.00% $86.24 Percent of Billed Charges 85.00% $133.28 Percent of Billed Charges 63.00% $98.78 Percent of Billed Charges 63.00% $98.78 Percent of Billed Charges 75.00% $117.60 Percent of Billed Charges 66.24% $103.86 Percent of Billed Charges 35.00% $54.88 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $94.08 Percent of Billed Charges HC COCHLEAR BAHA PHONE CLIP WIRELESS 270 CPT V5267 Outpatient $354.00 $123.90 $327.45 $354.00 61.04% $216.08 Percent of Billed Charges 69.29% $245.29 Percent of Billed Charges 56.78% $201.00 Percent of Billed Charges 74.74% $264.58 Percent of Billed Charges 68.24% $241.57 Percent of Billed Charges 65.00% $230.10 Percent of Billed Charges 67.00% $237.18 Percent of Billed Charges 77.50% $274.35 Percent of Billed Charges 79.97% $283.09 Percent of Billed Charges 55.00% $194.70 Percent of Billed Charges 49.55% $175.41 Percent of Billed Charges 55.00% $194.70 Percent of Billed Charges 55.00% $194.70 Percent of Billed Charges 78.94% $279.45 Percent of Billed Charges 74.00% $261.96 Percent of Billed Charges 92.50% $327.45 Percent of Billed Charges 55.00% $194.70 Percent of Billed Charges 85.00% $300.90 Percent of Billed Charges 63.00% $223.02 Percent of Billed Charges 63.00% $223.02 Percent of Billed Charges 75.00% $265.50 Percent of Billed Charges 66.24% $234.49 Percent of Billed Charges 35.00% $123.90 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $212.40 Percent of Billed Charges HC COCHLEAR BAHA SAFETY LINE 270 CPT V5267 Outpatient $8.50 $2.98 $7.86 $8.50 61.04% $5.19 Percent of Billed Charges 69.29% $5.89 Percent of Billed Charges 56.78% $4.83 Percent of Billed Charges 74.74% $6.35 Percent of Billed Charges 68.24% $5.80 Percent of Billed Charges 65.00% $5.53 Percent of Billed Charges 67.00% $5.70 Percent of Billed Charges 77.50% $6.59 Percent of Billed Charges 79.97% $6.80 Percent of Billed Charges 55.00% $4.68 Percent of Billed Charges 49.55% $4.21 Percent of Billed Charges 55.00% $4.68 Percent of Billed Charges 55.00% $4.68 Percent of Billed Charges 78.94% $6.71 Percent of Billed Charges 74.00% $6.29 Percent of Billed Charges 92.50% $7.86 Percent of Billed Charges 55.00% $4.68 Percent of Billed Charges 85.00% $7.23 Percent of Billed Charges 63.00% $5.36 Percent of Billed Charges 63.00% $5.36 Percent of Billed Charges 75.00% $6.38 Percent of Billed Charges 66.24% $5.63 Percent of Billed Charges 35.00% $2.98 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $5.10 Percent of Billed Charges HC COCHLEAR BAHA SOFT PADS 270 CPT V5267 Outpatient $7.02 $2.46 $6.49 $7.02 61.04% $4.29 Percent of Billed Charges 69.29% $4.86 Percent of Billed Charges 56.78% $3.99 Percent of Billed Charges 74.74% $5.25 Percent of Billed Charges 68.24% $4.79 Percent of Billed Charges 65.00% $4.56 Percent of Billed Charges 67.00% $4.70 Percent of Billed Charges 77.50% $5.44 Percent of Billed Charges 79.97% $5.61 Percent of Billed Charges 55.00% $3.86 Percent of Billed Charges 49.55% $3.48 Percent of Billed Charges 55.00% $3.86 Percent of Billed Charges 55.00% $3.86 Percent of Billed Charges 78.94% $5.54 Percent of Billed Charges 74.00% $5.19 Percent of Billed Charges 92.50% $6.49 Percent of Billed Charges 55.00% $3.86 Percent of Billed Charges 85.00% $5.97 Percent of Billed Charges 63.00% $4.42 Percent of Billed Charges 63.00% $4.42 Percent of Billed Charges 75.00% $5.27 Percent of Billed Charges 66.24% $4.65 Percent of Billed Charges 35.00% $2.46 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $4.21 Percent of Billed Charges HC COCHLEAR BAHA SOUNDARC 270 CPT V5267 Outpatient $107.80 $37.73 $99.72 $107.80 61.04% $65.80 Percent of Billed Charges 69.29% $74.69 Percent of Billed Charges 56.78% $61.21 Percent of Billed Charges 74.74% $80.57 Percent of Billed Charges 68.24% $73.56 Percent of Billed Charges 65.00% $70.07 Percent of Billed Charges 67.00% $72.23 Percent of Billed Charges 77.50% $83.55 Percent of Billed Charges 79.97% $86.21 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 49.55% $53.41 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 78.94% $85.10 Percent of Billed Charges 74.00% $79.77 Percent of Billed Charges 92.50% $99.72 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 85.00% $91.63 Percent of Billed Charges 63.00% $67.91 Percent of Billed Charges 63.00% $67.91 Percent of Billed Charges 75.00% $80.85 Percent of Billed Charges 66.24% $71.41 Percent of Billed Charges 35.00% $37.73 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $64.68 Percent of Billed Charges HC COCHLEAR BAHA SOUNDARC COLOR TIP KIT 270 CPT V5267 Outpatient $67.98 $23.79 $62.88 $67.98 61.04% $41.49 Percent of Billed Charges 69.29% $47.10 Percent of Billed Charges 56.78% $38.60 Percent of Billed Charges 74.74% $50.81 Percent of Billed Charges 68.24% $46.39 Percent of Billed Charges 65.00% $44.19 Percent of Billed Charges 67.00% $45.55 Percent of Billed Charges 77.50% $52.68 Percent of Billed Charges 79.97% $54.36 Percent of Billed Charges 55.00% $37.39 Percent of Billed Charges 49.55% $33.68 Percent of Billed Charges 55.00% $37.39 Percent of Billed Charges 55.00% $37.39 Percent of Billed Charges 78.94% $53.66 Percent of Billed Charges 74.00% $50.31 Percent of Billed Charges 92.50% $62.88 Percent of Billed Charges 55.00% $37.39 Percent of Billed Charges 85.00% $57.78 Percent of Billed Charges 63.00% $42.83 Percent of Billed Charges 63.00% $42.83 Percent of Billed Charges 75.00% $50.99 Percent of Billed Charges 66.24% $45.03 Percent of Billed Charges 35.00% $23.79 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $40.79 Percent of Billed Charges HC COCHLEAR BAHA UNILATERAL SOFTBAND 270 CPT V5267 Outpatient $107.80 $37.73 $99.72 $107.80 61.04% $65.80 Percent of Billed Charges 69.29% $74.69 Percent of Billed Charges 56.78% $61.21 Percent of Billed Charges 74.74% $80.57 Percent of Billed Charges 68.24% $73.56 Percent of Billed Charges 65.00% $70.07 Percent of Billed Charges 67.00% $72.23 Percent of Billed Charges 77.50% $83.55 Percent of Billed Charges 79.97% $86.21 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 49.55% $53.41 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 78.94% $85.10 Percent of Billed Charges 74.00% $79.77 Percent of Billed Charges 92.50% $99.72 Percent of Billed Charges 55.00% $59.29 Percent of Billed Charges 85.00% $91.63 Percent of Billed Charges 63.00% $67.91 Percent of Billed Charges 63.00% $67.91 Percent of Billed Charges 75.00% $80.85 Percent of Billed Charges 66.24% $71.41 Percent of Billed Charges 35.00% $37.73 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $64.68 Percent of Billed Charges HC COCHLEAR HEADBAND METAL 270 CPT V5267 Outpatient $90.00 $31.50 $83.25 $90.00 61.04% $54.94 Percent of Billed Charges 69.29% $62.36 Percent of Billed Charges 56.78% $51.10 Percent of Billed Charges 74.74% $67.27 Percent of Billed Charges 68.24% $61.42 Percent of Billed Charges 65.00% $58.50 Percent of Billed Charges 67.00% $60.30 Percent of Billed Charges 77.50% $69.75 Percent of Billed Charges 79.97% $71.97 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 49.55% $44.60 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 78.94% $71.05 Percent of Billed Charges 74.00% $66.60 Percent of Billed Charges 92.50% $83.25 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 85.00% $76.50 Percent of Billed Charges 63.00% $56.70 Percent of Billed Charges 63.00% $56.70 Percent of Billed Charges 75.00% $67.50 Percent of Billed Charges 66.24% $59.62 Percent of Billed Charges 35.00% $31.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $54.00 Percent of Billed Charges HC COCHLEAR MAGNET SOFT PADS 24 PACK 270 CPT V5267 Outpatient $68.60 $24.01 $63.46 $68.60 61.04% $41.87 Percent of Billed Charges 69.29% $47.53 Percent of Billed Charges 56.78% $38.95 Percent of Billed Charges 74.74% $51.27 Percent of Billed Charges 68.24% $46.81 Percent of Billed Charges 65.00% $44.59 Percent of Billed Charges 67.00% $45.96 Percent of Billed Charges 77.50% $53.17 Percent of Billed Charges 79.97% $54.86 Percent of Billed Charges 55.00% $37.73 Percent of Billed Charges 49.55% $33.99 Percent of Billed Charges 55.00% $37.73 Percent of Billed Charges 55.00% $37.73 Percent of Billed Charges 78.94% $54.15 Percent of Billed Charges 74.00% $50.76 Percent of Billed Charges 92.50% $63.46 Percent of Billed Charges 55.00% $37.73 Percent of Billed Charges 85.00% $58.31 Percent of Billed Charges 63.00% $43.22 Percent of Billed Charges 63.00% $43.22 Percent of Billed Charges 75.00% $51.45 Percent of Billed Charges 66.24% $45.44 Percent of Billed Charges 35.00% $24.01 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $41.16 Percent of Billed Charges HC COCHLEAR MINI MIC 2+ 270 CPT V5267 Outpatient $474.00 $165.90 $438.45 $474.00 61.04% $289.33 Percent of Billed Charges 69.29% $328.43 Percent of Billed Charges 56.78% $269.14 Percent of Billed Charges 74.74% $354.27 Percent of Billed Charges 68.24% $323.46 Percent of Billed Charges 65.00% $308.10 Percent of Billed Charges 67.00% $317.58 Percent of Billed Charges 77.50% $367.35 Percent of Billed Charges 79.97% $379.06 Percent of Billed Charges 55.00% $260.70 Percent of Billed Charges 49.55% $234.87 Percent of Billed Charges 55.00% $260.70 Percent of Billed Charges 55.00% $260.70 Percent of Billed Charges 78.94% $374.18 Percent of Billed Charges 74.00% $350.76 Percent of Billed Charges 92.50% $438.45 Percent of Billed Charges 55.00% $260.70 Percent of Billed Charges 85.00% $402.90 Percent of Billed Charges 63.00% $298.62 Percent of Billed Charges 63.00% $298.62 Percent of Billed Charges 75.00% $355.50 Percent of Billed Charges 66.24% $313.98 Percent of Billed Charges 35.00% $165.90 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $284.40 Percent of Billed Charges HC COCHLEAR SOUND ARC CONNECTOR DISC 270 CPT V5267 Outpatient $49.00 $17.15 $45.33 $49.00 61.04% $29.91 Percent of Billed Charges 69.29% $33.95 Percent of Billed Charges 56.78% $27.82 Percent of Billed Charges 74.74% $36.62 Percent of Billed Charges 68.24% $33.44 Percent of Billed Charges 65.00% $31.85 Percent of Billed Charges 67.00% $32.83 Percent of Billed Charges 77.50% $37.98 Percent of Billed Charges 79.97% $39.19 Percent of Billed Charges 55.00% $26.95 Percent of Billed Charges 49.55% $24.28 Percent of Billed Charges 55.00% $26.95 Percent of Billed Charges 55.00% $26.95 Percent of Billed Charges 78.94% $38.68 Percent of Billed Charges 74.00% $36.26 Percent of Billed Charges 92.50% $45.33 Percent of Billed Charges 55.00% $26.95 Percent of Billed Charges 85.00% $41.65 Percent of Billed Charges 63.00% $30.87 Percent of Billed Charges 63.00% $30.87 Percent of Billed Charges 75.00% $36.75 Percent of Billed Charges 66.24% $32.46 Percent of Billed Charges 35.00% $17.15 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $29.40 Percent of Billed Charges HC HEAR AID RENTAL PER DAY 270 CPT V5298 RR Outpatient $5.00 $1.75 $4.63 $5.00 61.04% $3.05 Percent of Billed Charges 69.29% $3.46 Percent of Billed Charges 56.78% $2.84 Percent of Billed Charges 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 35.00% $1.75 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $3.00 Percent of Billed Charges HC MEDEL ADHEAR ADHESIVE ADAPTER 15 COUNT 270 CPT V5267 Outpatient $44.00 $15.40 $40.70 $44.00 61.04% $26.86 Percent of Billed Charges 69.29% $30.49 Percent of Billed Charges 56.78% $24.98 Percent of Billed Charges 74.74% $32.89 Percent of Billed Charges 68.24% $30.03 Percent of Billed Charges 65.00% $28.60 Percent of Billed Charges 67.00% $29.48 Percent of Billed Charges 77.50% $34.10 Percent of Billed Charges 79.97% $35.19 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 49.55% $21.80 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 78.94% $34.73 Percent of Billed Charges 74.00% $32.56 Percent of Billed Charges 92.50% $40.70 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 85.00% $37.40 Percent of Billed Charges 63.00% $27.72 Percent of Billed Charges 63.00% $27.72 Percent of Billed Charges 75.00% $33.00 Percent of Billed Charges 66.24% $29.15 Percent of Billed Charges 35.00% $15.40 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $26.40 Percent of Billed Charges HC MEDEL ADHEAR ADHESIVE ADAPTER 75 COUNT 270 CPT V5267 Outpatient $196.00 $68.60 $181.30 $196.00 61.04% $119.64 Percent of Billed Charges 69.29% $135.81 Percent of Billed Charges 56.78% $111.29 Percent of Billed Charges 74.74% $146.49 Percent of Billed Charges 68.24% $133.75 Percent of Billed Charges 65.00% $127.40 Percent of Billed Charges 67.00% $131.32 Percent of Billed Charges 77.50% $151.90 Percent of Billed Charges 79.97% $156.74 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 49.55% $97.12 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 78.94% $154.72 Percent of Billed Charges 74.00% $145.04 Percent of Billed Charges 92.50% $181.30 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 85.00% $166.60 Percent of Billed Charges 63.00% $123.48 Percent of Billed Charges 63.00% $123.48 Percent of Billed Charges 75.00% $147.00 Percent of Billed Charges 66.24% $129.83 Percent of Billed Charges 35.00% $68.60 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $117.60 Percent of Billed Charges HC MEDEL ADHEAR SILICONE SLEEVE 270 CPT V5267 Outpatient $42.00 $14.70 $38.85 $42.00 61.04% $25.64 Percent of Billed Charges 69.29% $29.10 Percent of Billed Charges 56.78% $23.85 Percent of Billed Charges 74.74% $31.39 Percent of Billed Charges 68.24% $28.66 Percent of Billed Charges 65.00% $27.30 Percent of Billed Charges 67.00% $28.14 Percent of Billed Charges 77.50% $32.55 Percent of Billed Charges 79.97% $33.59 Percent of Billed Charges 55.00% $23.10 Percent of Billed Charges 49.55% $20.81 Percent of Billed Charges 55.00% $23.10 Percent of Billed Charges 55.00% $23.10 Percent of Billed Charges 78.94% $33.15 Percent of Billed Charges 74.00% $31.08 Percent of Billed Charges 92.50% $38.85 Percent of Billed Charges 55.00% $23.10 Percent of Billed Charges 85.00% $35.70 Percent of Billed Charges 63.00% $26.46 Percent of Billed Charges 63.00% $26.46 Percent of Billed Charges 75.00% $31.50 Percent of Billed Charges 66.24% $27.82 Percent of Billed Charges 35.00% $14.70 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $25.20 Percent of Billed Charges HC MEDEL AHDEAR ACCESSORIES BOX 270 CPT V5267 Outpatient $130.00 $45.50 $120.25 $130.00 61.04% $79.35 Percent of Billed Charges 69.29% $90.08 Percent of Billed Charges 56.78% $73.81 Percent of Billed Charges 74.74% $97.16 Percent of Billed Charges 68.24% $88.71 Percent of Billed Charges 65.00% $84.50 Percent of Billed Charges 67.00% $87.10 Percent of Billed Charges 77.50% $100.75 Percent of Billed Charges 79.97% $103.96 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 49.55% $64.42 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 78.94% $102.62 Percent of Billed Charges 74.00% $96.20 Percent of Billed Charges 92.50% $120.25 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 85.00% $110.50 Percent of Billed Charges 63.00% $81.90 Percent of Billed Charges 63.00% $81.90 Percent of Billed Charges 75.00% $97.50 Percent of Billed Charges 66.24% $86.11 Percent of Billed Charges 35.00% $45.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $78.00 Percent of Billed Charges HC MEDEL AHDEAR SOFTBAND 270 CPT V5267 Outpatient $138.00 $48.30 $127.65 $138.00 61.04% $84.24 Percent of Billed Charges 69.29% $95.62 Percent of Billed Charges 56.78% $78.36 Percent of Billed Charges 74.74% $103.14 Percent of Billed Charges 68.24% $94.17 Percent of Billed Charges 65.00% $89.70 Percent of Billed Charges 67.00% $92.46 Percent of Billed Charges 77.50% $106.95 Percent of Billed Charges 79.97% $110.36 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 49.55% $68.38 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 78.94% $108.94 Percent of Billed Charges 74.00% $102.12 Percent of Billed Charges 92.50% $127.65 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 85.00% $117.30 Percent of Billed Charges 63.00% $86.94 Percent of Billed Charges 63.00% $86.94 Percent of Billed Charges 75.00% $103.50 Percent of Billed Charges 66.24% $91.41 Percent of Billed Charges 35.00% $48.30 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $82.80 Percent of Billed Charges HC AUD CABLE UNILATERAL 270 CPT V5267 Outpatient $120.00 $42.00 $111.00 $120.00 61.04% $73.25 Percent of Billed Charges 69.29% $83.15 Percent of Billed Charges 56.78% $68.14 Percent of Billed Charges 74.74% $89.69 Percent of Billed Charges 68.24% $81.89 Percent of Billed Charges 65.00% $78.00 Percent of Billed Charges 67.00% $80.40 Percent of Billed Charges 77.50% $93.00 Percent of Billed Charges 79.97% $95.96 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 49.55% $59.46 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 78.94% $94.73 Percent of Billed Charges 74.00% $88.80 Percent of Billed Charges 92.50% $111.00 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 85.00% $102.00 Percent of Billed Charges 63.00% $75.60 Percent of Billed Charges 63.00% $75.60 Percent of Billed Charges 75.00% $90.00 Percent of Billed Charges 66.24% $79.49 Percent of Billed Charges 35.00% $42.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $72.00 Percent of Billed Charges HC AUD CABLE BILATERAL 270 CPT V5267 Outpatient $130.00 $45.50 $120.25 $130.00 61.04% $79.35 Percent of Billed Charges 69.29% $90.08 Percent of Billed Charges 56.78% $73.81 Percent of Billed Charges 74.74% $97.16 Percent of Billed Charges 68.24% $88.71 Percent of Billed Charges 65.00% $84.50 Percent of Billed Charges 67.00% $87.10 Percent of Billed Charges 77.50% $100.75 Percent of Billed Charges 79.97% $103.96 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 49.55% $64.42 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 78.94% $102.62 Percent of Billed Charges 74.00% $96.20 Percent of Billed Charges 92.50% $120.25 Percent of Billed Charges 55.00% $71.50 Percent of Billed Charges 85.00% $110.50 Percent of Billed Charges 63.00% $81.90 Percent of Billed Charges 63.00% $81.90 Percent of Billed Charges 75.00% $97.50 Percent of Billed Charges 66.24% $86.11 Percent of Billed Charges 35.00% $45.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $78.00 Percent of Billed Charges HC MEDEL RETENTION CLIP 270 CPT V5267 Outpatient $50.00 $17.50 $46.25 $50.00 61.04% $30.52 Percent of Billed Charges 69.29% $34.65 Percent of Billed Charges 56.78% $28.39 Percent of Billed Charges 74.74% $37.37 Percent of Billed Charges 68.24% $34.12 Percent of Billed Charges 65.00% $32.50 Percent of Billed Charges 67.00% $33.50 Percent of Billed Charges 77.50% $38.75 Percent of Billed Charges 79.97% $39.99 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 49.55% $24.78 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 78.94% $39.47 Percent of Billed Charges 74.00% $37.00 Percent of Billed Charges 92.50% $46.25 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 85.00% $42.50 Percent of Billed Charges 63.00% $31.50 Percent of Billed Charges 63.00% $31.50 Percent of Billed Charges 75.00% $37.50 Percent of Billed Charges 66.24% $33.12 Percent of Billed Charges 35.00% $17.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $30.00 Percent of Billed Charges HC OTICON MEDICAL NEW SAFETY LINE 270 CPT V5267 Outpatient $10.00 $3.50 $9.25 $10.00 61.04% $6.10 Percent of Billed Charges 69.29% $6.93 Percent of Billed Charges 56.78% $5.68 Percent of Billed Charges 74.74% $7.47 Percent of Billed Charges 68.24% $6.82 Percent of Billed Charges 65.00% $6.50 Percent of Billed Charges 67.00% $6.70 Percent of Billed Charges 77.50% $7.75 Percent of Billed Charges 79.97% $8.00 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 49.55% $4.96 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 78.94% $7.89 Percent of Billed Charges 74.00% $7.40 Percent of Billed Charges 92.50% $9.25 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 85.00% $8.50 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 75.00% $7.50 Percent of Billed Charges 66.24% $6.62 Percent of Billed Charges 35.00% $3.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $6.00 Percent of Billed Charges HC OTICON OPN PLY 1 MINIRITE-R+ 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC OTICON OPN PLY 2 MINIRITE-R+ 270 CPT V5298 Outpatient $800.00 $280.00 $740.00 $800.00 61.04% $488.32 Percent of Billed Charges 69.29% $554.32 Percent of Billed Charges 56.78% $454.24 Percent of Billed Charges 74.74% $597.92 Percent of Billed Charges 68.24% $545.92 Percent of Billed Charges 65.00% $520.00 Percent of Billed Charges 67.00% $536.00 Percent of Billed Charges 77.50% $620.00 Percent of Billed Charges 79.97% $639.76 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 49.55% $396.40 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 78.94% $631.52 Percent of Billed Charges 74.00% $592.00 Percent of Billed Charges 92.50% $740.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 85.00% $680.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 75.00% $600.00 Percent of Billed Charges 66.24% $529.92 Percent of Billed Charges 35.00% $280.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $480.00 Percent of Billed Charges HC OTICON CONNECTLINE MIC 270 CPT V5267 Outpatient $297.50 $104.13 $275.19 $297.50 61.04% $181.59 Percent of Billed Charges 69.29% $206.14 Percent of Billed Charges 56.78% $168.92 Percent of Billed Charges 74.74% $222.35 Percent of Billed Charges 68.24% $203.01 Percent of Billed Charges 65.00% $193.38 Percent of Billed Charges 67.00% $199.33 Percent of Billed Charges 77.50% $230.56 Percent of Billed Charges 79.97% $237.91 Percent of Billed Charges 55.00% $163.63 Percent of Billed Charges 49.55% $147.41 Percent of Billed Charges 55.00% $163.63 Percent of Billed Charges 55.00% $163.63 Percent of Billed Charges 78.94% $234.85 Percent of Billed Charges 74.00% $220.15 Percent of Billed Charges 92.50% $275.19 Percent of Billed Charges 55.00% $163.63 Percent of Billed Charges 85.00% $252.88 Percent of Billed Charges 63.00% $187.43 Percent of Billed Charges 63.00% $187.43 Percent of Billed Charges 75.00% $223.13 Percent of Billed Charges 66.24% $197.06 Percent of Billed Charges 35.00% $104.13 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $178.50 Percent of Billed Charges HC OTICON CONNECTLINE PHONE 2.0 270 CPT V5267 Outpatient $170.00 $59.50 $157.25 $170.00 61.04% $103.77 Percent of Billed Charges 69.29% $117.79 Percent of Billed Charges 56.78% $96.53 Percent of Billed Charges 74.74% $127.06 Percent of Billed Charges 68.24% $116.01 Percent of Billed Charges 65.00% $110.50 Percent of Billed Charges 67.00% $113.90 Percent of Billed Charges 77.50% $131.75 Percent of Billed Charges 79.97% $135.95 Percent of Billed Charges 55.00% $93.50 Percent of Billed Charges 49.55% $84.24 Percent of Billed Charges 55.00% $93.50 Percent of Billed Charges 55.00% $93.50 Percent of Billed Charges 78.94% $134.20 Percent of Billed Charges 74.00% $125.80 Percent of Billed Charges 92.50% $157.25 Percent of Billed Charges 55.00% $93.50 Percent of Billed Charges 85.00% $144.50 Percent of Billed Charges 63.00% $107.10 Percent of Billed Charges 63.00% $107.10 Percent of Billed Charges 75.00% $127.50 Percent of Billed Charges 66.24% $112.61 Percent of Billed Charges 35.00% $59.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $102.00 Percent of Billed Charges HC OTICON CONNECTLINE TV 2.0 270 CPT V5267 Outpatient $255.00 $89.25 $235.88 $255.00 61.04% $155.65 Percent of Billed Charges 69.29% $176.69 Percent of Billed Charges 56.78% $144.79 Percent of Billed Charges 74.74% $190.59 Percent of Billed Charges 68.24% $174.01 Percent of Billed Charges 65.00% $165.75 Percent of Billed Charges 67.00% $170.85 Percent of Billed Charges 77.50% $197.63 Percent of Billed Charges 79.97% $203.92 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 49.55% $126.35 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 78.94% $201.30 Percent of Billed Charges 74.00% $188.70 Percent of Billed Charges 92.50% $235.88 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 85.00% $216.75 Percent of Billed Charges 63.00% $160.65 Percent of Billed Charges 63.00% $160.65 Percent of Billed Charges 75.00% $191.25 Percent of Billed Charges 66.24% $168.91 Percent of Billed Charges 35.00% $89.25 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $153.00 Percent of Billed Charges HC OTICON CORDA EARMOLD 270 CPT V5264 Outpatient $57.00 $28.24 $90.63 $57.00 61.04% $34.79 Percent of Billed Charges 69.29% $39.50 Percent of Billed Charges 56.78% $32.36 Percent of Billed Charges 74.74% $42.60 Percent of Billed Charges 68.24% $38.90 Percent of Billed Charges 65.00% $37.05 Percent of Billed Charges 67.00% $38.19 Percent of Billed Charges 77.50% $44.18 Percent of Billed Charges 79.97% $45.58 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 49.55% $28.24 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 78.94% $45.00 Percent of Billed Charges 74.00% $42.18 Percent of Billed Charges 92.50% $52.73 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 85.00% $48.45 Percent of Billed Charges 63.00% $35.91 Percent of Billed Charges 63.00% $35.91 Percent of Billed Charges 75.00% $42.75 Percent of Billed Charges 66.24% $37.76 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $90.63 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $34.20 Percent of Billed Charges HC OTICON CROS/CROS PX R 270 CPT V5181 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC OTICON DOME PACK 270 CPT V5265 Outpatient $12.00 $4.20 $11.10 $12.00 61.04% $7.32 Percent of Billed Charges 69.29% $8.31 Percent of Billed Charges 56.78% $6.81 Percent of Billed Charges 74.74% $8.97 Percent of Billed Charges 68.24% $8.19 Percent of Billed Charges 65.00% $7.80 Percent of Billed Charges 67.00% $8.04 Percent of Billed Charges 77.50% $9.30 Percent of Billed Charges 79.97% $9.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 49.55% $5.95 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 78.94% $9.47 Percent of Billed Charges 74.00% $8.88 Percent of Billed Charges 92.50% $11.10 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 85.00% $10.20 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 75.00% $9.00 Percent of Billed Charges 66.24% $7.95 Percent of Billed Charges 35.00% $4.20 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $7.20 Percent of Billed Charges HC OTICON MEDICAL CONNECT CLIP 270 CPT V5267 Outpatient $398.00 $139.30 $368.15 $398.00 61.04% $242.94 Percent of Billed Charges 69.29% $275.77 Percent of Billed Charges 56.78% $225.98 Percent of Billed Charges 74.74% $297.47 Percent of Billed Charges 68.24% $271.60 Percent of Billed Charges 65.00% $258.70 Percent of Billed Charges 67.00% $266.66 Percent of Billed Charges 77.50% $308.45 Percent of Billed Charges 79.97% $318.28 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 49.55% $197.21 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 78.94% $314.18 Percent of Billed Charges 74.00% $294.52 Percent of Billed Charges 92.50% $368.15 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 85.00% $338.30 Percent of Billed Charges 63.00% $250.74 Percent of Billed Charges 63.00% $250.74 Percent of Billed Charges 75.00% $298.50 Percent of Billed Charges 66.24% $263.64 Percent of Billed Charges 35.00% $139.30 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $238.80 Percent of Billed Charges HC OTICON MINIRITE R-CHARGER 270 CPT V5267 Outpatient $400.00 $140.00 $370.00 $400.00 61.04% $244.16 Percent of Billed Charges 69.29% $277.16 Percent of Billed Charges 56.78% $227.12 Percent of Billed Charges 74.74% $298.96 Percent of Billed Charges 68.24% $272.96 Percent of Billed Charges 65.00% $260.00 Percent of Billed Charges 67.00% $268.00 Percent of Billed Charges 77.50% $310.00 Percent of Billed Charges 79.97% $319.88 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 49.55% $198.20 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 78.94% $315.76 Percent of Billed Charges 74.00% $296.00 Percent of Billed Charges 92.50% $370.00 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 85.00% $340.00 Percent of Billed Charges 63.00% $252.00 Percent of Billed Charges 63.00% $252.00 Percent of Billed Charges 75.00% $300.00 Percent of Billed Charges 66.24% $264.96 Percent of Billed Charges 35.00% $140.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $240.00 Percent of Billed Charges HC OTICON OPN 3 270 CPT V5298 Outpatient " $1,316.00 " $460.60 " $1,217.30 " " $1,316.00 " 61.04% $803.29 Percent of Billed Charges 69.29% $911.86 Percent of Billed Charges 56.78% $747.22 Percent of Billed Charges 74.74% $983.58 Percent of Billed Charges 68.24% $898.04 Percent of Billed Charges 65.00% $855.40 Percent of Billed Charges 67.00% $881.72 Percent of Billed Charges 77.50% " $1,019.90 " Percent of Billed Charges 79.97% " $1,052.41 " Percent of Billed Charges 55.00% $723.80 Percent of Billed Charges 49.55% $652.08 Percent of Billed Charges 55.00% $723.80 Percent of Billed Charges 55.00% $723.80 Percent of Billed Charges 78.94% " $1,038.85 " Percent of Billed Charges 74.00% $973.84 Percent of Billed Charges 92.50% " $1,217.30 " Percent of Billed Charges 55.00% $723.80 Percent of Billed Charges 85.00% " $1,118.60 " Percent of Billed Charges 63.00% $829.08 Percent of Billed Charges 63.00% $829.08 Percent of Billed Charges 75.00% $987.00 Percent of Billed Charges 66.24% $871.72 Percent of Billed Charges 35.00% $460.60 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $789.60 Percent of Billed Charges HC OTICON OPN 1 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC OTICON OPN PLY 1 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC OTICON OPN PLY 2 270 CPT V5298 Outpatient $800.00 $280.00 $740.00 $800.00 61.04% $488.32 Percent of Billed Charges 69.29% $554.32 Percent of Billed Charges 56.78% $454.24 Percent of Billed Charges 74.74% $597.92 Percent of Billed Charges 68.24% $545.92 Percent of Billed Charges 65.00% $520.00 Percent of Billed Charges 67.00% $536.00 Percent of Billed Charges 77.50% $620.00 Percent of Billed Charges 79.97% $639.76 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 49.55% $396.40 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 78.94% $631.52 Percent of Billed Charges 74.00% $592.00 Percent of Billed Charges 92.50% $740.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 85.00% $680.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 75.00% $600.00 Percent of Billed Charges 66.24% $529.92 Percent of Billed Charges 35.00% $280.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $480.00 Percent of Billed Charges HC OTICON OPN S1 270 CPT V5298 Outpatient " $2,472.50 " $865.38 " $2,287.06 " " $2,472.50 " 61.04% " $1,509.21 " Percent of Billed Charges 69.29% " $1,713.20 " Percent of Billed Charges 56.78% " $1,403.89 " Percent of Billed Charges 74.74% " $1,847.95 " Percent of Billed Charges 68.24% " $1,687.23 " Percent of Billed Charges 65.00% " $1,607.13 " Percent of Billed Charges 67.00% " $1,656.58 " Percent of Billed Charges 77.50% " $1,916.19 " Percent of Billed Charges 79.97% " $1,977.26 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 49.55% " $1,225.12 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 78.94% " $1,951.79 " Percent of Billed Charges 74.00% " $1,829.65 " Percent of Billed Charges 92.50% " $2,287.06 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 85.00% " $2,101.63 " Percent of Billed Charges 63.00% " $1,557.68 " Percent of Billed Charges 63.00% " $1,557.68 " Percent of Billed Charges 75.00% " $1,854.38 " Percent of Billed Charges 66.24% " $1,637.78 " Percent of Billed Charges 35.00% $865.38 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,483.50 " Percent of Billed Charges HC OTICON OPN S2 270 CPT V5298 Outpatient " $2,859.50 " " $1,000.83 " " $2,645.04 " " $2,859.50 " 61.04% " $1,745.44 " Percent of Billed Charges 69.29% " $1,981.35 " Percent of Billed Charges 56.78% " $1,623.62 " Percent of Billed Charges 74.74% " $2,137.19 " Percent of Billed Charges 68.24% " $1,951.32 " Percent of Billed Charges 65.00% " $1,858.68 " Percent of Billed Charges 67.00% " $1,915.87 " Percent of Billed Charges 77.50% " $2,216.11 " Percent of Billed Charges 79.97% " $2,286.74 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 49.55% " $1,416.88 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 78.94% " $2,257.29 " Percent of Billed Charges 74.00% " $2,116.03 " Percent of Billed Charges 92.50% " $2,645.04 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 85.00% " $2,430.58 " Percent of Billed Charges 63.00% " $1,801.49 " Percent of Billed Charges 63.00% " $1,801.49 " Percent of Billed Charges 75.00% " $2,144.63 " Percent of Billed Charges 66.24% " $1,894.13 " Percent of Billed Charges 35.00% " $1,000.83 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,715.70 " Percent of Billed Charges HC OTICON OPN S3 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC OTICON PEDIATRIC CARE KIT 270 CPT V5267 Outpatient $60.00 $21.00 $55.50 $60.00 61.04% $36.62 Percent of Billed Charges 69.29% $41.57 Percent of Billed Charges 56.78% $34.07 Percent of Billed Charges 74.74% $44.84 Percent of Billed Charges 68.24% $40.94 Percent of Billed Charges 65.00% $39.00 Percent of Billed Charges 67.00% $40.20 Percent of Billed Charges 77.50% $46.50 Percent of Billed Charges 79.97% $47.98 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 49.55% $29.73 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 78.94% $47.36 Percent of Billed Charges 74.00% $44.40 Percent of Billed Charges 92.50% $55.50 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 85.00% $51.00 Percent of Billed Charges 63.00% $37.80 Percent of Billed Charges 63.00% $37.80 Percent of Billed Charges 75.00% $45.00 Percent of Billed Charges 66.24% $39.74 Percent of Billed Charges 35.00% $21.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $36.00 Percent of Billed Charges HC OTICON REMOTE CONTROL 270 CPT V5267 Outpatient $246.50 $86.28 $228.01 $246.50 61.04% $150.46 Percent of Billed Charges 69.29% $170.80 Percent of Billed Charges 56.78% $139.96 Percent of Billed Charges 74.74% $184.23 Percent of Billed Charges 68.24% $168.21 Percent of Billed Charges 65.00% $160.23 Percent of Billed Charges 67.00% $165.16 Percent of Billed Charges 77.50% $191.04 Percent of Billed Charges 79.97% $197.13 Percent of Billed Charges 55.00% $135.58 Percent of Billed Charges 49.55% $122.14 Percent of Billed Charges 55.00% $135.58 Percent of Billed Charges 55.00% $135.58 Percent of Billed Charges 78.94% $194.59 Percent of Billed Charges 74.00% $182.41 Percent of Billed Charges 92.50% $228.01 Percent of Billed Charges 55.00% $135.58 Percent of Billed Charges 85.00% $209.53 Percent of Billed Charges 63.00% $155.30 Percent of Billed Charges 63.00% $155.30 Percent of Billed Charges 75.00% $184.88 Percent of Billed Charges 66.24% $163.28 Percent of Billed Charges 35.00% $86.28 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $147.90 Percent of Billed Charges HC OTICON RIC 60/85/100 GAIN RECEIVER 270 CPT V5267 Outpatient $150.00 $52.50 $138.75 $150.00 61.04% $91.56 Percent of Billed Charges 69.29% $103.94 Percent of Billed Charges 56.78% $85.17 Percent of Billed Charges 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 35.00% $52.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $90.00 Percent of Billed Charges HC OTICON RIC EARMOLD 270 CPT V5264 Outpatient $57.00 $28.24 $90.63 $57.00 61.04% $34.79 Percent of Billed Charges 69.29% $39.50 Percent of Billed Charges 56.78% $32.36 Percent of Billed Charges 74.74% $42.60 Percent of Billed Charges 68.24% $38.90 Percent of Billed Charges 65.00% $37.05 Percent of Billed Charges 67.00% $38.19 Percent of Billed Charges 77.50% $44.18 Percent of Billed Charges 79.97% $45.58 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 49.55% $28.24 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 78.94% $45.00 Percent of Billed Charges 74.00% $42.18 Percent of Billed Charges 92.50% $52.73 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 85.00% $48.45 Percent of Billed Charges 63.00% $35.91 Percent of Billed Charges 63.00% $35.91 Percent of Billed Charges 75.00% $42.75 Percent of Billed Charges 66.24% $37.76 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $90.63 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $34.20 Percent of Billed Charges HC OTICON XCEED PLAY 1 270 CPT V5298 Outpatient " $1,100.00 " $385.00 " $1,017.50 " " $1,100.00 " 61.04% $671.44 Percent of Billed Charges 69.29% $762.19 Percent of Billed Charges 56.78% $624.58 Percent of Billed Charges 74.74% $822.14 Percent of Billed Charges 68.24% $750.64 Percent of Billed Charges 65.00% $715.00 Percent of Billed Charges 67.00% $737.00 Percent of Billed Charges 77.50% $852.50 Percent of Billed Charges 79.97% $879.67 Percent of Billed Charges 55.00% $605.00 Percent of Billed Charges 49.55% $545.05 Percent of Billed Charges 55.00% $605.00 Percent of Billed Charges 55.00% $605.00 Percent of Billed Charges 78.94% $868.34 Percent of Billed Charges 74.00% $814.00 Percent of Billed Charges 92.50% " $1,017.50 " Percent of Billed Charges 55.00% $605.00 Percent of Billed Charges 85.00% $935.00 Percent of Billed Charges 63.00% $693.00 Percent of Billed Charges 63.00% $693.00 Percent of Billed Charges 75.00% $825.00 Percent of Billed Charges 66.24% $728.64 Percent of Billed Charges 35.00% $385.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $660.00 Percent of Billed Charges HC OTICON XCEED PLAY 2 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC PHONAK PARTNER MIC 270 CPT V5267 Outpatient $850.00 $297.50 $786.25 $850.00 61.04% $518.84 Percent of Billed Charges 69.29% $588.97 Percent of Billed Charges 56.78% $482.63 Percent of Billed Charges 74.74% $635.29 Percent of Billed Charges 68.24% $580.04 Percent of Billed Charges 65.00% $552.50 Percent of Billed Charges 67.00% $569.50 Percent of Billed Charges 77.50% $658.75 Percent of Billed Charges 79.97% $679.75 Percent of Billed Charges 55.00% $467.50 Percent of Billed Charges 49.55% $421.18 Percent of Billed Charges 55.00% $467.50 Percent of Billed Charges 55.00% $467.50 Percent of Billed Charges 78.94% $670.99 Percent of Billed Charges 74.00% $629.00 Percent of Billed Charges 92.50% $786.25 Percent of Billed Charges 55.00% $467.50 Percent of Billed Charges 85.00% $722.50 Percent of Billed Charges 63.00% $535.50 Percent of Billed Charges 63.00% $535.50 Percent of Billed Charges 75.00% $637.50 Percent of Billed Charges 66.24% $563.04 Percent of Billed Charges 35.00% $297.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $510.00 Percent of Billed Charges HC PERFECT DRY LUX 270 CPT V5267 Outpatient $107.50 $37.63 $99.44 $107.50 61.04% $65.62 Percent of Billed Charges 69.29% $74.49 Percent of Billed Charges 56.78% $61.04 Percent of Billed Charges 74.74% $80.35 Percent of Billed Charges 68.24% $73.36 Percent of Billed Charges 65.00% $69.88 Percent of Billed Charges 67.00% $72.03 Percent of Billed Charges 77.50% $83.31 Percent of Billed Charges 79.97% $85.97 Percent of Billed Charges 55.00% $59.13 Percent of Billed Charges 49.55% $53.27 Percent of Billed Charges 55.00% $59.13 Percent of Billed Charges 55.00% $59.13 Percent of Billed Charges 78.94% $84.86 Percent of Billed Charges 74.00% $79.55 Percent of Billed Charges 92.50% $99.44 Percent of Billed Charges 55.00% $59.13 Percent of Billed Charges 85.00% $91.38 Percent of Billed Charges 63.00% $67.73 Percent of Billed Charges 63.00% $67.73 Percent of Billed Charges 75.00% $80.63 Percent of Billed Charges 66.24% $71.21 Percent of Billed Charges 35.00% $37.63 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $64.50 Percent of Billed Charges HC PHONAK M30 270 CPT V5298 Outpatient " $1,408.00 " $492.80 " $1,302.40 " " $1,408.00 " 61.04% $859.44 Percent of Billed Charges 69.29% $975.60 Percent of Billed Charges 56.78% $799.46 Percent of Billed Charges 74.74% " $1,052.34 " Percent of Billed Charges 68.24% $960.82 Percent of Billed Charges 65.00% $915.20 Percent of Billed Charges 67.00% $943.36 Percent of Billed Charges 77.50% " $1,091.20 " Percent of Billed Charges 79.97% " $1,125.98 " Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 49.55% $697.66 Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 78.94% " $1,111.48 " Percent of Billed Charges 74.00% " $1,041.92 " Percent of Billed Charges 92.50% " $1,302.40 " Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 85.00% " $1,196.80 " Percent of Billed Charges 63.00% $887.04 Percent of Billed Charges 63.00% $887.04 Percent of Billed Charges 75.00% " $1,056.00 " Percent of Billed Charges 66.24% $932.66 Percent of Billed Charges 35.00% $492.80 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $844.80 Percent of Billed Charges HC PHONAK B50 270 CPT V5298 Outpatient $940.00 $329.00 $869.50 $940.00 61.04% $573.78 Percent of Billed Charges 69.29% $651.33 Percent of Billed Charges 56.78% $533.73 Percent of Billed Charges 74.74% $702.56 Percent of Billed Charges 68.24% $641.46 Percent of Billed Charges 65.00% $611.00 Percent of Billed Charges 67.00% $629.80 Percent of Billed Charges 77.50% $728.50 Percent of Billed Charges 79.97% $751.72 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 49.55% $465.77 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 78.94% $742.04 Percent of Billed Charges 74.00% $695.60 Percent of Billed Charges 92.50% $869.50 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 85.00% $799.00 Percent of Billed Charges 63.00% $592.20 Percent of Billed Charges 63.00% $592.20 Percent of Billed Charges 75.00% $705.00 Percent of Billed Charges 66.24% $622.66 Percent of Billed Charges 35.00% $329.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $564.00 Percent of Billed Charges HC PHONAK B70 270 CPT V5298 Outpatient " $2,569.04 " $899.16 " $2,376.36 " " $2,569.04 " 61.04% " $1,568.14 " Percent of Billed Charges 69.29% " $1,780.09 " Percent of Billed Charges 56.78% " $1,458.70 " Percent of Billed Charges 74.74% " $1,920.10 " Percent of Billed Charges 68.24% " $1,753.11 " Percent of Billed Charges 65.00% " $1,669.88 " Percent of Billed Charges 67.00% " $1,721.26 " Percent of Billed Charges 77.50% " $1,991.01 " Percent of Billed Charges 79.97% " $2,054.46 " Percent of Billed Charges 55.00% " $1,412.97 " Percent of Billed Charges 49.55% " $1,272.96 " Percent of Billed Charges 55.00% " $1,412.97 " Percent of Billed Charges 55.00% " $1,412.97 " Percent of Billed Charges 78.94% " $2,028.00 " Percent of Billed Charges 74.00% " $1,901.09 " Percent of Billed Charges 92.50% " $2,376.36 " Percent of Billed Charges 55.00% " $1,412.97 " Percent of Billed Charges 85.00% " $2,183.68 " Percent of Billed Charges 63.00% " $1,618.50 " Percent of Billed Charges 63.00% " $1,618.50 " Percent of Billed Charges 75.00% " $1,926.78 " Percent of Billed Charges 66.24% " $1,701.73 " Percent of Billed Charges 35.00% $899.16 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,541.42 " Percent of Billed Charges HC PHONAK B90 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC PHONAK CROS/B/P 270 CPT V5181 Outpatient " $1,396.00 " $488.60 " $1,291.30 " " $1,396.00 " 61.04% $852.12 Percent of Billed Charges 69.29% $967.29 Percent of Billed Charges 56.78% $792.65 Percent of Billed Charges 74.74% " $1,043.37 " Percent of Billed Charges 68.24% $952.63 Percent of Billed Charges 65.00% $907.40 Percent of Billed Charges 67.00% $935.32 Percent of Billed Charges 77.50% " $1,081.90 " Percent of Billed Charges 79.97% " $1,116.38 " Percent of Billed Charges 55.00% $767.80 Percent of Billed Charges 49.55% $691.72 Percent of Billed Charges 55.00% $767.80 Percent of Billed Charges 55.00% $767.80 Percent of Billed Charges 78.94% " $1,102.00 " Percent of Billed Charges 74.00% " $1,033.04 " Percent of Billed Charges 92.50% " $1,291.30 " Percent of Billed Charges 55.00% $767.80 Percent of Billed Charges 85.00% " $1,186.60 " Percent of Billed Charges 63.00% $879.48 Percent of Billed Charges 63.00% $879.48 Percent of Billed Charges 75.00% " $1,047.00 " Percent of Billed Charges 66.24% $924.71 Percent of Billed Charges 35.00% $488.60 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $837.60 Percent of Billed Charges HC PHONAK EARMOLD 270 CPT V5264 Outpatient $51.00 $25.27 $81.09 $51.00 61.04% $31.13 Percent of Billed Charges 69.29% $35.34 Percent of Billed Charges 56.78% $28.96 Percent of Billed Charges 74.74% $38.12 Percent of Billed Charges 68.24% $34.80 Percent of Billed Charges 65.00% $33.15 Percent of Billed Charges 67.00% $34.17 Percent of Billed Charges 77.50% $39.53 Percent of Billed Charges 79.97% $40.78 Percent of Billed Charges 55.00% $28.05 Percent of Billed Charges 49.55% $25.27 Percent of Billed Charges 55.00% $28.05 Percent of Billed Charges 55.00% $28.05 Percent of Billed Charges 78.94% $40.26 Percent of Billed Charges 74.00% $37.74 Percent of Billed Charges 92.50% $47.18 Percent of Billed Charges 55.00% $28.05 Percent of Billed Charges 85.00% $43.35 Percent of Billed Charges 63.00% $32.13 Percent of Billed Charges 63.00% $32.13 Percent of Billed Charges 75.00% $38.25 Percent of Billed Charges 66.24% $33.78 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $81.09 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $30.60 Percent of Billed Charges HC PHONAK PEDIATRIC CARE KIT 270 CPT V5267 Outpatient $66.00 $23.10 $61.05 $66.00 61.04% $40.29 Percent of Billed Charges 69.29% $45.73 Percent of Billed Charges 56.78% $37.47 Percent of Billed Charges 74.74% $49.33 Percent of Billed Charges 68.24% $45.04 Percent of Billed Charges 65.00% $42.90 Percent of Billed Charges 67.00% $44.22 Percent of Billed Charges 77.50% $51.15 Percent of Billed Charges 79.97% $52.78 Percent of Billed Charges 55.00% $36.30 Percent of Billed Charges 49.55% $32.70 Percent of Billed Charges 55.00% $36.30 Percent of Billed Charges 55.00% $36.30 Percent of Billed Charges 78.94% $52.10 Percent of Billed Charges 74.00% $48.84 Percent of Billed Charges 92.50% $61.05 Percent of Billed Charges 55.00% $36.30 Percent of Billed Charges 85.00% $56.10 Percent of Billed Charges 63.00% $41.58 Percent of Billed Charges 63.00% $41.58 Percent of Billed Charges 75.00% $49.50 Percent of Billed Charges 66.24% $43.72 Percent of Billed Charges 35.00% $23.10 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $39.60 Percent of Billed Charges HC PHONAK ROGER 10 15 11INTEG RX 270 CPT V5267 Outpatient " $1,389.00 " $486.15 " $1,284.83 " " $1,389.00 " 61.04% $847.85 Percent of Billed Charges 69.29% $962.44 Percent of Billed Charges 56.78% $788.67 Percent of Billed Charges 74.74% " $1,038.14 " Percent of Billed Charges 68.24% $947.85 Percent of Billed Charges 65.00% $902.85 Percent of Billed Charges 67.00% $930.63 Percent of Billed Charges 77.50% " $1,076.48 " Percent of Billed Charges 79.97% " $1,110.78 " Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 49.55% $688.25 Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 78.94% " $1,096.48 " Percent of Billed Charges 74.00% " $1,027.86 " Percent of Billed Charges 92.50% " $1,284.83 " Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 85.00% " $1,180.65 " Percent of Billed Charges 63.00% $875.07 Percent of Billed Charges 63.00% $875.07 Percent of Billed Charges 75.00% " $1,041.75 " Percent of Billed Charges 66.24% $920.07 Percent of Billed Charges 35.00% $486.15 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $833.40 Percent of Billed Charges HC PHONAK ROGER 18 19 INTEG RX 270 CPT V5267 Outpatient " $1,389.00 " $486.15 " $1,284.83 " " $1,389.00 " 61.04% $847.85 Percent of Billed Charges 69.29% $962.44 Percent of Billed Charges 56.78% $788.67 Percent of Billed Charges 74.74% " $1,038.14 " Percent of Billed Charges 68.24% $947.85 Percent of Billed Charges 65.00% $902.85 Percent of Billed Charges 67.00% $930.63 Percent of Billed Charges 77.50% " $1,076.48 " Percent of Billed Charges 79.97% " $1,110.78 " Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 49.55% $688.25 Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 78.94% " $1,096.48 " Percent of Billed Charges 74.00% " $1,027.86 " Percent of Billed Charges 92.50% " $1,284.83 " Percent of Billed Charges 55.00% $763.95 Percent of Billed Charges 85.00% " $1,180.65 " Percent of Billed Charges 63.00% $875.07 Percent of Billed Charges 63.00% $875.07 Percent of Billed Charges 75.00% " $1,041.75 " Percent of Billed Charges 66.24% $920.07 Percent of Billed Charges 35.00% $486.15 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $833.40 Percent of Billed Charges HC PHONAK ROGER CLIP-ON MIC 270 CPT V5267 Outpatient $960.00 $336.00 $888.00 $960.00 61.04% $585.98 Percent of Billed Charges 69.29% $665.18 Percent of Billed Charges 56.78% $545.09 Percent of Billed Charges 74.74% $717.50 Percent of Billed Charges 68.24% $655.10 Percent of Billed Charges 65.00% $624.00 Percent of Billed Charges 67.00% $643.20 Percent of Billed Charges 77.50% $744.00 Percent of Billed Charges 79.97% $767.71 Percent of Billed Charges 55.00% $528.00 Percent of Billed Charges 49.55% $475.68 Percent of Billed Charges 55.00% $528.00 Percent of Billed Charges 55.00% $528.00 Percent of Billed Charges 78.94% $757.82 Percent of Billed Charges 74.00% $710.40 Percent of Billed Charges 92.50% $888.00 Percent of Billed Charges 55.00% $528.00 Percent of Billed Charges 85.00% $816.00 Percent of Billed Charges 63.00% $604.80 Percent of Billed Charges 63.00% $604.80 Percent of Billed Charges 75.00% $720.00 Percent of Billed Charges 66.24% $635.90 Percent of Billed Charges 35.00% $336.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $576.00 Percent of Billed Charges HC PHONAK ROGER PEN 270 CPT V5267 Outpatient " $1,237.50 " $433.13 " $1,144.69 " " $1,237.50 " 61.04% $755.37 Percent of Billed Charges 69.29% $857.46 Percent of Billed Charges 56.78% $702.65 Percent of Billed Charges 74.74% $924.91 Percent of Billed Charges 68.24% $844.47 Percent of Billed Charges 65.00% $804.38 Percent of Billed Charges 67.00% $829.13 Percent of Billed Charges 77.50% $959.06 Percent of Billed Charges 79.97% $989.63 Percent of Billed Charges 55.00% $680.63 Percent of Billed Charges 49.55% $613.18 Percent of Billed Charges 55.00% $680.63 Percent of Billed Charges 55.00% $680.63 Percent of Billed Charges 78.94% $976.88 Percent of Billed Charges 74.00% $915.75 Percent of Billed Charges 92.50% " $1,144.69 " Percent of Billed Charges 55.00% $680.63 Percent of Billed Charges 85.00% " $1,051.88 " Percent of Billed Charges 63.00% $779.63 Percent of Billed Charges 63.00% $779.63 Percent of Billed Charges 75.00% $928.13 Percent of Billed Charges 66.24% $819.72 Percent of Billed Charges 35.00% $433.13 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $742.50 Percent of Billed Charges HC PHONAK ROGER X (02) 270 CPT V5267 Outpatient " $2,083.50 " $729.23 " $1,927.24 " " $2,083.50 " 61.04% " $1,271.77 " Percent of Billed Charges 69.29% " $1,443.66 " Percent of Billed Charges 56.78% " $1,183.01 " Percent of Billed Charges 74.74% " $1,557.21 " Percent of Billed Charges 68.24% " $1,421.78 " Percent of Billed Charges 65.00% " $1,354.28 " Percent of Billed Charges 67.00% " $1,395.95 " Percent of Billed Charges 77.50% " $1,614.71 " Percent of Billed Charges 79.97% " $1,666.17 " Percent of Billed Charges 55.00% " $1,145.93 " Percent of Billed Charges 49.55% " $1,032.37 " Percent of Billed Charges 55.00% " $1,145.93 " Percent of Billed Charges 55.00% " $1,145.93 " Percent of Billed Charges 78.94% " $1,644.71 " Percent of Billed Charges 74.00% " $1,541.79 " Percent of Billed Charges 92.50% " $1,927.24 " Percent of Billed Charges 55.00% " $1,145.93 " Percent of Billed Charges 85.00% " $1,770.98 " Percent of Billed Charges 63.00% " $1,312.61 " Percent of Billed Charges 63.00% " $1,312.61 " Percent of Billed Charges 75.00% " $1,562.63 " Percent of Billed Charges 66.24% " $1,380.11 " Percent of Billed Charges 35.00% $729.23 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,250.10 " Percent of Billed Charges HC PHONAK ROGER X (03) 270 CPT V5267 Outpatient " $1,665.00 " $582.75 " $1,540.13 " " $1,665.00 " 61.04% " $1,016.32 " Percent of Billed Charges 69.29% " $1,153.68 " Percent of Billed Charges 56.78% $945.39 Percent of Billed Charges 74.74% " $1,244.42 " Percent of Billed Charges 68.24% " $1,136.20 " Percent of Billed Charges 65.00% " $1,082.25 " Percent of Billed Charges 67.00% " $1,115.55 " Percent of Billed Charges 77.50% " $1,290.38 " Percent of Billed Charges 79.97% " $1,331.50 " Percent of Billed Charges 55.00% $915.75 Percent of Billed Charges 49.55% $825.01 Percent of Billed Charges 55.00% $915.75 Percent of Billed Charges 55.00% $915.75 Percent of Billed Charges 78.94% " $1,314.35 " Percent of Billed Charges 74.00% " $1,232.10 " Percent of Billed Charges 92.50% " $1,540.13 " Percent of Billed Charges 55.00% $915.75 Percent of Billed Charges 85.00% " $1,415.25 " Percent of Billed Charges 63.00% " $1,048.95 " Percent of Billed Charges 63.00% " $1,048.95 " Percent of Billed Charges 75.00% " $1,248.75 " Percent of Billed Charges 66.24% " $1,102.90 " Percent of Billed Charges 35.00% $582.75 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $999.00 Percent of Billed Charges HC PHONAK B50 270 CPT V5298 Outpatient $940.00 $329.00 $869.50 $940.00 61.04% $573.78 Percent of Billed Charges 69.29% $651.33 Percent of Billed Charges 56.78% $533.73 Percent of Billed Charges 74.74% $702.56 Percent of Billed Charges 68.24% $641.46 Percent of Billed Charges 65.00% $611.00 Percent of Billed Charges 67.00% $629.80 Percent of Billed Charges 77.50% $728.50 Percent of Billed Charges 79.97% $751.72 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 49.55% $465.77 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 78.94% $742.04 Percent of Billed Charges 74.00% $695.60 Percent of Billed Charges 92.50% $869.50 Percent of Billed Charges 55.00% $517.00 Percent of Billed Charges 85.00% $799.00 Percent of Billed Charges 63.00% $592.20 Percent of Billed Charges 63.00% $592.20 Percent of Billed Charges 75.00% $705.00 Percent of Billed Charges 66.24% $622.66 Percent of Billed Charges 35.00% $329.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $564.00 Percent of Billed Charges HC PHONAK B50 PR 270 CPT V5298 Outpatient " $1,040.00 " $364.00 $962.00 " $1,040.00 " 61.04% $634.82 Percent of Billed Charges 69.29% $720.62 Percent of Billed Charges 56.78% $590.51 Percent of Billed Charges 74.74% $777.30 Percent of Billed Charges 68.24% $709.70 Percent of Billed Charges 65.00% $676.00 Percent of Billed Charges 67.00% $696.80 Percent of Billed Charges 77.50% $806.00 Percent of Billed Charges 79.97% $831.69 Percent of Billed Charges 55.00% $572.00 Percent of Billed Charges 49.55% $515.32 Percent of Billed Charges 55.00% $572.00 Percent of Billed Charges 55.00% $572.00 Percent of Billed Charges 78.94% $820.98 Percent of Billed Charges 74.00% $769.60 Percent of Billed Charges 92.50% $962.00 Percent of Billed Charges 55.00% $572.00 Percent of Billed Charges 85.00% $884.00 Percent of Billed Charges 63.00% $655.20 Percent of Billed Charges 63.00% $655.20 Percent of Billed Charges 75.00% $780.00 Percent of Billed Charges 66.24% $688.90 Percent of Billed Charges 35.00% $364.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $624.00 Percent of Billed Charges HC PHONAK M50 PR 270 CPT V5298 Outpatient " $1,859.92 " $650.97 " $1,720.43 " " $1,859.92 " 61.04% " $1,135.30 " Percent of Billed Charges 69.29% " $1,288.74 " Percent of Billed Charges 56.78% " $1,056.06 " Percent of Billed Charges 74.74% " $1,390.10 " Percent of Billed Charges 68.24% " $1,269.21 " Percent of Billed Charges 65.00% " $1,208.95 " Percent of Billed Charges 67.00% " $1,246.15 " Percent of Billed Charges 77.50% " $1,441.44 " Percent of Billed Charges 79.97% " $1,487.38 " Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 49.55% $921.59 Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 78.94% " $1,468.22 " Percent of Billed Charges 74.00% " $1,376.34 " Percent of Billed Charges 92.50% " $1,720.43 " Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 85.00% " $1,580.93 " Percent of Billed Charges 63.00% " $1,171.75 " Percent of Billed Charges 63.00% " $1,171.75 " Percent of Billed Charges 75.00% " $1,394.94 " Percent of Billed Charges 66.24% " $1,232.01 " Percent of Billed Charges 35.00% $650.97 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,115.95 " Percent of Billed Charges HC PHONAK TV CONNECTOR 270 CPT V5267 Outpatient $530.60 $185.71 $490.81 $530.60 61.04% $323.88 Percent of Billed Charges 69.29% $367.65 Percent of Billed Charges 56.78% $301.27 Percent of Billed Charges 74.74% $396.57 Percent of Billed Charges 68.24% $362.08 Percent of Billed Charges 65.00% $344.89 Percent of Billed Charges 67.00% $355.50 Percent of Billed Charges 77.50% $411.22 Percent of Billed Charges 79.97% $424.32 Percent of Billed Charges 55.00% $291.83 Percent of Billed Charges 49.55% $262.91 Percent of Billed Charges 55.00% $291.83 Percent of Billed Charges 55.00% $291.83 Percent of Billed Charges 78.94% $418.86 Percent of Billed Charges 74.00% $392.64 Percent of Billed Charges 92.50% $490.81 Percent of Billed Charges 55.00% $291.83 Percent of Billed Charges 85.00% $451.01 Percent of Billed Charges 63.00% $334.28 Percent of Billed Charges 63.00% $334.28 Percent of Billed Charges 75.00% $397.95 Percent of Billed Charges 66.24% $351.47 Percent of Billed Charges 35.00% $185.71 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $318.36 Percent of Billed Charges HC PHONAK XS/XP RECEIVER 270 CPT V5267 Outpatient $80.00 $28.00 $74.00 $80.00 61.04% $48.83 Percent of Billed Charges 69.29% $55.43 Percent of Billed Charges 56.78% $45.42 Percent of Billed Charges 74.74% $59.79 Percent of Billed Charges 68.24% $54.59 Percent of Billed Charges 65.00% $52.00 Percent of Billed Charges 67.00% $53.60 Percent of Billed Charges 77.50% $62.00 Percent of Billed Charges 79.97% $63.98 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 49.55% $39.64 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 78.94% $63.15 Percent of Billed Charges 74.00% $59.20 Percent of Billed Charges 92.50% $74.00 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 85.00% $68.00 Percent of Billed Charges 63.00% $50.40 Percent of Billed Charges 63.00% $50.40 Percent of Billed Charges 75.00% $60.00 Percent of Billed Charges 66.24% $52.99 Percent of Billed Charges 35.00% $28.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $48.00 Percent of Billed Charges HC OTICON MEDICAL PONTO 4 BATTERY DR 270 CPT V5267 Outpatient $60.00 $21.00 $55.50 $60.00 61.04% $36.62 Percent of Billed Charges 69.29% $41.57 Percent of Billed Charges 56.78% $34.07 Percent of Billed Charges 74.74% $44.84 Percent of Billed Charges 68.24% $40.94 Percent of Billed Charges 65.00% $39.00 Percent of Billed Charges 67.00% $40.20 Percent of Billed Charges 77.50% $46.50 Percent of Billed Charges 79.97% $47.98 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 49.55% $29.73 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 78.94% $47.36 Percent of Billed Charges 74.00% $44.40 Percent of Billed Charges 92.50% $55.50 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 85.00% $51.00 Percent of Billed Charges 63.00% $37.80 Percent of Billed Charges 63.00% $37.80 Percent of Billed Charges 75.00% $45.00 Percent of Billed Charges 66.24% $39.74 Percent of Billed Charges 35.00% $21.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $36.00 Percent of Billed Charges HC OTICON MEDICAL SOFT BAND BILAT 270 CPT V5267 Outpatient $144.00 $50.40 $133.20 $144.00 61.04% $87.90 Percent of Billed Charges 69.29% $99.78 Percent of Billed Charges 56.78% $81.76 Percent of Billed Charges 74.74% $107.63 Percent of Billed Charges 68.24% $98.27 Percent of Billed Charges 65.00% $93.60 Percent of Billed Charges 67.00% $96.48 Percent of Billed Charges 77.50% $111.60 Percent of Billed Charges 79.97% $115.16 Percent of Billed Charges 55.00% $79.20 Percent of Billed Charges 49.55% $71.35 Percent of Billed Charges 55.00% $79.20 Percent of Billed Charges 55.00% $79.20 Percent of Billed Charges 78.94% $113.67 Percent of Billed Charges 74.00% $106.56 Percent of Billed Charges 92.50% $133.20 Percent of Billed Charges 55.00% $79.20 Percent of Billed Charges 85.00% $122.40 Percent of Billed Charges 63.00% $90.72 Percent of Billed Charges 63.00% $90.72 Percent of Billed Charges 75.00% $108.00 Percent of Billed Charges 66.24% $95.39 Percent of Billed Charges 35.00% $50.40 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $86.40 Percent of Billed Charges HC OTICON MEDICAL SOFT BAND UNILAT 270 CPT V5267 Outpatient $108.00 $37.80 $99.90 $108.00 61.04% $65.92 Percent of Billed Charges 69.29% $74.83 Percent of Billed Charges 56.78% $61.32 Percent of Billed Charges 74.74% $80.72 Percent of Billed Charges 68.24% $73.70 Percent of Billed Charges 65.00% $70.20 Percent of Billed Charges 67.00% $72.36 Percent of Billed Charges 77.50% $83.70 Percent of Billed Charges 79.97% $86.37 Percent of Billed Charges 55.00% $59.40 Percent of Billed Charges 49.55% $53.51 Percent of Billed Charges 55.00% $59.40 Percent of Billed Charges 55.00% $59.40 Percent of Billed Charges 78.94% $85.26 Percent of Billed Charges 74.00% $79.92 Percent of Billed Charges 92.50% $99.90 Percent of Billed Charges 55.00% $59.40 Percent of Billed Charges 85.00% $91.80 Percent of Billed Charges 63.00% $68.04 Percent of Billed Charges 63.00% $68.04 Percent of Billed Charges 75.00% $81.00 Percent of Billed Charges 66.24% $71.54 Percent of Billed Charges 35.00% $37.80 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $64.80 Percent of Billed Charges HC PHONAK RECEIVER 4.0 270 CPT V5267 Outpatient $106.60 $37.31 $98.61 $106.60 61.04% $65.07 Percent of Billed Charges 69.29% $73.86 Percent of Billed Charges 56.78% $60.53 Percent of Billed Charges 74.74% $79.67 Percent of Billed Charges 68.24% $72.74 Percent of Billed Charges 65.00% $69.29 Percent of Billed Charges 67.00% $71.42 Percent of Billed Charges 77.50% $82.62 Percent of Billed Charges 79.97% $85.25 Percent of Billed Charges 55.00% $58.63 Percent of Billed Charges 49.55% $52.82 Percent of Billed Charges 55.00% $58.63 Percent of Billed Charges 55.00% $58.63 Percent of Billed Charges 78.94% $84.15 Percent of Billed Charges 74.00% $78.88 Percent of Billed Charges 92.50% $98.61 Percent of Billed Charges 55.00% $58.63 Percent of Billed Charges 85.00% $90.61 Percent of Billed Charges 63.00% $67.16 Percent of Billed Charges 63.00% $67.16 Percent of Billed Charges 75.00% $79.95 Percent of Billed Charges 66.24% $70.61 Percent of Billed Charges 35.00% $37.31 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $63.96 Percent of Billed Charges HC PHONAK ROGER FOCUS 270 CPT V5287 Outpatient " $1,125.00 " $393.75 " $1,040.63 " " $1,125.00 " 61.04% $686.70 Percent of Billed Charges 69.29% $779.51 Percent of Billed Charges 56.78% $638.78 Percent of Billed Charges 74.74% $840.83 Percent of Billed Charges 68.24% $767.70 Percent of Billed Charges 65.00% $731.25 Percent of Billed Charges 67.00% $753.75 Percent of Billed Charges 77.50% $871.88 Percent of Billed Charges 79.97% $899.66 Percent of Billed Charges 55.00% $618.75 Percent of Billed Charges 49.55% $557.44 Percent of Billed Charges 55.00% $618.75 Percent of Billed Charges 55.00% $618.75 Percent of Billed Charges 78.94% $888.08 Percent of Billed Charges 74.00% $832.50 Percent of Billed Charges 92.50% " $1,040.63 " Percent of Billed Charges 55.00% $618.75 Percent of Billed Charges 85.00% $956.25 Percent of Billed Charges 63.00% $708.75 Percent of Billed Charges 63.00% $708.75 Percent of Billed Charges 75.00% $843.75 Percent of Billed Charges 66.24% $745.20 Percent of Billed Charges 35.00% $393.75 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $675.00 Percent of Billed Charges HC PHONAK ROGER PEN IN 270 CPT V5267 Outpatient " $2,023.50 " $708.23 " $1,871.74 " " $2,023.50 " 61.04% " $1,235.14 " Percent of Billed Charges 69.29% " $1,402.08 " Percent of Billed Charges 56.78% " $1,148.94 " Percent of Billed Charges 74.74% " $1,512.36 " Percent of Billed Charges 68.24% " $1,380.84 " Percent of Billed Charges 65.00% " $1,315.28 " Percent of Billed Charges 67.00% " $1,355.75 " Percent of Billed Charges 77.50% " $1,568.21 " Percent of Billed Charges 79.97% " $1,618.19 " Percent of Billed Charges 55.00% " $1,112.93 " Percent of Billed Charges 49.55% " $1,002.64 " Percent of Billed Charges 55.00% " $1,112.93 " Percent of Billed Charges 55.00% " $1,112.93 " Percent of Billed Charges 78.94% " $1,597.35 " Percent of Billed Charges 74.00% " $1,497.39 " Percent of Billed Charges 92.50% " $1,871.74 " Percent of Billed Charges 55.00% " $1,112.93 " Percent of Billed Charges 85.00% " $1,719.98 " Percent of Billed Charges 63.00% " $1,274.81 " Percent of Billed Charges 63.00% " $1,274.81 " Percent of Billed Charges 75.00% " $1,517.63 " Percent of Billed Charges 66.24% " $1,340.37 " Percent of Billed Charges 35.00% $708.23 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,214.10 " Percent of Billed Charges HC PHONAK ROGER SELECT IN 270 CPT V5267 Outpatient " $2,098.50 " $734.48 " $1,941.11 " " $2,098.50 " 61.04% " $1,280.92 " Percent of Billed Charges 69.29% " $1,454.05 " Percent of Billed Charges 56.78% " $1,191.53 " Percent of Billed Charges 74.74% " $1,568.42 " Percent of Billed Charges 68.24% " $1,432.02 " Percent of Billed Charges 65.00% " $1,364.03 " Percent of Billed Charges 67.00% " $1,406.00 " Percent of Billed Charges 77.50% " $1,626.34 " Percent of Billed Charges 79.97% " $1,678.17 " Percent of Billed Charges 55.00% " $1,154.18 " Percent of Billed Charges 49.55% " $1,039.81 " Percent of Billed Charges 55.00% " $1,154.18 " Percent of Billed Charges 55.00% " $1,154.18 " Percent of Billed Charges 78.94% " $1,656.56 " Percent of Billed Charges 74.00% " $1,552.89 " Percent of Billed Charges 92.50% " $1,941.11 " Percent of Billed Charges 55.00% " $1,154.18 " Percent of Billed Charges 85.00% " $1,783.73 " Percent of Billed Charges 63.00% " $1,322.06 " Percent of Billed Charges 63.00% " $1,322.06 " Percent of Billed Charges 75.00% " $1,573.88 " Percent of Billed Charges 66.24% " $1,390.05 " Percent of Billed Charges 35.00% $734.48 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,259.10 " Percent of Billed Charges HC OTICON MEDICAL SKIN SET PONTO 4 270 CPT V5267 Outpatient $54.00 $18.90 $49.95 $54.00 61.04% $32.96 Percent of Billed Charges 69.29% $37.42 Percent of Billed Charges 56.78% $30.66 Percent of Billed Charges 74.74% $40.36 Percent of Billed Charges 68.24% $36.85 Percent of Billed Charges 65.00% $35.10 Percent of Billed Charges 67.00% $36.18 Percent of Billed Charges 77.50% $41.85 Percent of Billed Charges 79.97% $43.18 Percent of Billed Charges 55.00% $29.70 Percent of Billed Charges 49.55% $26.76 Percent of Billed Charges 55.00% $29.70 Percent of Billed Charges 55.00% $29.70 Percent of Billed Charges 78.94% $42.63 Percent of Billed Charges 74.00% $39.96 Percent of Billed Charges 92.50% $49.95 Percent of Billed Charges 55.00% $29.70 Percent of Billed Charges 85.00% $45.90 Percent of Billed Charges 63.00% $34.02 Percent of Billed Charges 63.00% $34.02 Percent of Billed Charges 75.00% $40.50 Percent of Billed Charges 66.24% $35.77 Percent of Billed Charges 35.00% $18.90 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $32.40 Percent of Billed Charges HC PHONAK M70/NAIDA LINK 270 CPT V5298 Outpatient " $2,664.20 " $932.47 " $2,464.39 " " $2,664.20 " 61.04% " $1,626.23 " Percent of Billed Charges 69.29% " $1,846.02 " Percent of Billed Charges 56.78% " $1,512.73 " Percent of Billed Charges 74.74% " $1,991.22 " Percent of Billed Charges 68.24% " $1,818.05 " Percent of Billed Charges 65.00% " $1,731.73 " Percent of Billed Charges 67.00% " $1,785.01 " Percent of Billed Charges 77.50% " $2,064.76 " Percent of Billed Charges 79.97% " $2,130.56 " Percent of Billed Charges 55.00% " $1,465.31 " Percent of Billed Charges 49.55% " $1,320.11 " Percent of Billed Charges 55.00% " $1,465.31 " Percent of Billed Charges 55.00% " $1,465.31 " Percent of Billed Charges 78.94% " $2,103.12 " Percent of Billed Charges 74.00% " $1,971.51 " Percent of Billed Charges 92.50% " $2,464.39 " Percent of Billed Charges 55.00% " $1,465.31 " Percent of Billed Charges 85.00% " $2,264.57 " Percent of Billed Charges 63.00% " $1,678.45 " Percent of Billed Charges 63.00% " $1,678.45 " Percent of Billed Charges 75.00% " $1,998.15 " Percent of Billed Charges 66.24% " $1,764.77 " Percent of Billed Charges 35.00% $932.47 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,598.52 " Percent of Billed Charges HC PHONAK M70 PR M70-R 270 CPT V5298 Outpatient " $2,751.74 " $963.11 " $2,545.36 " " $2,751.74 " 61.04% " $1,679.66 " Percent of Billed Charges 69.29% " $1,906.68 " Percent of Billed Charges 56.78% " $1,562.44 " Percent of Billed Charges 74.74% " $2,056.65 " Percent of Billed Charges 68.24% " $1,877.79 " Percent of Billed Charges 65.00% " $1,788.63 " Percent of Billed Charges 67.00% " $1,843.67 " Percent of Billed Charges 77.50% " $2,132.60 " Percent of Billed Charges 79.97% " $2,200.57 " Percent of Billed Charges 55.00% " $1,513.46 " Percent of Billed Charges 49.55% " $1,363.49 " Percent of Billed Charges 55.00% " $1,513.46 " Percent of Billed Charges 55.00% " $1,513.46 " Percent of Billed Charges 78.94% " $2,172.22 " Percent of Billed Charges 74.00% " $2,036.29 " Percent of Billed Charges 92.50% " $2,545.36 " Percent of Billed Charges 55.00% " $1,513.46 " Percent of Billed Charges 85.00% " $2,338.98 " Percent of Billed Charges 63.00% " $1,733.60 " Percent of Billed Charges 63.00% " $1,733.60 " Percent of Billed Charges 75.00% " $2,063.81 " Percent of Billed Charges 66.24% " $1,822.75 " Percent of Billed Charges 35.00% $963.11 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,651.04 " Percent of Billed Charges HC PHONAK M90 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC PHONAK M90 PR/M90-R 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC OTICON MEDICAL STICKER SET PONTO 4 270 CPT V5267 Outpatient $10.00 $3.50 $9.25 $10.00 61.04% $6.10 Percent of Billed Charges 69.29% $6.93 Percent of Billed Charges 56.78% $5.68 Percent of Billed Charges 74.74% $7.47 Percent of Billed Charges 68.24% $6.82 Percent of Billed Charges 65.00% $6.50 Percent of Billed Charges 67.00% $6.70 Percent of Billed Charges 77.50% $7.75 Percent of Billed Charges 79.97% $8.00 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 49.55% $4.96 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 78.94% $7.89 Percent of Billed Charges 74.00% $7.40 Percent of Billed Charges 92.50% $9.25 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 85.00% $8.50 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 75.00% $7.50 Percent of Billed Charges 66.24% $6.62 Percent of Billed Charges 35.00% $3.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $6.00 Percent of Billed Charges HC OTICON MEDICAL TV ADAPTER 3.0 270 CPT V5267 Outpatient $300.00 $105.00 $277.50 $300.00 61.04% $183.12 Percent of Billed Charges 69.29% $207.87 Percent of Billed Charges 56.78% $170.34 Percent of Billed Charges 74.74% $224.22 Percent of Billed Charges 68.24% $204.72 Percent of Billed Charges 65.00% $195.00 Percent of Billed Charges 67.00% $201.00 Percent of Billed Charges 77.50% $232.50 Percent of Billed Charges 79.97% $239.91 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 49.55% $148.65 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 78.94% $236.82 Percent of Billed Charges 74.00% $222.00 Percent of Billed Charges 92.50% $277.50 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 85.00% $255.00 Percent of Billed Charges 63.00% $189.00 Percent of Billed Charges 63.00% $189.00 Percent of Billed Charges 75.00% $225.00 Percent of Billed Charges 66.24% $198.72 Percent of Billed Charges 35.00% $105.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $180.00 Percent of Billed Charges HC WESTONE AQUANOT SWIM PLUG 270 CPT V5264 Outpatient $77.90 $34.95 $123.86 $77.90 61.04% $47.55 Percent of Billed Charges 69.29% $53.98 Percent of Billed Charges 56.78% $44.23 Percent of Billed Charges 74.74% $58.22 Percent of Billed Charges 68.24% $53.16 Percent of Billed Charges 65.00% $50.64 Percent of Billed Charges 67.00% $52.19 Percent of Billed Charges 77.50% $60.37 Percent of Billed Charges 79.97% $62.30 Percent of Billed Charges 55.00% $42.85 Percent of Billed Charges 49.55% $38.60 Percent of Billed Charges 55.00% $42.85 Percent of Billed Charges 55.00% $42.85 Percent of Billed Charges 78.94% $61.49 Percent of Billed Charges 74.00% $57.65 Percent of Billed Charges 92.50% $72.06 Percent of Billed Charges 55.00% $42.85 Percent of Billed Charges 85.00% $66.22 Percent of Billed Charges 63.00% $49.08 Percent of Billed Charges 63.00% $49.08 Percent of Billed Charges 75.00% $58.43 Percent of Billed Charges 66.24% $51.60 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $123.86 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $46.74 Percent of Billed Charges HC WESTONE SOLID FULL SHELL HEARING PROTECTION 270 CPT V5264 Outpatient $79.90 $34.95 $127.04 $79.90 61.04% $48.77 Percent of Billed Charges 69.29% $55.36 Percent of Billed Charges 56.78% $45.37 Percent of Billed Charges 74.74% $59.72 Percent of Billed Charges 68.24% $54.52 Percent of Billed Charges 65.00% $51.94 Percent of Billed Charges 67.00% $53.53 Percent of Billed Charges 77.50% $61.92 Percent of Billed Charges 79.97% $63.90 Percent of Billed Charges 55.00% $43.95 Percent of Billed Charges 49.55% $39.59 Percent of Billed Charges 55.00% $43.95 Percent of Billed Charges 55.00% $43.95 Percent of Billed Charges 78.94% $63.07 Percent of Billed Charges 74.00% $59.13 Percent of Billed Charges 92.50% $73.91 Percent of Billed Charges 55.00% $43.95 Percent of Billed Charges 85.00% $67.92 Percent of Billed Charges 63.00% $50.34 Percent of Billed Charges 63.00% $50.34 Percent of Billed Charges 75.00% $59.93 Percent of Billed Charges 66.24% $52.93 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $127.04 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $47.94 Percent of Billed Charges HC WESTONE FULL SHELL SURFERS PLUG 270 CPT V5264 Outpatient $107.90 $34.95 $171.56 $107.90 61.04% $65.86 Percent of Billed Charges 69.29% $74.76 Percent of Billed Charges 56.78% $61.27 Percent of Billed Charges 74.74% $80.64 Percent of Billed Charges 68.24% $73.63 Percent of Billed Charges 65.00% $70.14 Percent of Billed Charges 67.00% $72.29 Percent of Billed Charges 77.50% $83.62 Percent of Billed Charges 79.97% $86.29 Percent of Billed Charges 55.00% $59.35 Percent of Billed Charges 49.55% $53.46 Percent of Billed Charges 55.00% $59.35 Percent of Billed Charges 55.00% $59.35 Percent of Billed Charges 78.94% $85.18 Percent of Billed Charges 74.00% $79.85 Percent of Billed Charges 92.50% $99.81 Percent of Billed Charges 55.00% $59.35 Percent of Billed Charges 85.00% $91.72 Percent of Billed Charges 63.00% $67.98 Percent of Billed Charges 63.00% $67.98 Percent of Billed Charges 75.00% $80.93 Percent of Billed Charges 66.24% $71.47 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $171.56 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $64.74 Percent of Billed Charges HC WESTONE EARMOLD 270 CPT V5264 Outpatient $115.38 $34.95 $183.45 $115.38 61.04% $70.43 Percent of Billed Charges 69.29% $79.95 Percent of Billed Charges 56.78% $65.51 Percent of Billed Charges 74.74% $86.24 Percent of Billed Charges 68.24% $78.74 Percent of Billed Charges 65.00% $75.00 Percent of Billed Charges 67.00% $77.30 Percent of Billed Charges 77.50% $89.42 Percent of Billed Charges 79.97% $92.27 Percent of Billed Charges 55.00% $63.46 Percent of Billed Charges 49.55% $57.17 Percent of Billed Charges 55.00% $63.46 Percent of Billed Charges 55.00% $63.46 Percent of Billed Charges 78.94% $91.08 Percent of Billed Charges 74.00% $85.38 Percent of Billed Charges 92.50% $106.73 Percent of Billed Charges 55.00% $63.46 Percent of Billed Charges 85.00% $98.07 Percent of Billed Charges 63.00% $72.69 Percent of Billed Charges 63.00% $72.69 Percent of Billed Charges 75.00% $86.54 Percent of Billed Charges 66.24% $76.43 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $183.45 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $69.23 Percent of Billed Charges HC WESTONE MUSICIANS FILTER ONLY ER9/15/25 270 CPT V5267 Outpatient $47.98 $16.79 $44.38 $47.98 61.04% $29.29 Percent of Billed Charges 69.29% $33.25 Percent of Billed Charges 56.78% $27.24 Percent of Billed Charges 74.74% $35.86 Percent of Billed Charges 68.24% $32.74 Percent of Billed Charges 65.00% $31.19 Percent of Billed Charges 67.00% $32.15 Percent of Billed Charges 77.50% $37.18 Percent of Billed Charges 79.97% $38.37 Percent of Billed Charges 55.00% $26.39 Percent of Billed Charges 49.55% $23.77 Percent of Billed Charges 55.00% $26.39 Percent of Billed Charges 55.00% $26.39 Percent of Billed Charges 78.94% $37.88 Percent of Billed Charges 74.00% $35.51 Percent of Billed Charges 92.50% $44.38 Percent of Billed Charges 55.00% $26.39 Percent of Billed Charges 85.00% $40.78 Percent of Billed Charges 63.00% $30.23 Percent of Billed Charges 63.00% $30.23 Percent of Billed Charges 75.00% $35.99 Percent of Billed Charges 66.24% $31.78 Percent of Billed Charges 35.00% $16.79 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $28.79 Percent of Billed Charges HC WESTONE MUSICIANS PLUG + FILTER 270 CPT V5264 Outpatient $119.90 $34.95 $190.64 $119.90 61.04% $73.19 Percent of Billed Charges 69.29% $83.08 Percent of Billed Charges 56.78% $68.08 Percent of Billed Charges 74.74% $89.61 Percent of Billed Charges 68.24% $81.82 Percent of Billed Charges 65.00% $77.94 Percent of Billed Charges 67.00% $80.33 Percent of Billed Charges 77.50% $92.92 Percent of Billed Charges 79.97% $95.88 Percent of Billed Charges 55.00% $65.95 Percent of Billed Charges 49.55% $59.41 Percent of Billed Charges 55.00% $65.95 Percent of Billed Charges 55.00% $65.95 Percent of Billed Charges 78.94% $94.65 Percent of Billed Charges 74.00% $88.73 Percent of Billed Charges 92.50% $110.91 Percent of Billed Charges 55.00% $65.95 Percent of Billed Charges 85.00% $101.92 Percent of Billed Charges 63.00% $75.54 Percent of Billed Charges 63.00% $75.54 Percent of Billed Charges 75.00% $89.93 Percent of Billed Charges 66.24% $79.42 Percent of Billed Charges 165.81% $45.63 Fee Schedule Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 127.00% $34.95 Fee Schedule 191.24% $52.63 Fee Schedule 159.00% $190.64 Fee Schedule 145.00% $39.90 Fee Schedule 60.00% $71.94 Percent of Billed Charges HC OTICON EDUMIC 270 CPT V5267 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC PHONAK P30 270 CPT V5298 Outpatient " $1,408.00 " $492.80 " $1,302.40 " " $1,408.00 " 61.04% $859.44 Percent of Billed Charges 69.29% $975.60 Percent of Billed Charges 56.78% $799.46 Percent of Billed Charges 74.74% " $1,052.34 " Percent of Billed Charges 68.24% $960.82 Percent of Billed Charges 65.00% $915.20 Percent of Billed Charges 67.00% $943.36 Percent of Billed Charges 77.50% " $1,091.20 " Percent of Billed Charges 79.97% " $1,125.98 " Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 49.55% $697.66 Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 78.94% " $1,111.48 " Percent of Billed Charges 74.00% " $1,041.92 " Percent of Billed Charges 92.50% " $1,302.40 " Percent of Billed Charges 55.00% $774.40 Percent of Billed Charges 85.00% " $1,196.80 " Percent of Billed Charges 63.00% $887.04 Percent of Billed Charges 63.00% $887.04 Percent of Billed Charges 75.00% " $1,056.00 " Percent of Billed Charges 66.24% $932.66 Percent of Billed Charges 35.00% $492.80 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $844.80 Percent of Billed Charges HC PHONAK P30-R 270 CPT V5298 Outpatient " $1,508.00 " $527.80 " $1,394.90 " " $1,508.00 " 61.04% $920.48 Percent of Billed Charges 69.29% " $1,044.89 " Percent of Billed Charges 56.78% $856.24 Percent of Billed Charges 74.74% " $1,127.08 " Percent of Billed Charges 68.24% " $1,029.06 " Percent of Billed Charges 65.00% $980.20 Percent of Billed Charges 67.00% " $1,010.36 " Percent of Billed Charges 77.50% " $1,168.70 " Percent of Billed Charges 79.97% " $1,205.95 " Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 49.55% $747.21 Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 78.94% " $1,190.42 " Percent of Billed Charges 74.00% " $1,115.92 " Percent of Billed Charges 92.50% " $1,394.90 " Percent of Billed Charges 55.00% $829.40 Percent of Billed Charges 85.00% " $1,281.80 " Percent of Billed Charges 63.00% $950.04 Percent of Billed Charges 63.00% $950.04 Percent of Billed Charges 75.00% " $1,131.00 " Percent of Billed Charges 66.24% $998.90 Percent of Billed Charges 35.00% $527.80 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $904.80 Percent of Billed Charges HC PHONAK P50 270 CPT V5298 Outpatient " $1,759.92 " $615.97 " $1,627.93 " " $1,759.92 " 61.04% " $1,074.26 " Percent of Billed Charges 69.29% " $1,219.45 " Percent of Billed Charges 56.78% $999.28 Percent of Billed Charges 74.74% " $1,315.36 " Percent of Billed Charges 68.24% " $1,200.97 " Percent of Billed Charges 65.00% " $1,143.95 " Percent of Billed Charges 67.00% " $1,179.15 " Percent of Billed Charges 77.50% " $1,363.94 " Percent of Billed Charges 79.97% " $1,407.41 " Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 49.55% $872.04 Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 78.94% " $1,389.28 " Percent of Billed Charges 74.00% " $1,302.34 " Percent of Billed Charges 92.50% " $1,627.93 " Percent of Billed Charges 55.00% $967.96 Percent of Billed Charges 85.00% " $1,495.93 " Percent of Billed Charges 63.00% " $1,108.75 " Percent of Billed Charges 63.00% " $1,108.75 " Percent of Billed Charges 75.00% " $1,319.94 " Percent of Billed Charges 66.24% " $1,165.77 " Percent of Billed Charges 35.00% $615.97 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,055.95 " Percent of Billed Charges HC PHONAK P50-R 270 CPT V5298 Outpatient " $1,859.92 " $650.97 " $1,720.43 " " $1,859.92 " 61.04% " $1,135.30 " Percent of Billed Charges 69.29% " $1,288.74 " Percent of Billed Charges 56.78% " $1,056.06 " Percent of Billed Charges 74.74% " $1,390.10 " Percent of Billed Charges 68.24% " $1,269.21 " Percent of Billed Charges 65.00% " $1,208.95 " Percent of Billed Charges 67.00% " $1,246.15 " Percent of Billed Charges 77.50% " $1,441.44 " Percent of Billed Charges 79.97% " $1,487.38 " Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 49.55% $921.59 Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 78.94% " $1,468.22 " Percent of Billed Charges 74.00% " $1,376.34 " Percent of Billed Charges 92.50% " $1,720.43 " Percent of Billed Charges 55.00% " $1,022.96 " Percent of Billed Charges 85.00% " $1,580.93 " Percent of Billed Charges 63.00% " $1,171.75 " Percent of Billed Charges 63.00% " $1,171.75 " Percent of Billed Charges 75.00% " $1,394.94 " Percent of Billed Charges 66.24% " $1,232.01 " Percent of Billed Charges 35.00% $650.97 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,115.95 " Percent of Billed Charges HC PHONAK P70 270 CPT V5298 Outpatient " $2,664.24 " $932.48 " $2,464.42 " " $2,664.24 " 61.04% " $1,626.25 " Percent of Billed Charges 69.29% " $1,846.05 " Percent of Billed Charges 56.78% " $1,512.76 " Percent of Billed Charges 74.74% " $1,991.25 " Percent of Billed Charges 68.24% " $1,818.08 " Percent of Billed Charges 65.00% " $1,731.76 " Percent of Billed Charges 67.00% " $1,785.04 " Percent of Billed Charges 77.50% " $2,064.79 " Percent of Billed Charges 79.97% " $2,130.59 " Percent of Billed Charges 55.00% " $1,465.33 " Percent of Billed Charges 49.55% " $1,320.13 " Percent of Billed Charges 55.00% " $1,465.33 " Percent of Billed Charges 55.00% " $1,465.33 " Percent of Billed Charges 78.94% " $2,103.15 " Percent of Billed Charges 74.00% " $1,971.54 " Percent of Billed Charges 92.50% " $2,464.42 " Percent of Billed Charges 55.00% " $1,465.33 " Percent of Billed Charges 85.00% " $2,264.60 " Percent of Billed Charges 63.00% " $1,678.47 " Percent of Billed Charges 63.00% " $1,678.47 " Percent of Billed Charges 75.00% " $1,998.18 " Percent of Billed Charges 66.24% " $1,764.79 " Percent of Billed Charges 35.00% $932.48 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,598.54 " Percent of Billed Charges HC PHONAK P70-R 270 CPT V5298 Outpatient " $2,751.77 " $963.12 " $2,545.39 " " $2,751.77 " 61.04% " $1,679.68 " Percent of Billed Charges 69.29% " $1,906.70 " Percent of Billed Charges 56.78% " $1,562.46 " Percent of Billed Charges 74.74% " $2,056.67 " Percent of Billed Charges 68.24% " $1,877.81 " Percent of Billed Charges 65.00% " $1,788.65 " Percent of Billed Charges 67.00% " $1,843.69 " Percent of Billed Charges 77.50% " $2,132.62 " Percent of Billed Charges 79.97% " $2,200.59 " Percent of Billed Charges 55.00% " $1,513.47 " Percent of Billed Charges 49.55% " $1,363.50 " Percent of Billed Charges 55.00% " $1,513.47 " Percent of Billed Charges 55.00% " $1,513.47 " Percent of Billed Charges 78.94% " $2,172.25 " Percent of Billed Charges 74.00% " $2,036.31 " Percent of Billed Charges 92.50% " $2,545.39 " Percent of Billed Charges 55.00% " $1,513.47 " Percent of Billed Charges 85.00% " $2,339.00 " Percent of Billed Charges 63.00% " $1,733.62 " Percent of Billed Charges 63.00% " $1,733.62 " Percent of Billed Charges 75.00% " $2,063.83 " Percent of Billed Charges 66.24% " $1,822.77 " Percent of Billed Charges 35.00% $963.12 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,651.06 " Percent of Billed Charges HC PHONAK P90 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC PHONAK P90-R 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC PHONAK PR CHARGER CASE COMBO 270 CPT V5267 Outpatient $105.98 $37.09 $98.03 $105.98 61.04% $64.69 Percent of Billed Charges 69.29% $73.43 Percent of Billed Charges 56.78% $60.18 Percent of Billed Charges 74.74% $79.21 Percent of Billed Charges 68.24% $72.32 Percent of Billed Charges 65.00% $68.89 Percent of Billed Charges 67.00% $71.01 Percent of Billed Charges 77.50% $82.13 Percent of Billed Charges 79.97% $84.75 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 49.55% $52.51 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 78.94% $83.66 Percent of Billed Charges 74.00% $78.43 Percent of Billed Charges 92.50% $98.03 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 85.00% $90.08 Percent of Billed Charges 63.00% $66.77 Percent of Billed Charges 63.00% $66.77 Percent of Billed Charges 75.00% $79.49 Percent of Billed Charges 66.24% $70.20 Percent of Billed Charges 35.00% $37.09 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $63.59 Percent of Billed Charges HC PHONAK AUDEO MINI CHARGER CASE 270 CPT V5267 Outpatient $105.98 $37.09 $98.03 $105.98 61.04% $64.69 Percent of Billed Charges 69.29% $73.43 Percent of Billed Charges 56.78% $60.18 Percent of Billed Charges 74.74% $79.21 Percent of Billed Charges 68.24% $72.32 Percent of Billed Charges 65.00% $68.89 Percent of Billed Charges 67.00% $71.01 Percent of Billed Charges 77.50% $82.13 Percent of Billed Charges 79.97% $84.75 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 49.55% $52.51 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 78.94% $83.66 Percent of Billed Charges 74.00% $78.43 Percent of Billed Charges 92.50% $98.03 Percent of Billed Charges 55.00% $58.29 Percent of Billed Charges 85.00% $90.08 Percent of Billed Charges 63.00% $66.77 Percent of Billed Charges 63.00% $66.77 Percent of Billed Charges 75.00% $79.49 Percent of Billed Charges 66.24% $70.20 Percent of Billed Charges 35.00% $37.09 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $63.59 Percent of Billed Charges HC PHONAK CROS P-R 270 CPT V5181 Outpatient " $1,545.08 " $540.78 " $1,429.20 " " $1,545.08 " 61.04% $943.12 Percent of Billed Charges 69.29% " $1,070.59 " Percent of Billed Charges 56.78% $877.30 Percent of Billed Charges 74.74% " $1,154.79 " Percent of Billed Charges 68.24% " $1,054.36 " Percent of Billed Charges 65.00% " $1,004.30 " Percent of Billed Charges 67.00% " $1,035.20 " Percent of Billed Charges 77.50% " $1,197.44 " Percent of Billed Charges 79.97% " $1,235.60 " Percent of Billed Charges 55.00% $849.79 Percent of Billed Charges 49.55% $765.59 Percent of Billed Charges 55.00% $849.79 Percent of Billed Charges 55.00% $849.79 Percent of Billed Charges 78.94% " $1,219.69 " Percent of Billed Charges 74.00% " $1,143.36 " Percent of Billed Charges 92.50% " $1,429.20 " Percent of Billed Charges 55.00% $849.79 Percent of Billed Charges 85.00% " $1,313.32 " Percent of Billed Charges 63.00% $973.40 Percent of Billed Charges 63.00% $973.40 Percent of Billed Charges 75.00% " $1,158.81 " Percent of Billed Charges 66.24% " $1,023.46 " Percent of Billed Charges 35.00% $540.78 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $927.05 Percent of Billed Charges HC OTICON PLAY PX 1 or R 270 CPT V5298 Outpatient " $1,925.00 " $673.75 " $1,780.63 " " $1,925.00 " 61.04% " $1,175.02 " Percent of Billed Charges 69.29% " $1,333.83 " Percent of Billed Charges 56.78% " $1,093.02 " Percent of Billed Charges 74.74% " $1,438.75 " Percent of Billed Charges 68.24% " $1,313.62 " Percent of Billed Charges 65.00% " $1,251.25 " Percent of Billed Charges 67.00% " $1,289.75 " Percent of Billed Charges 77.50% " $1,491.88 " Percent of Billed Charges 79.97% " $1,539.42 " Percent of Billed Charges 55.00% " $1,058.75 " Percent of Billed Charges 49.55% $953.84 Percent of Billed Charges 55.00% " $1,058.75 " Percent of Billed Charges 55.00% " $1,058.75 " Percent of Billed Charges 78.94% " $1,519.60 " Percent of Billed Charges 74.00% " $1,424.50 " Percent of Billed Charges 92.50% " $1,780.63 " Percent of Billed Charges 55.00% " $1,058.75 " Percent of Billed Charges 85.00% " $1,636.25 " Percent of Billed Charges 63.00% " $1,212.75 " Percent of Billed Charges 63.00% " $1,212.75 " Percent of Billed Charges 75.00% " $1,443.75 " Percent of Billed Charges 66.24% " $1,275.12 " Percent of Billed Charges 35.00% $673.75 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,155.00 " Percent of Billed Charges HC OTICON PLAY PX 2 or R 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC PHONAK ROGER ON + DOCKING 270 CPT V5267 Outpatient " $1,425.00 " $498.75 " $1,318.13 " " $1,425.00 " 61.04% $869.82 Percent of Billed Charges 69.29% $987.38 Percent of Billed Charges 56.78% $809.12 Percent of Billed Charges 74.74% " $1,065.05 " Percent of Billed Charges 68.24% $972.42 Percent of Billed Charges 65.00% $926.25 Percent of Billed Charges 67.00% $954.75 Percent of Billed Charges 77.50% " $1,104.38 " Percent of Billed Charges 79.97% " $1,139.57 " Percent of Billed Charges 55.00% $783.75 Percent of Billed Charges 49.55% $706.09 Percent of Billed Charges 55.00% $783.75 Percent of Billed Charges 55.00% $783.75 Percent of Billed Charges 78.94% " $1,124.90 " Percent of Billed Charges 74.00% " $1,054.50 " Percent of Billed Charges 92.50% " $1,318.13 " Percent of Billed Charges 55.00% $783.75 Percent of Billed Charges 85.00% " $1,211.25 " Percent of Billed Charges 63.00% $897.75 Percent of Billed Charges 63.00% $897.75 Percent of Billed Charges 75.00% " $1,068.75 " Percent of Billed Charges 66.24% $943.92 Percent of Billed Charges 35.00% $498.75 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $855.00 Percent of Billed Charges HC PHONAK ROGER ON IN 270 CPT V5267 Outpatient " $2,248.50 " $786.98 " $2,079.86 " " $2,248.50 " 61.04% " $1,372.48 " Percent of Billed Charges 69.29% " $1,557.99 " Percent of Billed Charges 56.78% " $1,276.70 " Percent of Billed Charges 74.74% " $1,680.53 " Percent of Billed Charges 68.24% " $1,534.38 " Percent of Billed Charges 65.00% " $1,461.53 " Percent of Billed Charges 67.00% " $1,506.50 " Percent of Billed Charges 77.50% " $1,742.59 " Percent of Billed Charges 79.97% " $1,798.13 " Percent of Billed Charges 55.00% " $1,236.68 " Percent of Billed Charges 49.55% " $1,114.13 " Percent of Billed Charges 55.00% " $1,236.68 " Percent of Billed Charges 55.00% " $1,236.68 " Percent of Billed Charges 78.94% " $1,774.97 " Percent of Billed Charges 74.00% " $1,663.89 " Percent of Billed Charges 92.50% " $2,079.86 " Percent of Billed Charges 55.00% " $1,236.68 " Percent of Billed Charges 85.00% " $1,911.23 " Percent of Billed Charges 63.00% " $1,416.56 " Percent of Billed Charges 63.00% " $1,416.56 " Percent of Billed Charges 75.00% " $1,686.38 " Percent of Billed Charges 66.24% " $1,489.41 " Percent of Billed Charges 35.00% $786.98 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,349.10 " Percent of Billed Charges HC PHONAK ROGER TOUCHSCREEN MIC 270 CPT V5267 Outpatient " $1,492.50 " $522.38 " $1,380.56 " " $1,492.50 " 61.04% $911.02 Percent of Billed Charges 69.29% " $1,034.15 " Percent of Billed Charges 56.78% $847.44 Percent of Billed Charges 74.74% " $1,115.49 " Percent of Billed Charges 68.24% " $1,018.48 " Percent of Billed Charges 65.00% $970.13 Percent of Billed Charges 67.00% $999.98 Percent of Billed Charges 77.50% " $1,156.69 " Percent of Billed Charges 79.97% " $1,193.55 " Percent of Billed Charges 55.00% $820.88 Percent of Billed Charges 49.55% $739.53 Percent of Billed Charges 55.00% $820.88 Percent of Billed Charges 55.00% $820.88 Percent of Billed Charges 78.94% " $1,178.18 " Percent of Billed Charges 74.00% " $1,104.45 " Percent of Billed Charges 92.50% " $1,380.56 " Percent of Billed Charges 55.00% $820.88 Percent of Billed Charges 85.00% " $1,268.63 " Percent of Billed Charges 63.00% $940.28 Percent of Billed Charges 63.00% $940.28 Percent of Billed Charges 75.00% " $1,119.38 " Percent of Billed Charges 66.24% $988.63 Percent of Billed Charges 35.00% $522.38 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $895.50 Percent of Billed Charges HC OTICON MEDICAL CONNECT CLIP 270 CPT V5267 Outpatient $398.00 $139.30 $368.15 $398.00 61.04% $242.94 Percent of Billed Charges 69.29% $275.77 Percent of Billed Charges 56.78% $225.98 Percent of Billed Charges 74.74% $297.47 Percent of Billed Charges 68.24% $271.60 Percent of Billed Charges 65.00% $258.70 Percent of Billed Charges 67.00% $266.66 Percent of Billed Charges 77.50% $308.45 Percent of Billed Charges 79.97% $318.28 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 49.55% $197.21 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 78.94% $314.18 Percent of Billed Charges 74.00% $294.52 Percent of Billed Charges 92.50% $368.15 Percent of Billed Charges 55.00% $218.90 Percent of Billed Charges 85.00% $338.30 Percent of Billed Charges 63.00% $250.74 Percent of Billed Charges 63.00% $250.74 Percent of Billed Charges 75.00% $298.50 Percent of Billed Charges 66.24% $263.64 Percent of Billed Charges 35.00% $139.30 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $238.80 Percent of Billed Charges HC OTICON MEDICAL EDU MIC 270 CPT V5267 Outpatient " $1,300.00 " $455.00 " $1,202.50 " " $1,300.00 " 61.04% $793.52 Percent of Billed Charges 69.29% $900.77 Percent of Billed Charges 56.78% $738.14 Percent of Billed Charges 74.74% $971.62 Percent of Billed Charges 68.24% $887.12 Percent of Billed Charges 65.00% $845.00 Percent of Billed Charges 67.00% $871.00 Percent of Billed Charges 77.50% " $1,007.50 " Percent of Billed Charges 79.97% " $1,039.61 " Percent of Billed Charges 55.00% $715.00 Percent of Billed Charges 49.55% $644.15 Percent of Billed Charges 55.00% $715.00 Percent of Billed Charges 55.00% $715.00 Percent of Billed Charges 78.94% " $1,026.22 " Percent of Billed Charges 74.00% $962.00 Percent of Billed Charges 92.50% " $1,202.50 " Percent of Billed Charges 55.00% $715.00 Percent of Billed Charges 85.00% " $1,105.00 " Percent of Billed Charges 63.00% $819.00 Percent of Billed Charges 63.00% $819.00 Percent of Billed Charges 75.00% $975.00 Percent of Billed Charges 66.24% $861.12 Percent of Billed Charges 35.00% $455.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $780.00 Percent of Billed Charges HC OTICON OWN 1 CUSTOM 270 CPT V5298 Outpatient " $2,472.50 " $865.38 " $2,287.06 " " $2,472.50 " 61.04% " $1,509.21 " Percent of Billed Charges 69.29% " $1,713.20 " Percent of Billed Charges 56.78% " $1,403.89 " Percent of Billed Charges 74.74% " $1,847.95 " Percent of Billed Charges 68.24% " $1,687.23 " Percent of Billed Charges 65.00% " $1,607.13 " Percent of Billed Charges 67.00% " $1,656.58 " Percent of Billed Charges 77.50% " $1,916.19 " Percent of Billed Charges 79.97% " $1,977.26 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 49.55% " $1,225.12 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 78.94% " $1,951.79 " Percent of Billed Charges 74.00% " $1,829.65 " Percent of Billed Charges 92.50% " $2,287.06 " Percent of Billed Charges 55.00% " $1,359.88 " Percent of Billed Charges 85.00% " $2,101.63 " Percent of Billed Charges 63.00% " $1,557.68 " Percent of Billed Charges 63.00% " $1,557.68 " Percent of Billed Charges 75.00% " $1,854.38 " Percent of Billed Charges 66.24% " $1,637.78 " Percent of Billed Charges 35.00% $865.38 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,483.50 " Percent of Billed Charges HC OTICON OWN 2 CUSTOM 270 CPT V5298 Outpatient " $2,859.50 " " $1,000.83 " " $2,645.04 " " $2,859.50 " 61.04% " $1,745.44 " Percent of Billed Charges 69.29% " $1,981.35 " Percent of Billed Charges 56.78% " $1,623.62 " Percent of Billed Charges 74.74% " $2,137.19 " Percent of Billed Charges 68.24% " $1,951.32 " Percent of Billed Charges 65.00% " $1,858.68 " Percent of Billed Charges 67.00% " $1,915.87 " Percent of Billed Charges 77.50% " $2,216.11 " Percent of Billed Charges 79.97% " $2,286.74 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 49.55% " $1,416.88 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 78.94% " $2,257.29 " Percent of Billed Charges 74.00% " $2,116.03 " Percent of Billed Charges 92.50% " $2,645.04 " Percent of Billed Charges 55.00% " $1,572.73 " Percent of Billed Charges 85.00% " $2,430.58 " Percent of Billed Charges 63.00% " $1,801.49 " Percent of Billed Charges 63.00% " $1,801.49 " Percent of Billed Charges 75.00% " $2,144.63 " Percent of Billed Charges 66.24% " $1,894.13 " Percent of Billed Charges 35.00% " $1,000.83 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,715.70 " Percent of Billed Charges HC OTICON OWN 3 CUSTOM 270 CPT V5298 Outpatient " $1,400.00 " $490.00 " $1,295.00 " " $1,400.00 " 61.04% $854.56 Percent of Billed Charges 69.29% $970.06 Percent of Billed Charges 56.78% $794.92 Percent of Billed Charges 74.74% " $1,046.36 " Percent of Billed Charges 68.24% $955.36 Percent of Billed Charges 65.00% $910.00 Percent of Billed Charges 67.00% $938.00 Percent of Billed Charges 77.50% " $1,085.00 " Percent of Billed Charges 79.97% " $1,119.58 " Percent of Billed Charges 55.00% $770.00 Percent of Billed Charges 49.55% $693.70 Percent of Billed Charges 55.00% $770.00 Percent of Billed Charges 55.00% $770.00 Percent of Billed Charges 78.94% " $1,105.16 " Percent of Billed Charges 74.00% " $1,036.00 " Percent of Billed Charges 92.50% " $1,295.00 " Percent of Billed Charges 55.00% $770.00 Percent of Billed Charges 85.00% " $1,190.00 " Percent of Billed Charges 63.00% $882.00 Percent of Billed Charges 63.00% $882.00 Percent of Billed Charges 75.00% " $1,050.00 " Percent of Billed Charges 66.24% $927.36 Percent of Billed Charges 35.00% $490.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $840.00 Percent of Billed Charges HC OTICON OWN 4 CUSTOM 270 CPT V5298 Outpatient $900.00 $315.00 $832.50 $900.00 61.04% $549.36 Percent of Billed Charges 69.29% $623.61 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $540.00 Percent of Billed Charges HC OTICON OWN 5 CUSTOM 270 CPT V5298 Outpatient $700.00 $245.00 $647.50 $700.00 61.04% $427.28 Percent of Billed Charges 69.29% $485.03 Percent of Billed Charges 56.78% $397.46 Percent of Billed Charges 74.74% $523.18 Percent of Billed Charges 68.24% $477.68 Percent of Billed Charges 65.00% $455.00 Percent of Billed Charges 67.00% $469.00 Percent of Billed Charges 77.50% $542.50 Percent of Billed Charges 79.97% $559.79 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 49.55% $346.85 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 78.94% $552.58 Percent of Billed Charges 74.00% $518.00 Percent of Billed Charges 92.50% $647.50 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 85.00% $595.00 Percent of Billed Charges 63.00% $441.00 Percent of Billed Charges 63.00% $441.00 Percent of Billed Charges 75.00% $525.00 Percent of Billed Charges 66.24% $463.68 Percent of Billed Charges 35.00% $245.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $420.00 Percent of Billed Charges HC OTICON SMART CHARGER 270 CPT V5267 Outpatient $240.00 $84.00 $222.00 $240.00 61.04% $146.50 Percent of Billed Charges 69.29% $166.30 Percent of Billed Charges 56.78% $136.27 Percent of Billed Charges 74.74% $179.38 Percent of Billed Charges 68.24% $163.78 Percent of Billed Charges 65.00% $156.00 Percent of Billed Charges 67.00% $160.80 Percent of Billed Charges 77.50% $186.00 Percent of Billed Charges 79.97% $191.93 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 49.55% $118.92 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 78.94% $189.46 Percent of Billed Charges 74.00% $177.60 Percent of Billed Charges 92.50% $222.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 85.00% $204.00 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 75.00% $180.00 Percent of Billed Charges 66.24% $158.98 Percent of Billed Charges 35.00% $84.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $144.00 Percent of Billed Charges HC PHONAK CHARGER CASE GO 270 CPT V5267 Outpatient $296.20 $103.67 $273.99 $296.20 61.04% $180.80 Percent of Billed Charges 69.29% $205.24 Percent of Billed Charges 56.78% $168.18 Percent of Billed Charges 74.74% $221.38 Percent of Billed Charges 68.24% $202.13 Percent of Billed Charges 65.00% $192.53 Percent of Billed Charges 67.00% $198.45 Percent of Billed Charges 77.50% $229.56 Percent of Billed Charges 79.97% $236.87 Percent of Billed Charges 55.00% $162.91 Percent of Billed Charges 49.55% $146.77 Percent of Billed Charges 55.00% $162.91 Percent of Billed Charges 55.00% $162.91 Percent of Billed Charges 78.94% $233.82 Percent of Billed Charges 74.00% $219.19 Percent of Billed Charges 92.50% $273.99 Percent of Billed Charges 55.00% $162.91 Percent of Billed Charges 85.00% $251.77 Percent of Billed Charges 63.00% $186.61 Percent of Billed Charges 63.00% $186.61 Percent of Billed Charges 75.00% $222.15 Percent of Billed Charges 66.24% $196.20 Percent of Billed Charges 35.00% $103.67 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $177.72 Percent of Billed Charges HC PHONAK ROGER FOCUS II-R 270 CPT V5267 Outpatient " $1,275.00 " $446.25 " $1,179.38 " " $1,275.00 " 61.04% $778.26 Percent of Billed Charges 69.29% $883.45 Percent of Billed Charges 56.78% $723.95 Percent of Billed Charges 74.74% $952.94 Percent of Billed Charges 68.24% $870.06 Percent of Billed Charges 65.00% $828.75 Percent of Billed Charges 67.00% $854.25 Percent of Billed Charges 77.50% $988.13 Percent of Billed Charges 79.97% " $1,019.62 " Percent of Billed Charges 55.00% $701.25 Percent of Billed Charges 49.55% $631.76 Percent of Billed Charges 55.00% $701.25 Percent of Billed Charges 55.00% $701.25 Percent of Billed Charges 78.94% " $1,006.49 " Percent of Billed Charges 74.00% $943.50 Percent of Billed Charges 92.50% " $1,179.38 " Percent of Billed Charges 55.00% $701.25 Percent of Billed Charges 85.00% " $1,083.75 " Percent of Billed Charges 63.00% $803.25 Percent of Billed Charges 63.00% $803.25 Percent of Billed Charges 75.00% $956.25 Percent of Billed Charges 66.24% $844.56 Percent of Billed Charges 35.00% $446.25 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $765.00 Percent of Billed Charges HC PHONAK L30 270 CPT V5298 Outpatient " $1,600.00 " $560.00 " $1,480.00 " " $1,600.00 " 61.04% $976.64 Percent of Billed Charges 69.29% " $1,108.64 " Percent of Billed Charges 56.78% $908.48 Percent of Billed Charges 74.74% " $1,195.84 " Percent of Billed Charges 68.24% " $1,091.84 " Percent of Billed Charges 65.00% " $1,040.00 " Percent of Billed Charges 67.00% " $1,072.00 " Percent of Billed Charges 77.50% " $1,240.00 " Percent of Billed Charges 79.97% " $1,279.52 " Percent of Billed Charges 55.00% $880.00 Percent of Billed Charges 49.55% $792.80 Percent of Billed Charges 55.00% $880.00 Percent of Billed Charges 55.00% $880.00 Percent of Billed Charges 78.94% " $1,263.04 " Percent of Billed Charges 74.00% " $1,184.00 " Percent of Billed Charges 92.50% " $1,480.00 " Percent of Billed Charges 55.00% $880.00 Percent of Billed Charges 85.00% " $1,360.00 " Percent of Billed Charges 63.00% " $1,008.00 " Percent of Billed Charges 63.00% " $1,008.00 " Percent of Billed Charges 75.00% " $1,200.00 " Percent of Billed Charges 66.24% " $1,059.84 " Percent of Billed Charges 35.00% $560.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $960.00 Percent of Billed Charges HC PHONAK L50 270 CPT V5298 Outpatient " $1,996.00 " $698.60 " $1,846.30 " " $1,996.00 " 61.04% " $1,218.36 " Percent of Billed Charges 69.29% " $1,383.03 " Percent of Billed Charges 56.78% " $1,133.33 " Percent of Billed Charges 74.74% " $1,491.81 " Percent of Billed Charges 68.24% " $1,362.07 " Percent of Billed Charges 65.00% " $1,297.40 " Percent of Billed Charges 67.00% " $1,337.32 " Percent of Billed Charges 77.50% " $1,546.90 " Percent of Billed Charges 79.97% " $1,596.20 " Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 49.55% $989.02 Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 78.94% " $1,575.64 " Percent of Billed Charges 74.00% " $1,477.04 " Percent of Billed Charges 92.50% " $1,846.30 " Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 85.00% " $1,696.60 " Percent of Billed Charges 63.00% " $1,257.48 " Percent of Billed Charges 63.00% " $1,257.48 " Percent of Billed Charges 75.00% " $1,497.00 " Percent of Billed Charges 66.24% " $1,322.15 " Percent of Billed Charges 35.00% $698.60 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,197.60 " Percent of Billed Charges HC PHONAK L70 270 CPT V5298 Outpatient " $2,975.00 " " $1,041.25 " " $2,751.88 " " $2,975.00 " 61.04% " $1,815.94 " Percent of Billed Charges 69.29% " $2,061.38 " Percent of Billed Charges 56.78% " $1,689.21 " Percent of Billed Charges 74.74% " $2,223.52 " Percent of Billed Charges 68.24% " $2,030.14 " Percent of Billed Charges 65.00% " $1,933.75 " Percent of Billed Charges 67.00% " $1,993.25 " Percent of Billed Charges 77.50% " $2,305.63 " Percent of Billed Charges 79.97% " $2,379.11 " Percent of Billed Charges 55.00% " $1,636.25 " Percent of Billed Charges 49.55% " $1,474.11 " Percent of Billed Charges 55.00% " $1,636.25 " Percent of Billed Charges 55.00% " $1,636.25 " Percent of Billed Charges 78.94% " $2,348.47 " Percent of Billed Charges 74.00% " $2,201.50 " Percent of Billed Charges 92.50% " $2,751.88 " Percent of Billed Charges 55.00% " $1,636.25 " Percent of Billed Charges 85.00% " $2,528.75 " Percent of Billed Charges 63.00% " $1,874.25 " Percent of Billed Charges 63.00% " $1,874.25 " Percent of Billed Charges 75.00% " $2,231.25 " Percent of Billed Charges 66.24% " $1,970.64 " Percent of Billed Charges 35.00% " $1,041.25 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,785.00 " Percent of Billed Charges HC PHONAK L90 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC PHONAK L30-RL 270 CPT V5298 Outpatient " $1,700.00 " $595.00 " $1,572.50 " " $1,700.00 " 61.04% " $1,037.68 " Percent of Billed Charges 69.29% " $1,177.93 " Percent of Billed Charges 56.78% $965.26 Percent of Billed Charges 74.74% " $1,270.58 " Percent of Billed Charges 68.24% " $1,160.08 " Percent of Billed Charges 65.00% " $1,105.00 " Percent of Billed Charges 67.00% " $1,139.00 " Percent of Billed Charges 77.50% " $1,317.50 " Percent of Billed Charges 79.97% " $1,359.49 " Percent of Billed Charges 55.00% $935.00 Percent of Billed Charges 49.55% $842.35 Percent of Billed Charges 55.00% $935.00 Percent of Billed Charges 55.00% $935.00 Percent of Billed Charges 78.94% " $1,341.98 " Percent of Billed Charges 74.00% " $1,258.00 " Percent of Billed Charges 92.50% " $1,572.50 " Percent of Billed Charges 55.00% $935.00 Percent of Billed Charges 85.00% " $1,445.00 " Percent of Billed Charges 63.00% " $1,071.00 " Percent of Billed Charges 63.00% " $1,071.00 " Percent of Billed Charges 75.00% " $1,275.00 " Percent of Billed Charges 66.24% " $1,126.08 " Percent of Billed Charges 35.00% $595.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,020.00 " Percent of Billed Charges HC PHONAK L50-RL 270 CPT V5298 Outpatient " $1,837.50 " $643.13 " $1,699.69 " " $1,837.50 " 61.04% " $1,121.61 " Percent of Billed Charges 69.29% " $1,273.20 " Percent of Billed Charges 56.78% " $1,043.33 " Percent of Billed Charges 74.74% " $1,373.35 " Percent of Billed Charges 68.24% " $1,253.91 " Percent of Billed Charges 65.00% " $1,194.38 " Percent of Billed Charges 67.00% " $1,231.13 " Percent of Billed Charges 77.50% " $1,424.06 " Percent of Billed Charges 79.97% " $1,469.45 " Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 49.55% $910.48 Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 78.94% " $1,450.52 " Percent of Billed Charges 74.00% " $1,359.75 " Percent of Billed Charges 92.50% " $1,699.69 " Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 85.00% " $1,561.88 " Percent of Billed Charges 63.00% " $1,157.63 " Percent of Billed Charges 63.00% " $1,157.63 " Percent of Billed Charges 75.00% " $1,378.13 " Percent of Billed Charges 66.24% " $1,217.16 " Percent of Billed Charges 35.00% $643.13 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,102.50 " Percent of Billed Charges HC PHONAK L70-RL 270 CPT V5298 Outpatient " $3,311.00 " " $1,158.85 " " $3,062.68 " " $3,311.00 " 61.04% " $2,021.03 " Percent of Billed Charges 69.29% " $2,294.19 " Percent of Billed Charges 56.78% " $1,879.99 " Percent of Billed Charges 74.74% " $2,474.64 " Percent of Billed Charges 68.24% " $2,259.43 " Percent of Billed Charges 65.00% " $2,152.15 " Percent of Billed Charges 67.00% " $2,218.37 " Percent of Billed Charges 77.50% " $2,566.03 " Percent of Billed Charges 79.97% " $2,647.81 " Percent of Billed Charges 55.00% " $1,821.05 " Percent of Billed Charges 49.55% " $1,640.60 " Percent of Billed Charges 55.00% " $1,821.05 " Percent of Billed Charges 55.00% " $1,821.05 " Percent of Billed Charges 78.94% " $2,613.70 " Percent of Billed Charges 74.00% " $2,450.14 " Percent of Billed Charges 92.50% " $3,062.68 " Percent of Billed Charges 55.00% " $1,821.05 " Percent of Billed Charges 85.00% " $2,814.35 " Percent of Billed Charges 63.00% " $2,085.93 " Percent of Billed Charges 63.00% " $2,085.93 " Percent of Billed Charges 75.00% " $2,483.25 " Percent of Billed Charges 66.24% " $2,193.21 " Percent of Billed Charges 35.00% " $1,158.85 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,986.60 " Percent of Billed Charges HC PHONAK L90-RL 270 CPT V5298 Outpatient " $3,447.70 " " $1,206.70 " " $3,189.12 " " $3,447.70 " 61.04% " $2,104.48 " Percent of Billed Charges 69.29% " $2,388.91 " Percent of Billed Charges 56.78% " $1,957.60 " Percent of Billed Charges 74.74% " $2,576.81 " Percent of Billed Charges 68.24% " $2,352.71 " Percent of Billed Charges 65.00% " $2,241.01 " Percent of Billed Charges 67.00% " $2,309.96 " Percent of Billed Charges 77.50% " $2,671.97 " Percent of Billed Charges 79.97% " $2,757.13 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 49.55% " $1,708.34 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 78.94% " $2,721.61 " Percent of Billed Charges 74.00% " $2,551.30 " Percent of Billed Charges 92.50% " $3,189.12 " Percent of Billed Charges 55.00% " $1,896.24 " Percent of Billed Charges 85.00% " $2,930.55 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 63.00% " $2,172.05 " Percent of Billed Charges 75.00% " $2,585.78 " Percent of Billed Charges 66.24% " $2,283.76 " Percent of Billed Charges 35.00% " $1,206.70 " Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $2,068.62 " Percent of Billed Charges HC PHONAK SKY L90-UP/R 270 CPT V5298 Outpatient " $2,852.50 " $998.38 " $2,638.56 " " $2,852.50 " 61.04% " $1,741.17 " Percent of Billed Charges 69.29% " $1,976.50 " Percent of Billed Charges 56.78% " $1,619.65 " Percent of Billed Charges 74.74% " $2,131.96 " Percent of Billed Charges 68.24% " $1,946.55 " Percent of Billed Charges 65.00% " $1,854.13 " Percent of Billed Charges 67.00% " $1,911.18 " Percent of Billed Charges 77.50% " $2,210.69 " Percent of Billed Charges 79.97% " $2,281.14 " Percent of Billed Charges 55.00% " $1,568.88 " Percent of Billed Charges 49.55% " $1,413.41 " Percent of Billed Charges 55.00% " $1,568.88 " Percent of Billed Charges 55.00% " $1,568.88 " Percent of Billed Charges 78.94% " $2,251.76 " Percent of Billed Charges 74.00% " $2,110.85 " Percent of Billed Charges 92.50% " $2,638.56 " Percent of Billed Charges 55.00% " $1,568.88 " Percent of Billed Charges 85.00% " $2,424.63 " Percent of Billed Charges 63.00% " $1,797.08 " Percent of Billed Charges 63.00% " $1,797.08 " Percent of Billed Charges 75.00% " $2,139.38 " Percent of Billed Charges 66.24% " $1,889.50 " Percent of Billed Charges 35.00% $998.38 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,711.50 " Percent of Billed Charges HC PHONAK SKY L70-UP/R 270 CPT V5298 Outpatient " $1,837.50 " $643.13 " $1,699.69 " " $1,837.50 " 61.04% " $1,121.61 " Percent of Billed Charges 69.29% " $1,273.20 " Percent of Billed Charges 56.78% " $1,043.33 " Percent of Billed Charges 74.74% " $1,373.35 " Percent of Billed Charges 68.24% " $1,253.91 " Percent of Billed Charges 65.00% " $1,194.38 " Percent of Billed Charges 67.00% " $1,231.13 " Percent of Billed Charges 77.50% " $1,424.06 " Percent of Billed Charges 79.97% " $1,469.45 " Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 49.55% $910.48 Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 78.94% " $1,450.52 " Percent of Billed Charges 74.00% " $1,359.75 " Percent of Billed Charges 92.50% " $1,699.69 " Percent of Billed Charges 55.00% " $1,010.63 " Percent of Billed Charges 85.00% " $1,561.88 " Percent of Billed Charges 63.00% " $1,157.63 " Percent of Billed Charges 63.00% " $1,157.63 " Percent of Billed Charges 75.00% " $1,378.13 " Percent of Billed Charges 66.24% " $1,217.16 " Percent of Billed Charges 35.00% $643.13 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,102.50 " Percent of Billed Charges HC PHONAK SKY L50-UP/R 270 CPT V5298 Outpatient " $1,860.00 " $651.00 " $1,720.50 " " $1,860.00 " 61.04% " $1,135.34 " Percent of Billed Charges 69.29% " $1,288.79 " Percent of Billed Charges 56.78% " $1,056.11 " Percent of Billed Charges 74.74% " $1,390.16 " Percent of Billed Charges 68.24% " $1,269.26 " Percent of Billed Charges 65.00% " $1,209.00 " Percent of Billed Charges 67.00% " $1,246.20 " Percent of Billed Charges 77.50% " $1,441.50 " Percent of Billed Charges 79.97% " $1,487.44 " Percent of Billed Charges 55.00% " $1,023.00 " Percent of Billed Charges 49.55% $921.63 Percent of Billed Charges 55.00% " $1,023.00 " Percent of Billed Charges 55.00% " $1,023.00 " Percent of Billed Charges 78.94% " $1,468.28 " Percent of Billed Charges 74.00% " $1,376.40 " Percent of Billed Charges 92.50% " $1,720.50 " Percent of Billed Charges 55.00% " $1,023.00 " Percent of Billed Charges 85.00% " $1,581.00 " Percent of Billed Charges 63.00% " $1,171.80 " Percent of Billed Charges 63.00% " $1,171.80 " Percent of Billed Charges 75.00% " $1,395.00 " Percent of Billed Charges 66.24% " $1,232.06 " Percent of Billed Charges 35.00% $651.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,116.00 " Percent of Billed Charges HC PHONAK CHARGE AND CARE 270 CPT V5267 Outpatient $210.00 $73.50 $194.25 $210.00 61.04% $128.18 Percent of Billed Charges 69.29% $145.51 Percent of Billed Charges 56.78% $119.24 Percent of Billed Charges 74.74% $156.95 Percent of Billed Charges 68.24% $143.30 Percent of Billed Charges 65.00% $136.50 Percent of Billed Charges 67.00% $140.70 Percent of Billed Charges 77.50% $162.75 Percent of Billed Charges 79.97% $167.94 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 49.55% $104.06 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 78.94% $165.77 Percent of Billed Charges 74.00% $155.40 Percent of Billed Charges 92.50% $194.25 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 85.00% $178.50 Percent of Billed Charges 63.00% $132.30 Percent of Billed Charges 63.00% $132.30 Percent of Billed Charges 75.00% $157.50 Percent of Billed Charges 66.24% $139.10 Percent of Billed Charges 35.00% $73.50 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $126.00 Percent of Billed Charges HC PHONAK ROGER 21 (MED-EL) 270 CPT V5267 Outpatient " $1,392.52 " $487.38 " $1,288.08 " " $1,392.52 " 61.04% $849.99 Percent of Billed Charges 69.29% $964.88 Percent of Billed Charges 56.78% $790.67 Percent of Billed Charges 74.74% " $1,040.77 " Percent of Billed Charges 68.24% $950.26 Percent of Billed Charges 65.00% $905.14 Percent of Billed Charges 67.00% $932.99 Percent of Billed Charges 77.50% " $1,079.20 " Percent of Billed Charges 79.97% " $1,113.60 " Percent of Billed Charges 55.00% $765.89 Percent of Billed Charges 49.55% $689.99 Percent of Billed Charges 55.00% $765.89 Percent of Billed Charges 55.00% $765.89 Percent of Billed Charges 78.94% " $1,099.26 " Percent of Billed Charges 74.00% " $1,030.46 " Percent of Billed Charges 92.50% " $1,288.08 " Percent of Billed Charges 55.00% $765.89 Percent of Billed Charges 85.00% " $1,183.64 " Percent of Billed Charges 63.00% $877.29 Percent of Billed Charges 63.00% $877.29 Percent of Billed Charges 75.00% " $1,044.39 " Percent of Billed Charges 66.24% $922.41 Percent of Billed Charges 35.00% $487.38 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $835.51 Percent of Billed Charges "HC RESOUND LEVEL 7: OMNIA, CUSTOM, ONE, LINX, ENZO Q" 270 CPT V5298 Outpatient " $2,019.50 " $706.83 " $1,868.04 " " $2,019.50 " 61.04% " $1,232.70 " Percent of Billed Charges 69.29% " $1,399.31 " Percent of Billed Charges 56.78% " $1,146.67 " Percent of Billed Charges 74.74% " $1,509.37 " Percent of Billed Charges 68.24% " $1,378.11 " Percent of Billed Charges 65.00% " $1,312.68 " Percent of Billed Charges 67.00% " $1,353.07 " Percent of Billed Charges 77.50% " $1,565.11 " Percent of Billed Charges 79.97% " $1,614.99 " Percent of Billed Charges 55.00% " $1,110.73 " Percent of Billed Charges 49.55% " $1,000.66 " Percent of Billed Charges 55.00% " $1,110.73 " Percent of Billed Charges 55.00% " $1,110.73 " Percent of Billed Charges 78.94% " $1,594.19 " Percent of Billed Charges 74.00% " $1,494.43 " Percent of Billed Charges 92.50% " $1,868.04 " Percent of Billed Charges 55.00% " $1,110.73 " Percent of Billed Charges 85.00% " $1,716.58 " Percent of Billed Charges 63.00% " $1,272.29 " Percent of Billed Charges 63.00% " $1,272.29 " Percent of Billed Charges 75.00% " $1,514.63 " Percent of Billed Charges 66.24% " $1,337.72 " Percent of Billed Charges 35.00% $706.83 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,211.70 " Percent of Billed Charges "HC RESOUND LEVEL 5 OMNIA, CUSTOM, ONE, LINX" 270 CPT V5298 Outpatient " $1,980.00 " $693.00 " $1,831.50 " " $1,980.00 " 61.04% " $1,208.59 " Percent of Billed Charges 69.29% " $1,371.94 " Percent of Billed Charges 56.78% " $1,124.24 " Percent of Billed Charges 74.74% " $1,479.85 " Percent of Billed Charges 68.24% " $1,351.15 " Percent of Billed Charges 65.00% " $1,287.00 " Percent of Billed Charges 67.00% " $1,326.60 " Percent of Billed Charges 77.50% " $1,534.50 " Percent of Billed Charges 79.97% " $1,583.41 " Percent of Billed Charges 55.00% " $1,089.00 " Percent of Billed Charges 49.55% $981.09 Percent of Billed Charges 55.00% " $1,089.00 " Percent of Billed Charges 55.00% " $1,089.00 " Percent of Billed Charges 78.94% " $1,563.01 " Percent of Billed Charges 74.00% " $1,465.20 " Percent of Billed Charges 92.50% " $1,831.50 " Percent of Billed Charges 55.00% " $1,089.00 " Percent of Billed Charges 85.00% " $1,683.00 " Percent of Billed Charges 63.00% " $1,247.40 " Percent of Billed Charges 63.00% " $1,247.40 " Percent of Billed Charges 75.00% " $1,485.00 " Percent of Billed Charges 66.24% " $1,311.55 " Percent of Billed Charges 35.00% $693.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,188.00 " Percent of Billed Charges HC RESOUND ENZO Q 5 270 CPT V5298 Outpatient $852.00 $298.20 $788.10 $852.00 61.04% $520.06 Percent of Billed Charges 69.29% $590.35 Percent of Billed Charges 56.78% $483.77 Percent of Billed Charges 74.74% $636.78 Percent of Billed Charges 68.24% $581.40 Percent of Billed Charges 65.00% $553.80 Percent of Billed Charges 67.00% $570.84 Percent of Billed Charges 77.50% $660.30 Percent of Billed Charges 79.97% $681.34 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 49.55% $422.17 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 78.94% $672.57 Percent of Billed Charges 74.00% $630.48 Percent of Billed Charges 92.50% $788.10 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 85.00% $724.20 Percent of Billed Charges 63.00% $536.76 Percent of Billed Charges 63.00% $536.76 Percent of Billed Charges 75.00% $639.00 Percent of Billed Charges 66.24% $564.36 Percent of Billed Charges 35.00% $298.20 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $511.20 Percent of Billed Charges HC RESOUND KEY 4 270 CPT V5298 Outpatient $852.00 $298.20 $788.10 $852.00 61.04% $520.06 Percent of Billed Charges 69.29% $590.35 Percent of Billed Charges 56.78% $483.77 Percent of Billed Charges 74.74% $636.78 Percent of Billed Charges 68.24% $581.40 Percent of Billed Charges 65.00% $553.80 Percent of Billed Charges 67.00% $570.84 Percent of Billed Charges 77.50% $660.30 Percent of Billed Charges 79.97% $681.34 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 49.55% $422.17 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 78.94% $672.57 Percent of Billed Charges 74.00% $630.48 Percent of Billed Charges 92.50% $788.10 Percent of Billed Charges 55.00% $468.60 Percent of Billed Charges 85.00% $724.20 Percent of Billed Charges 63.00% $536.76 Percent of Billed Charges 63.00% $536.76 Percent of Billed Charges 75.00% $639.00 Percent of Billed Charges 66.24% $564.36 Percent of Billed Charges 35.00% $298.20 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $511.20 Percent of Billed Charges HC RESOUND KEY 3 270 CPT V5298 Outpatient $700.00 $245.00 $647.50 $700.00 61.04% $427.28 Percent of Billed Charges 69.29% $485.03 Percent of Billed Charges 56.78% $397.46 Percent of Billed Charges 74.74% $523.18 Percent of Billed Charges 68.24% $477.68 Percent of Billed Charges 65.00% $455.00 Percent of Billed Charges 67.00% $469.00 Percent of Billed Charges 77.50% $542.50 Percent of Billed Charges 79.97% $559.79 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 49.55% $346.85 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 78.94% $552.58 Percent of Billed Charges 74.00% $518.00 Percent of Billed Charges 92.50% $647.50 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 85.00% $595.00 Percent of Billed Charges 63.00% $441.00 Percent of Billed Charges 63.00% $441.00 Percent of Billed Charges 75.00% $525.00 Percent of Billed Charges 66.24% $463.68 Percent of Billed Charges 35.00% $245.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $420.00 Percent of Billed Charges HC RESOUND KEY 2 270 CPT V5298 Outpatient $600.00 $210.00 $555.00 $600.00 61.04% $366.24 Percent of Billed Charges 69.29% $415.74 Percent of Billed Charges 56.78% $340.68 Percent of Billed Charges 74.74% $448.44 Percent of Billed Charges 68.24% $409.44 Percent of Billed Charges 65.00% $390.00 Percent of Billed Charges 67.00% $402.00 Percent of Billed Charges 77.50% $465.00 Percent of Billed Charges 79.97% $479.82 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 49.55% $297.30 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 78.94% $473.64 Percent of Billed Charges 74.00% $444.00 Percent of Billed Charges 92.50% $555.00 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 85.00% $510.00 Percent of Billed Charges 63.00% $378.00 Percent of Billed Charges 63.00% $378.00 Percent of Billed Charges 75.00% $450.00 Percent of Billed Charges 66.24% $397.44 Percent of Billed Charges 35.00% $210.00 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% $360.00 Percent of Billed Charges HC PHONAK CROS L-R 270 CPT V5181 Outpatient " $1,996.00 " $698.60 " $1,846.30 " " $1,996.00 " 61.04% " $1,218.36 " Percent of Billed Charges 69.29% " $1,383.03 " Percent of Billed Charges 56.78% " $1,133.33 " Percent of Billed Charges 74.74% " $1,491.81 " Percent of Billed Charges 68.24% " $1,362.07 " Percent of Billed Charges 65.00% " $1,297.40 " Percent of Billed Charges 67.00% " $1,337.32 " Percent of Billed Charges 77.50% " $1,546.90 " Percent of Billed Charges 79.97% " $1,596.20 " Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 49.55% $989.02 Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 78.94% " $1,575.64 " Percent of Billed Charges 74.00% " $1,477.04 " Percent of Billed Charges 92.50% " $1,846.30 " Percent of Billed Charges 55.00% " $1,097.80 " Percent of Billed Charges 85.00% " $1,696.60 " Percent of Billed Charges 63.00% " $1,257.48 " Percent of Billed Charges 63.00% " $1,257.48 " Percent of Billed Charges 75.00% " $1,497.00 " Percent of Billed Charges 66.24% " $1,322.15 " Percent of Billed Charges 35.00% $698.60 Percent of Billed Charges Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost Reimbursed Cost Varies Cost 60.00% " $1,197.60 " Percent of Billed Charges HC OXYGEN PER 24 HRS 270 Revenue Inpatient " $1,894.00 " $- " $1,420.50 " " $1,894.00 " Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other 67.00% " $1,268.98 " Percent of Billed Charges Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other Included in Per-Diem $- Other 75.00% " $1,420.50 " Percent of Billed Charges 66.24% " $1,254.59 " Percent of Billed Charges Included in APR-DRG $- Other Included in APR-DRG $- Other Included in APR-DRG $- Other Included in APR-DRG $- Other Included in APR-DRG $- Other Included in APR-DRG $- Other Included in APR-DRG $- Other Included in Per-Diem $- Other HC OXYGEN PER 24 HRS 271 Revenue Outpatient " $1,894.00 " $- " $3,011.46 " " $1,894.00 " 61.04% " $1,156.10 " Percent of Billed Charges 69.29% " $1,312.35 " Percent of Billed Charges 56.78% " $1,075.41 " Percent of Billed Charges 74.74% " $1,415.58 " Percent of Billed Charges 68.24% " $1,292.47 " Percent of Billed Charges 65.00% " $1,231.10 " Percent of Billed Charges 67.00% " $1,268.98 " Percent of Billed Charges 77.50% " $1,467.85 " Percent of Billed Charges 79.97% " $1,514.63 " Percent of Billed Charges 55.00% " $1,041.70 " Percent of Billed Charges 49.55% $938.48 Percent of Billed Charges 55.00% " $1,041.70 " Percent of Billed Charges 55.00% " $1,041.70 " Percent of Billed Charges 78.94% " $1,495.12 " Percent of Billed Charges 74.00% " $1,401.56 " Percent of Billed Charges 92.50% " $1,751.95 " Percent of Billed Charges 55.00% " $1,041.70 " Percent of Billed Charges 85.00% " $1,609.90 " Percent of Billed Charges 63.00% " $1,193.22 " Percent of Billed Charges 63.00% " $1,193.22 " Percent of Billed Charges 75.00% " $1,420.50 " Percent of Billed Charges 66.24% " $1,254.59 " Percent of Billed Charges 35.00% $662.90 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 127.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $3,011.46 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $1,136.40 " Percent of Billed Charges HC MED-EL ADHEAR PROC/ADH 271 CPT L8692 Outpatient " $5,888.00 " $- " $9,361.92 " " $5,888.00 " 50.17% " $2,954.01 " Percent of Billed Charges 69.29% " $4,079.80 " Percent of Billed Charges 56.78% " $3,343.21 " Percent of Billed Charges 74.74% " $4,400.69 " Percent of Billed Charges 68.24% " $4,017.97 " Percent of Billed Charges 65.00% " $3,827.20 " Percent of Billed Charges 67.00% " $3,944.96 " Percent of Billed Charges 77.50% " $4,563.20 " Percent of Billed Charges 60.17% " $3,542.81 " Percent of Billed Charges 55.00% " $3,238.40 " Percent of Billed Charges 49.55% " $2,917.50 " Percent of Billed Charges 55.00% " $3,238.40 " Percent of Billed Charges 55.00% " $3,238.40 " Percent of Billed Charges 67.04% " $3,947.32 " Percent of Billed Charges 53.00% " $3,120.64 " Percent of Billed Charges 75.18% " $4,426.60 " Percent of Billed Charges 55.00% " $3,238.40 " Percent of Billed Charges 85.00% " $5,004.80 " Percent of Billed Charges 50.00% " $2,944.00 " Percent of Billed Charges 50.00% " $2,944.00 " Percent of Billed Charges 75.00% " $4,416.00 " Percent of Billed Charges 66.24% " $3,900.21 " Percent of Billed Charges 35.00% " $2,060.80 " Percent of Billed Charges 35.07% " $2,064.92 " Percent of Billed Charges Reimbursed Cost Varies Cost 26.64% " $1,568.56 " Percent of Billed Charges Cost + % " $1,764.80 " Cost 159.00% " $9,361.92 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $3,532.80 " Percent of Billed Charges HC OTICON MEDICAL PONTO 4 274 CPT L8692 Outpatient " $9,604.80 " $- " $15,271.63 " " $9,604.80 " 50.17% " $4,818.73 " Percent of Billed Charges 69.29% " $6,655.17 " Percent of Billed Charges 41.36% " $3,972.55 " Percent of Billed Charges 56.23% " $5,400.78 " Percent of Billed Charges 51.69% " $4,964.72 " Percent of Billed Charges 65.00% " $6,243.12 " Percent of Billed Charges 67.00% " $6,435.22 " Percent of Billed Charges 61.50% " $5,906.95 " Percent of Billed Charges 60.17% " $5,779.21 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 49.55% " $4,759.18 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 67.04% " $6,439.06 " Percent of Billed Charges 53.00% " $5,090.54 " Percent of Billed Charges 75.18% " $7,220.89 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 85.00% " $8,164.08 " Percent of Billed Charges 50.00% " $4,802.40 " Percent of Billed Charges 50.00% " $4,802.40 " Percent of Billed Charges 75.00% " $7,203.60 " Percent of Billed Charges 47.27% " $4,540.19 " Percent of Billed Charges 35.00% " $3,361.68 " Percent of Billed Charges 35.07% " $3,368.40 " Percent of Billed Charges Reimbursed Cost Varies Cost 26.64% " $2,558.72 " Percent of Billed Charges Cost + % " $2,878.82 " Cost 159.00% " $15,271.63 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $5,762.88 " Percent of Billed Charges HC COCHLEAR BAHA 6 MAX 274 CPT L8692 Outpatient " $9,534.42 " $- " $15,159.73 " " $9,534.42 " 50.17% " $4,783.42 " Percent of Billed Charges 69.29% " $6,606.40 " Percent of Billed Charges 41.36% " $3,943.44 " Percent of Billed Charges 56.23% " $5,361.20 " Percent of Billed Charges 51.69% " $4,928.34 " Percent of Billed Charges 65.00% " $6,197.37 " Percent of Billed Charges 67.00% " $6,388.06 " Percent of Billed Charges 61.50% " $5,863.67 " Percent of Billed Charges 60.17% " $5,736.86 " Percent of Billed Charges 55.00% " $5,243.93 " Percent of Billed Charges 49.55% " $4,724.31 " Percent of Billed Charges 55.00% " $5,243.93 " Percent of Billed Charges 55.00% " $5,243.93 " Percent of Billed Charges 67.04% " $6,391.88 " Percent of Billed Charges 53.00% " $5,053.24 " Percent of Billed Charges 75.18% " $7,167.98 " Percent of Billed Charges 55.00% " $5,243.93 " Percent of Billed Charges 85.00% " $8,104.26 " Percent of Billed Charges 50.00% " $4,767.21 " Percent of Billed Charges 50.00% " $4,767.21 " Percent of Billed Charges 75.00% " $7,150.82 " Percent of Billed Charges 47.27% " $4,506.92 " Percent of Billed Charges 35.00% " $3,337.05 " Percent of Billed Charges 35.07% " $3,343.72 " Percent of Billed Charges Reimbursed Cost Varies Cost 26.64% " $2,539.97 " Percent of Billed Charges Cost + % " $2,857.73 " Cost 159.00% " $15,159.73 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $5,720.65 " Percent of Billed Charges HC OTICON MEDICAL PONTO 5 MINI 274 CPT L8692 Outpatient " $9,604.80 " $- " $15,271.63 " " $9,604.80 " 50.17% " $4,818.73 " Percent of Billed Charges 69.29% " $6,655.17 " Percent of Billed Charges 41.36% " $3,972.55 " Percent of Billed Charges 56.23% " $5,400.78 " Percent of Billed Charges 51.69% " $4,964.72 " Percent of Billed Charges 65.00% " $6,243.12 " Percent of Billed Charges 67.00% " $6,435.22 " Percent of Billed Charges 61.50% " $5,906.95 " Percent of Billed Charges 60.17% " $5,779.21 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 49.55% " $4,759.18 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 67.04% " $6,439.06 " Percent of Billed Charges 53.00% " $5,090.54 " Percent of Billed Charges 75.18% " $7,220.89 " Percent of Billed Charges 55.00% " $5,282.64 " Percent of Billed Charges 85.00% " $8,164.08 " Percent of Billed Charges 50.00% " $4,802.40 " Percent of Billed Charges 50.00% " $4,802.40 " Percent of Billed Charges 75.00% " $7,203.60 " Percent of Billed Charges 47.27% " $4,540.19 " Percent of Billed Charges 35.00% " $3,361.68 " Percent of Billed Charges 35.07% " $3,368.40 " Percent of Billed Charges Reimbursed Cost Varies Cost 26.64% " $2,558.72 " Percent of Billed Charges Cost + % " $2,878.82 " Cost 159.00% " $15,271.63 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $5,762.88 " Percent of Billed Charges HC OTICON MEDICAL PONTO 5 SUPER POWER 274 CPT L8692 Outpatient " $9,936.00 " $- " $15,798.24 " " $9,936.00 " 50.17% " $4,984.89 " Percent of Billed Charges 69.29% " $6,884.65 " Percent of Billed Charges 41.36% " $4,109.53 " Percent of Billed Charges 56.23% " $5,587.01 " Percent of Billed Charges 51.69% " $5,135.92 " Percent of Billed Charges 65.00% " $6,458.40 " Percent of Billed Charges 67.00% " $6,657.12 " Percent of Billed Charges 61.50% " $6,110.64 " Percent of Billed Charges 60.17% " $5,978.49 " Percent of Billed Charges 55.00% " $5,464.80 " Percent of Billed Charges 49.55% " $4,923.29 " Percent of Billed Charges 55.00% " $5,464.80 " Percent of Billed Charges 55.00% " $5,464.80 " Percent of Billed Charges 67.04% " $6,661.09 " Percent of Billed Charges 53.00% " $5,266.08 " Percent of Billed Charges 75.18% " $7,469.88 " Percent of Billed Charges 55.00% " $5,464.80 " Percent of Billed Charges 85.00% " $8,445.60 " Percent of Billed Charges 50.00% " $4,968.00 " Percent of Billed Charges 50.00% " $4,968.00 " Percent of Billed Charges 75.00% " $7,452.00 " Percent of Billed Charges 47.27% " $4,696.75 " Percent of Billed Charges 35.00% " $3,477.60 " Percent of Billed Charges 35.07% " $3,484.56 " Percent of Billed Charges Reimbursed Cost Varies Cost 26.64% " $2,646.95 " Percent of Billed Charges Cost + % " $2,978.09 " Cost 159.00% " $15,798.24 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $5,961.60 " Percent of Billed Charges HC ARBOVIRUS ANTIBODY AB; ENCEPHALITIS E EQUINE 274 CPT 86652 90 Outpatient $19.13 $9.48 $30.42 $19.13 $71.88 $19.13 Fee Schedule $71.88 $19.13 Fee Schedule $115.02 $19.13 Fee Schedule 74.74% $14.30 Percent of Billed Charges 68.24% $13.05 Percent of Billed Charges 65.00% $12.43 Percent of Billed Charges 67.00% $12.82 Percent of Billed Charges 77.50% $14.83 Percent of Billed Charges 79.97% $15.30 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 49.55% $9.48 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 78.94% $15.10 Percent of Billed Charges 74.00% $14.16 Percent of Billed Charges 92.50% $17.70 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 85.00% $16.26 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 75.00% $14.35 Percent of Billed Charges 66.24% $12.67 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $30.42 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $11.48 Percent of Billed Charges HC ARBOVIRUS ANTIBODY WEST NILE VIRUS 300 CPT 86789 90 Outpatient $19.13 $9.48 $30.42 $19.13 $78.44 $19.13 Fee Schedule $78.44 $19.13 Fee Schedule $125.48 $19.13 Fee Schedule 74.74% $14.30 Percent of Billed Charges 68.24% $13.05 Percent of Billed Charges 65.00% $12.43 Percent of Billed Charges 67.00% $12.82 Percent of Billed Charges 77.50% $14.83 Percent of Billed Charges 79.97% $15.30 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 49.55% $9.48 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 78.94% $15.10 Percent of Billed Charges 74.00% $14.16 Percent of Billed Charges 92.50% $17.70 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 85.00% $16.26 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 75.00% $14.35 Percent of Billed Charges 66.24% $12.67 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $23.90 Fee Schedule 176.26% $25.36 Fee Schedule 129.00% $18.56 Fee Schedule 191.24% $27.52 Fee Schedule 159.00% $30.42 Fee Schedule 145.00% $20.87 Fee Schedule 60.00% $11.48 Percent of Billed Charges "HC FUNGAL PROBE, TEXAS" 300 CPT 87797 90 Outpatient $155.00 $38.74 $246.45 $155.00 $109.28 $109.28 Fee Schedule $109.28 $109.28 Fee Schedule $261.86 $155.00 Fee Schedule 74.74% $115.85 Percent of Billed Charges 68.24% $105.77 Percent of Billed Charges 65.00% $100.75 Percent of Billed Charges 67.00% $103.85 Percent of Billed Charges 77.50% $120.13 Percent of Billed Charges 79.97% $123.95 Percent of Billed Charges 55.00% $85.25 Percent of Billed Charges 49.55% $76.80 Percent of Billed Charges 55.00% $85.25 Percent of Billed Charges 55.00% $85.25 Percent of Billed Charges 78.94% $122.36 Percent of Billed Charges 74.00% $114.70 Percent of Billed Charges 92.50% $143.38 Percent of Billed Charges 55.00% $85.25 Percent of Billed Charges 85.00% $131.75 Percent of Billed Charges 63.00% $97.65 Percent of Billed Charges 63.00% $97.65 Percent of Billed Charges 75.00% $116.25 Percent of Billed Charges 66.24% $102.67 Percent of Billed Charges 165.81% $49.79 Fee Schedule 166.07% $49.87 Fee Schedule 176.26% $52.93 Fee Schedule 129.00% $38.74 Fee Schedule 191.24% $57.43 Fee Schedule 159.00% $246.45 Fee Schedule 145.00% $43.54 Fee Schedule 60.00% $93.00 Percent of Billed Charges HC 11-DEOXYCORTISOL LABCORP 300 CPT 82634 90 Outpatient $48.00 $23.78 $76.32 $48.00 $159.52 $48.00 Fee Schedule $159.52 $48.00 Fee Schedule $255.32 $48.00 Fee Schedule 74.74% $35.88 Percent of Billed Charges 68.24% $32.76 Percent of Billed Charges 65.00% $31.20 Percent of Billed Charges 67.00% $32.16 Percent of Billed Charges 77.50% $37.20 Percent of Billed Charges 79.97% $38.39 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 49.55% $23.78 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 78.94% $37.89 Percent of Billed Charges 74.00% $35.52 Percent of Billed Charges 92.50% $44.40 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 85.00% $40.80 Percent of Billed Charges 63.00% $30.24 Percent of Billed Charges 63.00% $30.24 Percent of Billed Charges 75.00% $36.00 Percent of Billed Charges 66.24% $31.80 Percent of Billed Charges 165.81% $48.00 Fee Schedule 166.07% $48.63 Fee Schedule 176.26% $51.61 Fee Schedule 129.00% $37.77 Fee Schedule 191.24% $56.00 Fee Schedule 159.00% $76.32 Fee Schedule 145.00% $42.46 Fee Schedule 60.00% $28.80 Percent of Billed Charges HC 17 OH PROGESTERONE QUEST 300 CPT 83498 90 Outpatient $16.00 $7.93 $51.96 $16.00 $148.04 $16.00 Fee Schedule $148.04 $16.00 Fee Schedule $236.92 $16.00 Fee Schedule 74.74% $11.96 Percent of Billed Charges 68.24% $10.92 Percent of Billed Charges 65.00% $10.40 Percent of Billed Charges 67.00% $10.72 Percent of Billed Charges 77.50% $12.40 Percent of Billed Charges 79.97% $12.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 49.55% $7.93 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 78.94% $12.63 Percent of Billed Charges 74.00% $11.84 Percent of Billed Charges 92.50% $14.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 85.00% $13.60 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 75.00% $12.00 Percent of Billed Charges 66.24% $10.60 Percent of Billed Charges 165.81% $16.00 Fee Schedule 166.07% $45.12 Fee Schedule 176.26% $47.89 Fee Schedule 129.00% $35.05 Fee Schedule 191.24% $51.96 Fee Schedule 159.00% $25.44 Fee Schedule 145.00% $39.40 Fee Schedule 60.00% $9.60 Percent of Billed Charges HC 17-HYDROXPREGNENOLONE LABCORP 300 CPT 84143 90 Outpatient $36.00 $17.84 $57.24 $36.00 $124.32 $36.00 Fee Schedule $124.32 $36.00 Fee Schedule $198.90 $36.00 Fee Schedule 74.74% $26.91 Percent of Billed Charges 68.24% $24.57 Percent of Billed Charges 65.00% $23.40 Percent of Billed Charges 67.00% $24.12 Percent of Billed Charges 77.50% $27.90 Percent of Billed Charges 79.97% $28.79 Percent of Billed Charges 55.00% $19.80 Percent of Billed Charges 49.55% $17.84 Percent of Billed Charges 55.00% $19.80 Percent of Billed Charges 55.00% $19.80 Percent of Billed Charges 78.94% $28.42 Percent of Billed Charges 74.00% $26.64 Percent of Billed Charges 92.50% $33.30 Percent of Billed Charges 55.00% $19.80 Percent of Billed Charges 85.00% $30.60 Percent of Billed Charges 63.00% $22.68 Percent of Billed Charges 63.00% $22.68 Percent of Billed Charges 75.00% $27.00 Percent of Billed Charges 66.24% $23.85 Percent of Billed Charges 165.81% $36.00 Fee Schedule 166.07% $37.88 Fee Schedule 176.26% $40.20 Fee Schedule 129.00% $29.42 Fee Schedule 191.24% $43.62 Fee Schedule 159.00% $57.24 Fee Schedule 145.00% $33.07 Fee Schedule 60.00% $21.60 Percent of Billed Charges HC 17-HYDROXYPROGESTERONE SJCNIC 300 CPT 83498 90 Outpatient $16.00 $7.93 $51.96 $16.00 $148.04 $16.00 Fee Schedule $148.04 $16.00 Fee Schedule $236.92 $16.00 Fee Schedule 74.74% $11.96 Percent of Billed Charges 68.24% $10.92 Percent of Billed Charges 65.00% $10.40 Percent of Billed Charges 67.00% $10.72 Percent of Billed Charges 77.50% $12.40 Percent of Billed Charges 79.97% $12.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 49.55% $7.93 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 78.94% $12.63 Percent of Billed Charges 74.00% $11.84 Percent of Billed Charges 92.50% $14.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 85.00% $13.60 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 75.00% $12.00 Percent of Billed Charges 66.24% $10.60 Percent of Billed Charges 165.81% $16.00 Fee Schedule 166.07% $45.12 Fee Schedule 176.26% $47.89 Fee Schedule 129.00% $35.05 Fee Schedule 191.24% $51.96 Fee Schedule 159.00% $25.44 Fee Schedule 145.00% $39.40 Fee Schedule 60.00% $9.60 Percent of Billed Charges HC 1ST CELL SURFACE MARKER UW 300 CPT 88184 90 Outpatient $136.53 $67.65 $217.08 $136.53 $837.68 $136.53 Fee Schedule $837.68 $136.53 Fee Schedule 56.78% $77.52 Percent of Billed Charges 74.74% $102.04 Percent of Billed Charges 68.24% $93.17 Percent of Billed Charges 65.00% $88.74 Percent of Billed Charges 67.00% $91.48 Percent of Billed Charges 77.50% $105.81 Percent of Billed Charges 79.97% $109.18 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 49.55% $67.65 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 78.94% $107.78 Percent of Billed Charges 74.00% $101.03 Percent of Billed Charges 92.50% $126.29 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 85.00% $116.05 Percent of Billed Charges 63.00% $86.01 Percent of Billed Charges 63.00% $86.01 Percent of Billed Charges 75.00% $102.40 Percent of Billed Charges 66.24% $90.44 Percent of Billed Charges 165.81% $97.71 Fee Schedule 166.07% $97.87 Fee Schedule 176.26% $103.87 Fee Schedule 129.00% $76.02 Fee Schedule 191.24% $112.70 Fee Schedule 159.00% $217.08 Fee Schedule 145.00% $85.45 Fee Schedule 60.00% $81.92 Percent of Billed Charges HC 5 NUCLEOTIDASE LABCORP 300 CPT 83915 90 Outpatient $4.00 $1.98 $21.32 $4.00 $60.76 $4.00 Fee Schedule $60.76 $4.00 Fee Schedule $97.23 $4.00 Fee Schedule 74.74% $2.99 Percent of Billed Charges 68.24% $2.73 Percent of Billed Charges 65.00% $2.60 Percent of Billed Charges 67.00% $2.68 Percent of Billed Charges 77.50% $3.10 Percent of Billed Charges 79.97% $3.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 49.55% $1.98 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 78.94% $3.16 Percent of Billed Charges 74.00% $2.96 Percent of Billed Charges 92.50% $3.70 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 85.00% $3.40 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 75.00% $3.00 Percent of Billed Charges 66.24% $2.65 Percent of Billed Charges 165.81% $4.00 Fee Schedule 166.07% $18.52 Fee Schedule 176.26% $19.65 Fee Schedule 129.00% $14.38 Fee Schedule 191.24% $21.32 Fee Schedule 159.00% $6.36 Fee Schedule 145.00% $16.17 Fee Schedule 60.00% $2.40 Percent of Billed Charges HC 5-HIAA ARUP 300 CPT 83497 90 Outpatient $18.88 $9.36 $30.02 $18.88 $70.24 $18.88 Fee Schedule $70.24 $18.88 Fee Schedule $112.49 $18.88 Fee Schedule 74.74% $14.11 Percent of Billed Charges 68.24% $12.88 Percent of Billed Charges 65.00% $12.27 Percent of Billed Charges 67.00% $12.65 Percent of Billed Charges 77.50% $14.63 Percent of Billed Charges 79.97% $15.10 Percent of Billed Charges 55.00% $10.38 Percent of Billed Charges 49.55% $9.36 Percent of Billed Charges 55.00% $10.38 Percent of Billed Charges 55.00% $10.38 Percent of Billed Charges 78.94% $14.90 Percent of Billed Charges 74.00% $13.97 Percent of Billed Charges 92.50% $17.46 Percent of Billed Charges 55.00% $10.38 Percent of Billed Charges 85.00% $16.05 Percent of Billed Charges 63.00% $11.89 Percent of Billed Charges 63.00% $11.89 Percent of Billed Charges 75.00% $14.16 Percent of Billed Charges 66.24% $12.51 Percent of Billed Charges 165.81% $18.88 Fee Schedule 166.07% $21.42 Fee Schedule 176.26% $22.74 Fee Schedule 129.00% $16.64 Fee Schedule 191.24% $24.67 Fee Schedule 159.00% $30.02 Fee Schedule 145.00% $18.71 Fee Schedule 60.00% $11.33 Percent of Billed Charges HC 7-DEHYDROCHOLESTEROL KENNEDY 300 CPT 82542 90 Outpatient $150.00 $31.08 $238.50 $150.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $150.00 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $90.00 Percent of Billed Charges HC A1 ANTITRYPSIN BLD LABCORP 300 CPT 82103 90 Outpatient $3.75 $1.86 $25.70 $3.75 $73.20 $3.75 Fee Schedule $73.20 $3.75 Fee Schedule $117.20 $3.75 Fee Schedule 74.74% $2.80 Percent of Billed Charges 68.24% $2.56 Percent of Billed Charges 65.00% $2.44 Percent of Billed Charges 67.00% $2.51 Percent of Billed Charges 77.50% $2.91 Percent of Billed Charges 79.97% $3.00 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 49.55% $1.86 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 78.94% $2.96 Percent of Billed Charges 74.00% $2.78 Percent of Billed Charges 92.50% $3.47 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 85.00% $3.19 Percent of Billed Charges 63.00% $2.36 Percent of Billed Charges 63.00% $2.36 Percent of Billed Charges 75.00% $2.81 Percent of Billed Charges 66.24% $2.48 Percent of Billed Charges 165.81% $3.75 Fee Schedule 166.07% $22.32 Fee Schedule 176.26% $23.69 Fee Schedule 129.00% $17.34 Fee Schedule 191.24% $25.70 Fee Schedule 159.00% $5.96 Fee Schedule 145.00% $19.49 Fee Schedule 60.00% $2.25 Percent of Billed Charges HC A1 ANTITRYPSIN PHENO LABCORP 300 CPT 82103 90 Outpatient $27.00 $13.38 $42.93 $27.00 $73.20 $27.00 Fee Schedule $73.20 $27.00 Fee Schedule $117.20 $27.00 Fee Schedule 74.74% $20.18 Percent of Billed Charges 68.24% $18.42 Percent of Billed Charges 65.00% $17.55 Percent of Billed Charges 67.00% $18.09 Percent of Billed Charges 77.50% $20.93 Percent of Billed Charges 79.97% $21.59 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 49.55% $13.38 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 78.94% $21.31 Percent of Billed Charges 74.00% $19.98 Percent of Billed Charges 92.50% $24.98 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 85.00% $22.95 Percent of Billed Charges 63.00% $17.01 Percent of Billed Charges 63.00% $17.01 Percent of Billed Charges 75.00% $20.25 Percent of Billed Charges 66.24% $17.88 Percent of Billed Charges 165.81% $22.28 Fee Schedule 166.07% $22.32 Fee Schedule 176.26% $23.69 Fee Schedule 129.00% $17.34 Fee Schedule 191.24% $25.70 Fee Schedule 159.00% $42.93 Fee Schedule 145.00% $19.49 Fee Schedule 60.00% $16.20 Percent of Billed Charges HC ACE LABCORP 300 CPT 82164 90 Outpatient $3.75 $1.86 $27.92 $3.75 $79.56 $3.75 Fee Schedule $79.56 $3.75 Fee Schedule $127.31 $3.75 Fee Schedule 74.74% $2.80 Percent of Billed Charges 68.24% $2.56 Percent of Billed Charges 65.00% $2.44 Percent of Billed Charges 67.00% $2.51 Percent of Billed Charges 77.50% $2.91 Percent of Billed Charges 79.97% $3.00 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 49.55% $1.86 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 78.94% $2.96 Percent of Billed Charges 74.00% $2.78 Percent of Billed Charges 92.50% $3.47 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 85.00% $3.19 Percent of Billed Charges 63.00% $2.36 Percent of Billed Charges 63.00% $2.36 Percent of Billed Charges 75.00% $2.81 Percent of Billed Charges 66.24% $2.48 Percent of Billed Charges 165.81% $3.75 Fee Schedule 166.07% $24.25 Fee Schedule 176.26% $25.73 Fee Schedule 129.00% $18.83 Fee Schedule 191.24% $27.92 Fee Schedule 159.00% $5.96 Fee Schedule 145.00% $21.17 Fee Schedule 60.00% $2.25 Percent of Billed Charges "HC ACETONE, QUANT, BLD ARUP" 300 CPT G0480 90 Outpatient $22.40 $11.10 $170.85 $22.40 $319.76 $22.40 Fee Schedule $319.76 $22.40 Fee Schedule $997.83 $22.40 Fee Schedule 74.74% $16.74 Percent of Billed Charges 68.24% $15.29 Percent of Billed Charges 65.00% $14.56 Percent of Billed Charges 67.00% $15.01 Percent of Billed Charges 77.50% $17.36 Percent of Billed Charges 79.97% $17.91 Percent of Billed Charges 55.00% $12.32 Percent of Billed Charges 49.55% $11.10 Percent of Billed Charges 55.00% $12.32 Percent of Billed Charges 55.00% $12.32 Percent of Billed Charges 78.94% $17.68 Percent of Billed Charges 74.00% $16.58 Percent of Billed Charges 92.50% $20.72 Percent of Billed Charges 55.00% $12.32 Percent of Billed Charges 85.00% $19.04 Percent of Billed Charges 63.00% $14.11 Percent of Billed Charges 63.00% $14.11 Percent of Billed Charges 75.00% $16.80 Percent of Billed Charges 66.24% $14.84 Percent of Billed Charges 165.81% $22.40 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $35.62 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $13.44 Percent of Billed Charges HC ACETYLCHOLINE RECEPTOR AB 300 CPT 83519 90 Outpatient $66.68 $23.74 $106.02 $66.68 $73.60 $66.68 Fee Schedule $73.60 $66.68 Fee Schedule $160.45 $66.68 Fee Schedule 74.74% $49.84 Percent of Billed Charges 68.24% $45.50 Percent of Billed Charges 65.00% $43.34 Percent of Billed Charges 67.00% $44.68 Percent of Billed Charges 77.50% $51.68 Percent of Billed Charges 79.97% $53.32 Percent of Billed Charges 55.00% $36.67 Percent of Billed Charges 49.55% $33.04 Percent of Billed Charges 55.00% $36.67 Percent of Billed Charges 55.00% $36.67 Percent of Billed Charges 78.94% $52.64 Percent of Billed Charges 74.00% $49.34 Percent of Billed Charges 92.50% $61.68 Percent of Billed Charges 55.00% $36.67 Percent of Billed Charges 85.00% $56.68 Percent of Billed Charges 63.00% $42.01 Percent of Billed Charges 63.00% $42.01 Percent of Billed Charges 75.00% $50.01 Percent of Billed Charges 66.24% $44.17 Percent of Billed Charges 165.81% $30.51 Fee Schedule 166.07% $30.56 Fee Schedule 176.26% $32.43 Fee Schedule 129.00% $23.74 Fee Schedule 191.24% $35.19 Fee Schedule 159.00% $106.02 Fee Schedule 145.00% $26.68 Fee Schedule 60.00% $40.01 Percent of Billed Charges HC ACT - POINT OF CARE 300 CPT 85347 Outpatient $374.00 $5.52 $594.66 $374.00 $23.20 $23.20 Fee Schedule $23.20 $23.20 Fee Schedule $37.32 $35.40 Fee Schedule 74.74% $279.53 Percent of Billed Charges 68.24% $255.22 Percent of Billed Charges 65.00% $243.10 Percent of Billed Charges 67.00% $250.58 Percent of Billed Charges 77.50% $289.85 Percent of Billed Charges 79.97% $299.09 Percent of Billed Charges 55.00% $205.70 Percent of Billed Charges 49.55% $185.32 Percent of Billed Charges 55.00% $205.70 Percent of Billed Charges 55.00% $205.70 Percent of Billed Charges 78.94% $295.24 Percent of Billed Charges 74.00% $276.76 Percent of Billed Charges 92.50% $345.95 Percent of Billed Charges 55.00% $205.70 Percent of Billed Charges 85.00% $317.90 Percent of Billed Charges 63.00% $235.62 Percent of Billed Charges 63.00% $235.62 Percent of Billed Charges 75.00% $280.50 Percent of Billed Charges 66.24% $247.74 Percent of Billed Charges 165.81% $7.10 Fee Schedule 166.07% $7.11 Fee Schedule 176.26% $7.54 Fee Schedule 129.00% $5.52 Fee Schedule 191.24% $8.19 Fee Schedule 159.00% $594.66 Fee Schedule 145.00% $6.21 Fee Schedule 60.00% $224.40 Percent of Billed Charges HC ACTH LABCORP 300 CPT 82024 90 Outpatient $14.00 $6.94 $73.86 $14.00 $210.44 $14.00 Fee Schedule $210.44 $14.00 Fee Schedule $336.77 $14.00 Fee Schedule 74.74% $10.46 Percent of Billed Charges 68.24% $9.55 Percent of Billed Charges 65.00% $9.10 Percent of Billed Charges 67.00% $9.38 Percent of Billed Charges 77.50% $10.85 Percent of Billed Charges 79.97% $11.20 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 49.55% $6.94 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 78.94% $11.05 Percent of Billed Charges 74.00% $10.36 Percent of Billed Charges 92.50% $12.95 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 85.00% $11.90 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 75.00% $10.50 Percent of Billed Charges 66.24% $9.27 Percent of Billed Charges 165.81% $14.00 Fee Schedule 166.07% $64.14 Fee Schedule 176.26% $68.07 Fee Schedule 129.00% $49.82 Fee Schedule 191.24% $73.86 Fee Schedule 159.00% $22.26 Fee Schedule 145.00% $56.00 Fee Schedule 60.00% $8.40 Percent of Billed Charges HC ACTIN SMOOTH MUSCLE AB LABCORP 300 CPT 83516 90 Outpatient $7.00 $3.47 $22.05 $7.00 $62.84 $7.00 Fee Schedule $62.84 $7.00 Fee Schedule $100.54 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC ACYGLYCINE QUEST 300 CPT 82542 90 Outpatient $165.24 $31.08 $262.73 $165.24 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $165.24 Fee Schedule 74.74% $123.50 Percent of Billed Charges 68.24% $112.76 Percent of Billed Charges 65.00% $107.41 Percent of Billed Charges 67.00% $110.71 Percent of Billed Charges 77.50% $128.06 Percent of Billed Charges 79.97% $132.14 Percent of Billed Charges 55.00% $90.88 Percent of Billed Charges 49.55% $81.88 Percent of Billed Charges 55.00% $90.88 Percent of Billed Charges 55.00% $90.88 Percent of Billed Charges 78.94% $130.44 Percent of Billed Charges 74.00% $122.28 Percent of Billed Charges 92.50% $152.85 Percent of Billed Charges 55.00% $90.88 Percent of Billed Charges 85.00% $140.45 Percent of Billed Charges 63.00% $104.10 Percent of Billed Charges 63.00% $104.10 Percent of Billed Charges 75.00% $123.93 Percent of Billed Charges 66.24% $109.45 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $262.73 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $99.14 Percent of Billed Charges HC ACYLCARNITINE LABCORP 300 CPT 82017 90 Outpatient $12.00 $5.95 $32.26 $12.00 $91.88 $12.00 Fee Schedule $91.88 $12.00 Fee Schedule $147.11 $12.00 Fee Schedule 74.74% $8.97 Percent of Billed Charges 68.24% $8.19 Percent of Billed Charges 65.00% $7.80 Percent of Billed Charges 67.00% $8.04 Percent of Billed Charges 77.50% $9.30 Percent of Billed Charges 79.97% $9.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 49.55% $5.95 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 78.94% $9.47 Percent of Billed Charges 74.00% $8.88 Percent of Billed Charges 92.50% $11.10 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 85.00% $10.20 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 75.00% $9.00 Percent of Billed Charges 66.24% $7.95 Percent of Billed Charges 165.81% $12.00 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $19.08 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $7.20 Percent of Billed Charges HC ACYLCARNITINE STANFORD 300 CPT 82017 90 Outpatient $78.00 $21.76 $124.02 $78.00 $91.88 $78.00 Fee Schedule $91.88 $78.00 Fee Schedule $147.11 $74.00 Fee Schedule 74.74% $58.30 Percent of Billed Charges 68.24% $53.23 Percent of Billed Charges 65.00% $50.70 Percent of Billed Charges 67.00% $52.26 Percent of Billed Charges 77.50% $60.45 Percent of Billed Charges 79.97% $62.38 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 49.55% $38.65 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 78.94% $61.57 Percent of Billed Charges 74.00% $57.72 Percent of Billed Charges 92.50% $72.15 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 85.00% $66.30 Percent of Billed Charges 63.00% $49.14 Percent of Billed Charges 63.00% $49.14 Percent of Billed Charges 75.00% $58.50 Percent of Billed Charges 66.24% $51.67 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $124.02 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $46.80 Percent of Billed Charges HC ADAMTS-13 MACHAON DIAGNOSTICS 300 CPT 83520 90 Outpatient $250.00 $22.28 $397.50 $250.00 $70.52 $70.52 Fee Schedule $70.52 $70.52 Fee Schedule $150.59 $142.82 Fee Schedule 74.74% $186.85 Percent of Billed Charges 68.24% $170.60 Percent of Billed Charges 65.00% $162.50 Percent of Billed Charges 67.00% $167.50 Percent of Billed Charges 77.50% $193.75 Percent of Billed Charges 79.97% $199.93 Percent of Billed Charges 55.00% $137.50 Percent of Billed Charges 49.55% $123.88 Percent of Billed Charges 55.00% $137.50 Percent of Billed Charges 55.00% $137.50 Percent of Billed Charges 78.94% $197.35 Percent of Billed Charges 74.00% $185.00 Percent of Billed Charges 92.50% $231.25 Percent of Billed Charges 55.00% $137.50 Percent of Billed Charges 85.00% $212.50 Percent of Billed Charges 63.00% $157.50 Percent of Billed Charges 63.00% $157.50 Percent of Billed Charges 75.00% $187.50 Percent of Billed Charges 66.24% $165.60 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $397.50 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $150.00 Percent of Billed Charges HC ADAMTS-13 MACHAON DIAGNOSTICS 300 CPT 85335 90 Outpatient $530.00 $16.60 $842.70 $530.00 $70.12 $70.12 Fee Schedule $70.12 $70.12 Fee Schedule $112.23 $106.43 Fee Schedule 74.74% $396.12 Percent of Billed Charges 68.24% $361.67 Percent of Billed Charges 65.00% $344.50 Percent of Billed Charges 67.00% $355.10 Percent of Billed Charges 77.50% $410.75 Percent of Billed Charges 79.97% $423.84 Percent of Billed Charges 55.00% $291.50 Percent of Billed Charges 49.55% $262.62 Percent of Billed Charges 55.00% $291.50 Percent of Billed Charges 55.00% $291.50 Percent of Billed Charges 78.94% $418.38 Percent of Billed Charges 74.00% $392.20 Percent of Billed Charges 92.50% $490.25 Percent of Billed Charges 55.00% $291.50 Percent of Billed Charges 85.00% $450.50 Percent of Billed Charges 63.00% $333.90 Percent of Billed Charges 63.00% $333.90 Percent of Billed Charges 75.00% $397.50 Percent of Billed Charges 66.24% $351.07 Percent of Billed Charges 165.81% $21.34 Fee Schedule 166.07% $21.37 Fee Schedule 176.26% $22.68 Fee Schedule 129.00% $16.60 Fee Schedule 191.24% $24.61 Fee Schedule 159.00% $842.70 Fee Schedule 145.00% $18.66 Fee Schedule 60.00% $318.00 Percent of Billed Charges HC ADAMTS-13 MACHAON DIAGNOSTICS 300 CPT 85397 90 Outpatient $248.00 $39.81 $394.32 $248.00 $125.00 $125.00 Fee Schedule $125.00 $125.00 Fee Schedule $269.10 $248.00 Fee Schedule 74.74% $185.36 Percent of Billed Charges 68.24% $169.24 Percent of Billed Charges 65.00% $161.20 Percent of Billed Charges 67.00% $166.16 Percent of Billed Charges 77.50% $192.20 Percent of Billed Charges 79.97% $198.33 Percent of Billed Charges 55.00% $136.40 Percent of Billed Charges 49.55% $122.88 Percent of Billed Charges 55.00% $136.40 Percent of Billed Charges 55.00% $136.40 Percent of Billed Charges 78.94% $195.77 Percent of Billed Charges 74.00% $183.52 Percent of Billed Charges 92.50% $229.40 Percent of Billed Charges 55.00% $136.40 Percent of Billed Charges 85.00% $210.80 Percent of Billed Charges 63.00% $156.24 Percent of Billed Charges 63.00% $156.24 Percent of Billed Charges 75.00% $186.00 Percent of Billed Charges 66.24% $164.28 Percent of Billed Charges 165.81% $51.17 Fee Schedule 166.07% $51.25 Fee Schedule 176.26% $54.39 Fee Schedule 129.00% $39.81 Fee Schedule 191.24% $59.02 Fee Schedule 159.00% $394.32 Fee Schedule 145.00% $44.75 Fee Schedule 60.00% $148.80 Percent of Billed Charges HC ADDL CELL SURFACE MARKERS UW 300 CPT 88185 90 Outpatient $136.53 $37.27 $217.08 $136.53 $186.20 $136.53 Fee Schedule $186.20 $136.53 Fee Schedule 56.78% $77.52 Percent of Billed Charges 74.74% $102.04 Percent of Billed Charges 68.24% $93.17 Percent of Billed Charges 65.00% $88.74 Percent of Billed Charges 67.00% $91.48 Percent of Billed Charges 77.50% $105.81 Percent of Billed Charges 79.97% $109.18 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 49.55% $67.65 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 78.94% $107.78 Percent of Billed Charges 74.00% $101.03 Percent of Billed Charges 92.50% $126.29 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 85.00% $116.05 Percent of Billed Charges 63.00% $86.01 Percent of Billed Charges 63.00% $86.01 Percent of Billed Charges 75.00% $102.40 Percent of Billed Charges 66.24% $90.44 Percent of Billed Charges 165.81% $47.90 Fee Schedule 166.07% $47.98 Fee Schedule 176.26% $50.92 Fee Schedule 129.00% $37.27 Fee Schedule 191.24% $55.25 Fee Schedule 159.00% $217.08 Fee Schedule 145.00% $41.89 Fee Schedule 60.00% $81.92 Percent of Billed Charges HC ADENOSINE DEAMINASE STAN 300 CPT 82657 90 Outpatient $31.54 $15.63 $50.15 $31.54 $98.40 $31.54 Fee Schedule $98.40 $31.54 Fee Schedule $193.32 $31.54 Fee Schedule 74.74% $23.57 Percent of Billed Charges 68.24% $21.52 Percent of Billed Charges 65.00% $20.50 Percent of Billed Charges 67.00% $21.13 Percent of Billed Charges 77.50% $24.44 Percent of Billed Charges 79.97% $25.22 Percent of Billed Charges 55.00% $17.35 Percent of Billed Charges 49.55% $15.63 Percent of Billed Charges 55.00% $17.35 Percent of Billed Charges 55.00% $17.35 Percent of Billed Charges 78.94% $24.90 Percent of Billed Charges 74.00% $23.34 Percent of Billed Charges 92.50% $29.17 Percent of Billed Charges 55.00% $17.35 Percent of Billed Charges 85.00% $26.81 Percent of Billed Charges 63.00% $19.87 Percent of Billed Charges 63.00% $19.87 Percent of Billed Charges 75.00% $23.66 Percent of Billed Charges 66.24% $20.89 Percent of Billed Charges 165.81% $31.54 Fee Schedule 166.07% $36.82 Fee Schedule 176.26% $39.08 Fee Schedule 129.00% $28.60 Fee Schedule 191.24% $42.40 Fee Schedule 159.00% $50.15 Fee Schedule 145.00% $32.15 Fee Schedule 60.00% $18.92 Percent of Billed Charges HC ADENOVIRUS DNA PCR VIRACOR 300 CPT 87799 90 Outpatient $201.31 $55.26 $320.08 $201.31 $233.40 $201.31 Fee Schedule $233.40 $201.31 Fee Schedule $373.56 $201.31 Fee Schedule 74.74% $150.46 Percent of Billed Charges 68.24% $137.37 Percent of Billed Charges 65.00% $130.85 Percent of Billed Charges 67.00% $134.88 Percent of Billed Charges 77.50% $156.02 Percent of Billed Charges 79.97% $160.99 Percent of Billed Charges 55.00% $110.72 Percent of Billed Charges 49.55% $99.75 Percent of Billed Charges 55.00% $110.72 Percent of Billed Charges 55.00% $110.72 Percent of Billed Charges 78.94% $158.91 Percent of Billed Charges 74.00% $148.97 Percent of Billed Charges 92.50% $186.21 Percent of Billed Charges 55.00% $110.72 Percent of Billed Charges 85.00% $171.11 Percent of Billed Charges 63.00% $126.83 Percent of Billed Charges 63.00% $126.83 Percent of Billed Charges 75.00% $150.98 Percent of Billed Charges 66.24% $133.35 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $320.08 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $120.79 Percent of Billed Charges "HC ADENOVIRUS DNA, QT PCR" 300 CPT 87799 90 Outpatient $295.85 $55.26 $470.40 $295.85 $233.40 $233.40 Fee Schedule $233.40 $233.40 Fee Schedule $373.56 $295.85 Fee Schedule 74.74% $221.12 Percent of Billed Charges 68.24% $201.89 Percent of Billed Charges 65.00% $192.30 Percent of Billed Charges 67.00% $198.22 Percent of Billed Charges 77.50% $229.28 Percent of Billed Charges 79.97% $236.59 Percent of Billed Charges 55.00% $162.72 Percent of Billed Charges 49.55% $146.59 Percent of Billed Charges 55.00% $162.72 Percent of Billed Charges 55.00% $162.72 Percent of Billed Charges 78.94% $233.54 Percent of Billed Charges 74.00% $218.93 Percent of Billed Charges 92.50% $273.66 Percent of Billed Charges 55.00% $162.72 Percent of Billed Charges 85.00% $251.47 Percent of Billed Charges 63.00% $186.39 Percent of Billed Charges 63.00% $186.39 Percent of Billed Charges 75.00% $221.89 Percent of Billed Charges 66.24% $195.97 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $470.40 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $177.51 Percent of Billed Charges HC ADENOVIRUS PCR QUEST 300 CPT 87798 90 Outpatient $71.34 $35.35 $113.43 $71.34 $191.20 $71.34 Fee Schedule $191.20 $71.34 Fee Schedule $305.98 $71.34 Fee Schedule 74.74% $53.32 Percent of Billed Charges 68.24% $48.68 Percent of Billed Charges 65.00% $46.37 Percent of Billed Charges 67.00% $47.80 Percent of Billed Charges 77.50% $55.29 Percent of Billed Charges 79.97% $57.05 Percent of Billed Charges 55.00% $39.24 Percent of Billed Charges 49.55% $35.35 Percent of Billed Charges 55.00% $39.24 Percent of Billed Charges 55.00% $39.24 Percent of Billed Charges 78.94% $56.32 Percent of Billed Charges 74.00% $52.79 Percent of Billed Charges 92.50% $65.99 Percent of Billed Charges 55.00% $39.24 Percent of Billed Charges 85.00% $60.64 Percent of Billed Charges 63.00% $44.94 Percent of Billed Charges 63.00% $44.94 Percent of Billed Charges 75.00% $53.51 Percent of Billed Charges 66.24% $47.26 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $113.43 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $42.80 Percent of Billed Charges HC ADH LABCORP 300 CPT 84588 90 Outpatient $20.00 $9.91 $64.91 $20.00 $184.96 $20.00 Fee Schedule $184.96 $20.00 Fee Schedule $295.96 $20.00 Fee Schedule 74.74% $14.95 Percent of Billed Charges 68.24% $13.65 Percent of Billed Charges 65.00% $13.00 Percent of Billed Charges 67.00% $13.40 Percent of Billed Charges 77.50% $15.50 Percent of Billed Charges 79.97% $15.99 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 49.55% $9.91 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 78.94% $15.79 Percent of Billed Charges 74.00% $14.80 Percent of Billed Charges 92.50% $18.50 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 85.00% $17.00 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 75.00% $15.00 Percent of Billed Charges 66.24% $13.25 Percent of Billed Charges 165.81% $20.00 Fee Schedule 166.07% $56.36 Fee Schedule 176.26% $59.82 Fee Schedule 129.00% $43.78 Fee Schedule 191.24% $64.91 Fee Schedule 159.00% $31.80 Fee Schedule 145.00% $49.21 Fee Schedule 60.00% $12.00 Percent of Billed Charges HC ADRENAL ANTIBODY LABCORP 300 CPT 86255 90 Outpatient $18.00 $8.92 $28.62 $18.00 $65.64 $18.00 Fee Schedule $65.64 $18.00 Fee Schedule $105.08 $18.00 Fee Schedule 74.74% $13.45 Percent of Billed Charges 68.24% $12.28 Percent of Billed Charges 65.00% $11.70 Percent of Billed Charges 67.00% $12.06 Percent of Billed Charges 77.50% $13.95 Percent of Billed Charges 79.97% $14.39 Percent of Billed Charges 55.00% $9.90 Percent of Billed Charges 49.55% $8.92 Percent of Billed Charges 55.00% $9.90 Percent of Billed Charges 55.00% $9.90 Percent of Billed Charges 78.94% $14.21 Percent of Billed Charges 74.00% $13.32 Percent of Billed Charges 92.50% $16.65 Percent of Billed Charges 55.00% $9.90 Percent of Billed Charges 85.00% $15.30 Percent of Billed Charges 63.00% $11.34 Percent of Billed Charges 63.00% $11.34 Percent of Billed Charges 75.00% $13.50 Percent of Billed Charges 66.24% $11.92 Percent of Billed Charges 165.81% $18.00 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% $28.62 Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $10.80 Percent of Billed Charges HC AEROBIC ORGANISM ID ARUP 300 CPT 87077 90 Outpatient $71.78 $10.42 $114.13 $71.78 $44.00 $44.00 Fee Schedule $44.00 $44.00 Fee Schedule $70.46 $66.82 Fee Schedule 74.74% $53.65 Percent of Billed Charges 68.24% $48.98 Percent of Billed Charges 65.00% $46.66 Percent of Billed Charges 67.00% $48.09 Percent of Billed Charges 77.50% $55.63 Percent of Billed Charges 79.97% $57.40 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 49.55% $35.57 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 78.94% $56.66 Percent of Billed Charges 74.00% $53.12 Percent of Billed Charges 92.50% $66.40 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 85.00% $61.01 Percent of Billed Charges 63.00% $45.22 Percent of Billed Charges 63.00% $45.22 Percent of Billed Charges 75.00% $53.84 Percent of Billed Charges 66.24% $47.55 Percent of Billed Charges 165.81% $13.40 Fee Schedule 166.07% $13.42 Fee Schedule 176.26% $14.24 Fee Schedule 129.00% $10.42 Fee Schedule 191.24% $15.45 Fee Schedule 159.00% $114.13 Fee Schedule 145.00% $11.72 Fee Schedule 60.00% $43.07 Percent of Billed Charges HC AEROBIC SUSCEPTIBILITY ARUP 300 CPT 87186 90 Outpatient $73.50 $11.16 $116.87 $73.50 $47.12 $47.12 Fee Schedule $47.12 $47.12 Fee Schedule $75.43 $71.54 Fee Schedule 74.74% $54.93 Percent of Billed Charges 68.24% $50.16 Percent of Billed Charges 65.00% $47.78 Percent of Billed Charges 67.00% $49.25 Percent of Billed Charges 77.50% $56.96 Percent of Billed Charges 79.97% $58.78 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 49.55% $36.42 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 78.94% $58.02 Percent of Billed Charges 74.00% $54.39 Percent of Billed Charges 92.50% $67.99 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 85.00% $62.48 Percent of Billed Charges 63.00% $46.31 Percent of Billed Charges 63.00% $46.31 Percent of Billed Charges 75.00% $55.13 Percent of Billed Charges 66.24% $48.69 Percent of Billed Charges 165.81% $14.34 Fee Schedule 166.07% $14.37 Fee Schedule 176.26% $15.25 Fee Schedule 129.00% $11.16 Fee Schedule 191.24% $16.54 Fee Schedule 159.00% $116.87 Fee Schedule 145.00% $12.54 Fee Schedule 60.00% $44.10 Percent of Billed Charges HC AFB CONCENTRATION LABCORP 300 CPT 87015 90 Outpatient $14.00 $6.94 $22.26 $14.00 $36.36 $14.00 Fee Schedule $36.36 $14.00 Fee Schedule $58.25 $14.00 Fee Schedule 74.74% $10.46 Percent of Billed Charges 68.24% $9.55 Percent of Billed Charges 65.00% $9.10 Percent of Billed Charges 67.00% $9.38 Percent of Billed Charges 77.50% $10.85 Percent of Billed Charges 79.97% $11.20 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 49.55% $6.94 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 78.94% $11.05 Percent of Billed Charges 74.00% $10.36 Percent of Billed Charges 92.50% $12.95 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 85.00% $11.90 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 75.00% $10.50 Percent of Billed Charges 66.24% $9.27 Percent of Billed Charges 165.81% $11.08 Fee Schedule 166.07% $11.09 Fee Schedule 176.26% $11.77 Fee Schedule 129.00% $8.62 Fee Schedule 191.24% $12.77 Fee Schedule 159.00% $22.26 Fee Schedule 145.00% $9.69 Fee Schedule 60.00% $8.40 Percent of Billed Charges HC AFB CULTURE LABCORP 300 CPT 87116 90 Outpatient $5.00 $2.48 $20.65 $5.00 $58.84 $5.00 Fee Schedule $58.84 $5.00 Fee Schedule $94.18 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $17.94 Fee Schedule 176.26% $19.04 Fee Schedule 129.00% $13.93 Fee Schedule 191.24% $20.65 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $15.66 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC AFB CULTURE AND STAIN QUEST 300 CPT 87015 90 Outpatient $53.78 $8.62 $85.51 $53.78 $36.36 $36.36 Fee Schedule $36.36 $36.36 Fee Schedule $58.25 $53.78 Fee Schedule 74.74% $40.20 Percent of Billed Charges 68.24% $36.70 Percent of Billed Charges 65.00% $34.96 Percent of Billed Charges 67.00% $36.03 Percent of Billed Charges 77.50% $41.68 Percent of Billed Charges 79.97% $43.01 Percent of Billed Charges 55.00% $29.58 Percent of Billed Charges 49.55% $26.65 Percent of Billed Charges 55.00% $29.58 Percent of Billed Charges 55.00% $29.58 Percent of Billed Charges 78.94% $42.45 Percent of Billed Charges 74.00% $39.80 Percent of Billed Charges 92.50% $49.75 Percent of Billed Charges 55.00% $29.58 Percent of Billed Charges 85.00% $45.71 Percent of Billed Charges 63.00% $33.88 Percent of Billed Charges 63.00% $33.88 Percent of Billed Charges 75.00% $40.34 Percent of Billed Charges 66.24% $35.62 Percent of Billed Charges 165.81% $11.08 Fee Schedule 166.07% $11.09 Fee Schedule 176.26% $11.77 Fee Schedule 129.00% $8.62 Fee Schedule 191.24% $12.77 Fee Schedule 159.00% $85.51 Fee Schedule 145.00% $9.69 Fee Schedule 60.00% $32.27 Percent of Billed Charges HC AFB ID BY DNA PROBE LABCO 300 CPT 87149 90 Outpatient $109.75 $25.86 $174.50 $109.75 $109.28 $109.28 Fee Schedule $109.28 $109.28 Fee Schedule $174.84 $109.75 Fee Schedule 74.74% $82.03 Percent of Billed Charges 68.24% $74.89 Percent of Billed Charges 65.00% $71.34 Percent of Billed Charges 67.00% $73.53 Percent of Billed Charges 77.50% $85.06 Percent of Billed Charges 79.97% $87.77 Percent of Billed Charges 55.00% $60.36 Percent of Billed Charges 49.55% $54.38 Percent of Billed Charges 55.00% $60.36 Percent of Billed Charges 55.00% $60.36 Percent of Billed Charges 78.94% $86.64 Percent of Billed Charges 74.00% $81.22 Percent of Billed Charges 92.50% $101.52 Percent of Billed Charges 55.00% $60.36 Percent of Billed Charges 85.00% $93.29 Percent of Billed Charges 63.00% $69.14 Percent of Billed Charges 63.00% $69.14 Percent of Billed Charges 75.00% $82.31 Percent of Billed Charges 66.24% $72.70 Percent of Billed Charges 165.81% $33.24 Fee Schedule 166.07% $33.30 Fee Schedule 176.26% $35.34 Fee Schedule 129.00% $25.86 Fee Schedule 191.24% $38.34 Fee Schedule 159.00% $174.50 Fee Schedule 145.00% $29.07 Fee Schedule 60.00% $65.85 Percent of Billed Charges HC AFB STAIN LABCORP 300 CPT 87206 90 Outpatient $6.00 $2.97 $10.31 $6.00 $29.32 $6.00 Fee Schedule $29.32 $6.00 Fee Schedule $47.00 $6.00 Fee Schedule 74.74% $4.48 Percent of Billed Charges 68.24% $4.09 Percent of Billed Charges 65.00% $3.90 Percent of Billed Charges 67.00% $4.02 Percent of Billed Charges 77.50% $4.65 Percent of Billed Charges 79.97% $4.80 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 49.55% $2.97 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 78.94% $4.74 Percent of Billed Charges 74.00% $4.44 Percent of Billed Charges 92.50% $5.55 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 85.00% $5.10 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 75.00% $4.50 Percent of Billed Charges 66.24% $3.97 Percent of Billed Charges 165.81% $6.00 Fee Schedule 166.07% $8.95 Fee Schedule 176.26% $9.50 Fee Schedule 129.00% $6.95 Fee Schedule 191.24% $10.31 Fee Schedule 159.00% $9.54 Fee Schedule 145.00% $7.82 Fee Schedule 60.00% $3.60 Percent of Billed Charges HC AFP AMINO INTEGRATED 300 CPT 82106 90 Outpatient $44.00 $21.80 $69.96 $44.00 $91.40 $44.00 Fee Schedule $91.40 $44.00 Fee Schedule $148.24 $44.00 Fee Schedule 74.74% $32.89 Percent of Billed Charges 68.24% $30.03 Percent of Billed Charges 65.00% $28.60 Percent of Billed Charges 67.00% $29.48 Percent of Billed Charges 77.50% $34.10 Percent of Billed Charges 79.97% $35.19 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 49.55% $21.80 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 78.94% $34.73 Percent of Billed Charges 74.00% $32.56 Percent of Billed Charges 92.50% $40.70 Percent of Billed Charges 55.00% $24.20 Percent of Billed Charges 85.00% $37.40 Percent of Billed Charges 63.00% $27.72 Percent of Billed Charges 63.00% $27.72 Percent of Billed Charges 75.00% $33.00 Percent of Billed Charges 66.24% $29.15 Percent of Billed Charges 165.81% $28.19 Fee Schedule 166.07% $28.23 Fee Schedule 176.26% $29.96 Fee Schedule 129.00% $21.93 Fee Schedule 191.24% $32.51 Fee Schedule 159.00% $69.96 Fee Schedule 145.00% $24.65 Fee Schedule 60.00% $26.40 Percent of Billed Charges HC AFP TUMOR MARKER ARUP 300 CPT 82105 90 Outpatient $13.23 $6.56 $32.07 $13.23 $91.40 $13.23 Fee Schedule $91.40 $13.23 Fee Schedule $146.23 $13.23 Fee Schedule 74.74% $9.89 Percent of Billed Charges 68.24% $9.03 Percent of Billed Charges 65.00% $8.60 Percent of Billed Charges 67.00% $8.86 Percent of Billed Charges 77.50% $10.25 Percent of Billed Charges 79.97% $10.58 Percent of Billed Charges 55.00% $7.28 Percent of Billed Charges 49.55% $6.56 Percent of Billed Charges 55.00% $7.28 Percent of Billed Charges 55.00% $7.28 Percent of Billed Charges 78.94% $10.44 Percent of Billed Charges 74.00% $9.79 Percent of Billed Charges 92.50% $12.24 Percent of Billed Charges 55.00% $7.28 Percent of Billed Charges 85.00% $11.25 Percent of Billed Charges 63.00% $8.33 Percent of Billed Charges 63.00% $8.33 Percent of Billed Charges 75.00% $9.92 Percent of Billed Charges 66.24% $8.76 Percent of Billed Charges 165.81% $13.23 Fee Schedule 166.07% $27.85 Fee Schedule 176.26% $29.56 Fee Schedule 129.00% $21.63 Fee Schedule 191.24% $32.07 Fee Schedule 159.00% $21.04 Fee Schedule 145.00% $24.32 Fee Schedule 60.00% $7.94 Percent of Billed Charges "HC AGGLUTININ SCREEN, INCUBATED, PREWARM TECHNIQUE" 300 CPT 86941 Outpatient $402.00 $15.62 $639.18 $402.00 $65.96 $65.96 Fee Schedule $65.96 $65.96 Fee Schedule $105.60 $100.15 Fee Schedule 74.74% $300.45 Percent of Billed Charges 68.24% $274.32 Percent of Billed Charges 65.00% $261.30 Percent of Billed Charges 67.00% $269.34 Percent of Billed Charges 77.50% $311.55 Percent of Billed Charges 79.97% $321.48 Percent of Billed Charges 55.00% $221.10 Percent of Billed Charges 49.55% $199.19 Percent of Billed Charges 55.00% $221.10 Percent of Billed Charges 55.00% $221.10 Percent of Billed Charges 78.94% $317.34 Percent of Billed Charges 74.00% $297.48 Percent of Billed Charges 92.50% $371.85 Percent of Billed Charges 55.00% $221.10 Percent of Billed Charges 85.00% $341.70 Percent of Billed Charges 63.00% $253.26 Percent of Billed Charges 63.00% $253.26 Percent of Billed Charges 75.00% $301.50 Percent of Billed Charges 66.24% $266.28 Percent of Billed Charges 165.81% $20.08 Fee Schedule 166.07% $20.11 Fee Schedule 176.26% $21.35 Fee Schedule 129.00% $15.62 Fee Schedule 191.24% $23.16 Fee Schedule 159.00% $639.18 Fee Schedule 145.00% $17.56 Fee Schedule 60.00% $241.20 Percent of Billed Charges "HC AGGLUTININ SCREEN, ROOM TEMPERATURE" 300 CPT 86940 Outpatient $238.00 $11.31 $378.42 $238.00 $44.68 $44.68 Fee Schedule $44.68 $44.68 Fee Schedule $76.47 $72.53 Fee Schedule 74.74% $177.88 Percent of Billed Charges 68.24% $162.41 Percent of Billed Charges 65.00% $154.70 Percent of Billed Charges 67.00% $159.46 Percent of Billed Charges 77.50% $184.45 Percent of Billed Charges 79.97% $190.33 Percent of Billed Charges 55.00% $130.90 Percent of Billed Charges 49.55% $117.93 Percent of Billed Charges 55.00% $130.90 Percent of Billed Charges 55.00% $130.90 Percent of Billed Charges 78.94% $187.88 Percent of Billed Charges 74.00% $176.12 Percent of Billed Charges 92.50% $220.15 Percent of Billed Charges 55.00% $130.90 Percent of Billed Charges 85.00% $202.30 Percent of Billed Charges 63.00% $149.94 Percent of Billed Charges 63.00% $149.94 Percent of Billed Charges 75.00% $178.50 Percent of Billed Charges 66.24% $157.65 Percent of Billed Charges 165.81% $14.54 Fee Schedule 166.07% $14.56 Fee Schedule 176.26% $15.46 Fee Schedule 129.00% $11.31 Fee Schedule 191.24% $16.77 Fee Schedule 159.00% $378.42 Fee Schedule 145.00% $12.72 Fee Schedule 60.00% $142.80 Percent of Billed Charges HC AH50/ALTERN.PATHWAY 300 CPT 86162 90 Outpatient $146.00 $26.21 $232.14 $146.00 $110.72 $110.72 Fee Schedule $110.72 $110.72 Fee Schedule $177.19 $146.00 Fee Schedule 74.74% $109.12 Percent of Billed Charges 68.24% $99.63 Percent of Billed Charges 65.00% $94.90 Percent of Billed Charges 67.00% $97.82 Percent of Billed Charges 77.50% $113.15 Percent of Billed Charges 79.97% $116.76 Percent of Billed Charges 55.00% $80.30 Percent of Billed Charges 49.55% $72.34 Percent of Billed Charges 55.00% $80.30 Percent of Billed Charges 55.00% $80.30 Percent of Billed Charges 78.94% $115.25 Percent of Billed Charges 74.00% $108.04 Percent of Billed Charges 92.50% $135.05 Percent of Billed Charges 55.00% $80.30 Percent of Billed Charges 85.00% $124.10 Percent of Billed Charges 63.00% $91.98 Percent of Billed Charges 63.00% $91.98 Percent of Billed Charges 75.00% $109.50 Percent of Billed Charges 66.24% $96.71 Percent of Billed Charges 165.81% $33.69 Fee Schedule 166.07% $33.75 Fee Schedule 176.26% $35.82 Fee Schedule 129.00% $26.21 Fee Schedule 191.24% $38.86 Fee Schedule 159.00% $232.14 Fee Schedule 145.00% $29.46 Fee Schedule 60.00% $87.60 Percent of Billed Charges HC ALA (D-AMINOL ACID) 300 CPT 82135 90 Outpatient $50.13 $21.22 $79.71 $50.13 $89.64 $50.13 Fee Schedule $89.64 $50.13 Fee Schedule $143.44 $50.13 Fee Schedule 74.74% $37.47 Percent of Billed Charges 68.24% $34.21 Percent of Billed Charges 65.00% $32.58 Percent of Billed Charges 67.00% $33.59 Percent of Billed Charges 77.50% $38.85 Percent of Billed Charges 79.97% $40.09 Percent of Billed Charges 55.00% $27.57 Percent of Billed Charges 49.55% $24.84 Percent of Billed Charges 55.00% $27.57 Percent of Billed Charges 55.00% $27.57 Percent of Billed Charges 78.94% $39.57 Percent of Billed Charges 74.00% $37.10 Percent of Billed Charges 92.50% $46.37 Percent of Billed Charges 55.00% $27.57 Percent of Billed Charges 85.00% $42.61 Percent of Billed Charges 63.00% $31.58 Percent of Billed Charges 63.00% $31.58 Percent of Billed Charges 75.00% $37.60 Percent of Billed Charges 66.24% $33.21 Percent of Billed Charges 165.81% $27.28 Fee Schedule 166.07% $27.32 Fee Schedule 176.26% $28.99 Fee Schedule 129.00% $21.22 Fee Schedule 191.24% $31.46 Fee Schedule 159.00% $79.71 Fee Schedule 145.00% $23.85 Fee Schedule 60.00% $30.08 Percent of Billed Charges "HC ALBUMIN,BODY FLUID ARUP" 300 CPT 82042 90 Outpatient $8.03 $3.98 $12.77 $8.03 $28.20 $8.03 Fee Schedule $28.20 $8.03 Fee Schedule $67.84 $8.03 Fee Schedule 74.74% $6.00 Percent of Billed Charges 68.24% $5.48 Percent of Billed Charges 65.00% $5.22 Percent of Billed Charges 67.00% $5.38 Percent of Billed Charges 77.50% $6.22 Percent of Billed Charges 79.97% $6.42 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 49.55% $3.98 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 78.94% $6.34 Percent of Billed Charges 74.00% $5.94 Percent of Billed Charges 92.50% $7.43 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 85.00% $6.83 Percent of Billed Charges 63.00% $5.06 Percent of Billed Charges 63.00% $5.06 Percent of Billed Charges 75.00% $6.02 Percent of Billed Charges 66.24% $5.32 Percent of Billed Charges 165.81% $8.03 Fee Schedule 166.07% $9.42 Fee Schedule 176.26% $9.99 Fee Schedule 129.00% $7.31 Fee Schedule 191.24% $10.84 Fee Schedule 159.00% $12.77 Fee Schedule 145.00% $8.22 Fee Schedule 60.00% $4.82 Percent of Billed Charges HC ALDOLASE LABCORP 300 CPT 82085 90 Outpatient $2.55 $1.26 $18.57 $2.55 $52.88 $2.55 Fee Schedule $52.88 $2.55 Fee Schedule $84.67 $2.55 Fee Schedule 74.74% $1.91 Percent of Billed Charges 68.24% $1.74 Percent of Billed Charges 65.00% $1.66 Percent of Billed Charges 67.00% $1.71 Percent of Billed Charges 77.50% $1.98 Percent of Billed Charges 79.97% $2.04 Percent of Billed Charges 55.00% $1.40 Percent of Billed Charges 49.55% $1.26 Percent of Billed Charges 55.00% $1.40 Percent of Billed Charges 55.00% $1.40 Percent of Billed Charges 78.94% $2.01 Percent of Billed Charges 74.00% $1.89 Percent of Billed Charges 92.50% $2.36 Percent of Billed Charges 55.00% $1.40 Percent of Billed Charges 85.00% $2.17 Percent of Billed Charges 63.00% $1.61 Percent of Billed Charges 63.00% $1.61 Percent of Billed Charges 75.00% $1.91 Percent of Billed Charges 66.24% $1.69 Percent of Billed Charges 165.81% $2.55 Fee Schedule 166.07% $16.13 Fee Schedule 176.26% $17.11 Fee Schedule 129.00% $12.53 Fee Schedule 191.24% $18.57 Fee Schedule 159.00% $4.05 Fee Schedule 145.00% $14.08 Fee Schedule 60.00% $1.53 Percent of Billed Charges HC ALDOSTERONE LABCORP 300 CPT 82088 90 Outpatient $6.00 $2.97 $77.93 $6.00 $222.04 $6.00 Fee Schedule $222.04 $6.00 Fee Schedule $355.34 $6.00 Fee Schedule 74.74% $4.48 Percent of Billed Charges 68.24% $4.09 Percent of Billed Charges 65.00% $3.90 Percent of Billed Charges 67.00% $4.02 Percent of Billed Charges 77.50% $4.65 Percent of Billed Charges 79.97% $4.80 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 49.55% $2.97 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 78.94% $4.74 Percent of Billed Charges 74.00% $4.44 Percent of Billed Charges 92.50% $5.55 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 85.00% $5.10 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 75.00% $4.50 Percent of Billed Charges 66.24% $3.97 Percent of Billed Charges 165.81% $6.00 Fee Schedule 166.07% $67.67 Fee Schedule 176.26% $71.83 Fee Schedule 129.00% $52.57 Fee Schedule 191.24% $77.93 Fee Schedule 159.00% $9.54 Fee Schedule 145.00% $59.09 Fee Schedule 60.00% $3.60 Percent of Billed Charges HC ALDOSTERONE LABCORP 300 CPT 82088 90 Outpatient $5.25 $2.60 $77.93 $5.25 $222.04 $5.25 Fee Schedule $222.04 $5.25 Fee Schedule $355.34 $5.25 Fee Schedule 74.74% $3.92 Percent of Billed Charges 68.24% $3.58 Percent of Billed Charges 65.00% $3.41 Percent of Billed Charges 67.00% $3.52 Percent of Billed Charges 77.50% $4.07 Percent of Billed Charges 79.97% $4.20 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 49.55% $2.60 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 78.94% $4.14 Percent of Billed Charges 74.00% $3.89 Percent of Billed Charges 92.50% $4.86 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 85.00% $4.46 Percent of Billed Charges 63.00% $3.31 Percent of Billed Charges 63.00% $3.31 Percent of Billed Charges 75.00% $3.94 Percent of Billed Charges 66.24% $3.48 Percent of Billed Charges 165.81% $5.25 Fee Schedule 166.07% $67.67 Fee Schedule 176.26% $71.83 Fee Schedule 129.00% $52.57 Fee Schedule 191.24% $77.93 Fee Schedule 159.00% $8.35 Fee Schedule 145.00% $59.09 Fee Schedule 60.00% $3.15 Percent of Billed Charges HC ALL PANEL BY FISH ARUP 300 CPT 88271 90 Outpatient $288.46 $27.63 $458.65 $288.46 $116.68 $116.68 Fee Schedule $116.68 $116.68 Fee Schedule $186.78 $177.14 Fee Schedule 74.74% $215.60 Percent of Billed Charges 68.24% $196.85 Percent of Billed Charges 65.00% $187.50 Percent of Billed Charges 67.00% $193.27 Percent of Billed Charges 77.50% $223.56 Percent of Billed Charges 79.97% $230.68 Percent of Billed Charges 55.00% $158.65 Percent of Billed Charges 49.55% $142.93 Percent of Billed Charges 55.00% $158.65 Percent of Billed Charges 55.00% $158.65 Percent of Billed Charges 78.94% $227.71 Percent of Billed Charges 74.00% $213.46 Percent of Billed Charges 92.50% $266.83 Percent of Billed Charges 55.00% $158.65 Percent of Billed Charges 85.00% $245.19 Percent of Billed Charges 63.00% $181.73 Percent of Billed Charges 63.00% $181.73 Percent of Billed Charges 75.00% $216.35 Percent of Billed Charges 66.24% $191.08 Percent of Billed Charges 165.81% $35.52 Fee Schedule 166.07% $35.57 Fee Schedule 176.26% $37.75 Fee Schedule 129.00% $27.63 Fee Schedule 191.24% $40.96 Fee Schedule 159.00% $458.65 Fee Schedule 145.00% $31.06 Fee Schedule 60.00% $173.08 Percent of Billed Charges HC ALL PANEL BY FISH ARUP 300 CPT 88275 90 Outpatient $280.46 $66.04 $445.93 $280.46 $218.80 $218.80 Fee Schedule $218.80 $218.80 Fee Schedule $446.38 $280.46 Fee Schedule 74.74% $209.62 Percent of Billed Charges 68.24% $191.39 Percent of Billed Charges 65.00% $182.30 Percent of Billed Charges 67.00% $187.91 Percent of Billed Charges 77.50% $217.36 Percent of Billed Charges 79.97% $224.28 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 49.55% $138.97 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 78.94% $221.40 Percent of Billed Charges 74.00% $207.54 Percent of Billed Charges 92.50% $259.43 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 85.00% $238.39 Percent of Billed Charges 63.00% $176.69 Percent of Billed Charges 63.00% $176.69 Percent of Billed Charges 75.00% $210.35 Percent of Billed Charges 66.24% $185.78 Percent of Billed Charges 165.81% $84.88 Fee Schedule 166.07% $85.01 Fee Schedule 176.26% $90.23 Fee Schedule 129.00% $66.04 Fee Schedule 191.24% $97.90 Fee Schedule 159.00% $445.93 Fee Schedule 145.00% $74.23 Fee Schedule 60.00% $168.28 Percent of Billed Charges HC ALL PANEL BY FISH ARUP 300 CPT 88291 90 Outpatient $280.46 $61.06 $445.93 $280.46 $128.88 $128.88 Fee Schedule $128.88 $128.88 Fee Schedule 56.78% $159.25 Percent of Billed Charges 74.74% $209.62 Percent of Billed Charges 68.24% $191.39 Percent of Billed Charges 65.00% $182.30 Percent of Billed Charges 67.00% $187.91 Percent of Billed Charges 77.50% $217.36 Percent of Billed Charges 79.97% $224.28 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 49.55% $138.97 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 78.94% $221.40 Percent of Billed Charges 74.00% $207.54 Percent of Billed Charges 92.50% $259.43 Percent of Billed Charges 55.00% $154.25 Percent of Billed Charges 85.00% $238.39 Percent of Billed Charges 63.00% $176.69 Percent of Billed Charges 63.00% $176.69 Percent of Billed Charges 75.00% $210.35 Percent of Billed Charges 66.24% $185.78 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $445.93 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $168.28 Percent of Billed Charges HC ALLERGEN IGE ARUP 300 CPT 86003 90 Outpatient $5.00 $2.48 $9.98 $5.00 $28.44 $5.00 Fee Schedule $28.44 $5.00 Fee Schedule $45.52 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC ALLERGEN IGE VIRACOR 300 CPT 86003 90 Outpatient $12.00 $5.95 $19.08 $12.00 $28.44 $12.00 Fee Schedule $28.44 $12.00 Fee Schedule $45.52 $12.00 Fee Schedule 74.74% $8.97 Percent of Billed Charges 68.24% $8.19 Percent of Billed Charges 65.00% $7.80 Percent of Billed Charges 67.00% $8.04 Percent of Billed Charges 77.50% $9.30 Percent of Billed Charges 79.97% $9.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 49.55% $5.95 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 78.94% $9.47 Percent of Billed Charges 74.00% $8.88 Percent of Billed Charges 92.50% $11.10 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 85.00% $10.20 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 75.00% $9.00 Percent of Billed Charges 66.24% $7.95 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $19.08 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $7.20 Percent of Billed Charges HC ALLERGEN SPECIFIC IGE LABCORP 300 CPT 86003 90 Outpatient $40.00 $6.73 $63.60 $40.00 $28.44 $28.44 Fee Schedule $28.44 $28.44 Fee Schedule $45.52 $40.00 Fee Schedule 74.74% $29.90 Percent of Billed Charges 68.24% $27.30 Percent of Billed Charges 65.00% $26.00 Percent of Billed Charges 67.00% $26.80 Percent of Billed Charges 77.50% $31.00 Percent of Billed Charges 79.97% $31.99 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 49.55% $19.82 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 78.94% $31.58 Percent of Billed Charges 74.00% $29.60 Percent of Billed Charges 92.50% $37.00 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 85.00% $34.00 Percent of Billed Charges 63.00% $25.20 Percent of Billed Charges 63.00% $25.20 Percent of Billed Charges 75.00% $30.00 Percent of Billed Charges 66.24% $26.50 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $63.60 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $24.00 Percent of Billed Charges HC ALLERGEN SPECIFIC IGE QUE 300 CPT 86003 90 Outpatient $10.07 $4.99 $16.01 $10.07 $28.44 $10.07 Fee Schedule $28.44 $10.07 Fee Schedule $45.52 $10.07 Fee Schedule 74.74% $7.53 Percent of Billed Charges 68.24% $6.87 Percent of Billed Charges 65.00% $6.55 Percent of Billed Charges 67.00% $6.75 Percent of Billed Charges 77.50% $7.80 Percent of Billed Charges 79.97% $8.05 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 49.55% $4.99 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 78.94% $7.95 Percent of Billed Charges 74.00% $7.45 Percent of Billed Charges 92.50% $9.31 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 85.00% $8.56 Percent of Billed Charges 63.00% $6.34 Percent of Billed Charges 63.00% $6.34 Percent of Billed Charges 75.00% $7.55 Percent of Billed Charges 66.24% $6.67 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $16.01 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $6.04 Percent of Billed Charges HC ALLERGEN SPECIFIC IGE VIRACOR 300 CPT 86003 90 Outpatient $7.22 $3.58 $11.48 $7.22 $28.44 $7.22 Fee Schedule $28.44 $7.22 Fee Schedule $45.52 $7.22 Fee Schedule 74.74% $5.40 Percent of Billed Charges 68.24% $4.93 Percent of Billed Charges 65.00% $4.69 Percent of Billed Charges 67.00% $4.84 Percent of Billed Charges 77.50% $5.60 Percent of Billed Charges 79.97% $5.77 Percent of Billed Charges 55.00% $3.97 Percent of Billed Charges 49.55% $3.58 Percent of Billed Charges 55.00% $3.97 Percent of Billed Charges 55.00% $3.97 Percent of Billed Charges 78.94% $5.70 Percent of Billed Charges 74.00% $5.34 Percent of Billed Charges 92.50% $6.68 Percent of Billed Charges 55.00% $3.97 Percent of Billed Charges 85.00% $6.14 Percent of Billed Charges 63.00% $4.55 Percent of Billed Charges 63.00% $4.55 Percent of Billed Charges 75.00% $5.42 Percent of Billed Charges 66.24% $4.78 Percent of Billed Charges 165.81% $7.22 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $11.48 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $4.33 Percent of Billed Charges HC ALPHA GLOBIN GENE SEQ MAY 300 CPT 81259 90 Outpatient $659.00 $326.53 " $1,147.44 " $659.00 " $2,400.00 " $659.00 Fee Schedule " $2,400.00 " $659.00 Fee Schedule " $5,232.00 " $659.00 Fee Schedule 74.74% $492.54 Percent of Billed Charges 68.24% $449.70 Percent of Billed Charges 65.00% $428.35 Percent of Billed Charges 67.00% $441.53 Percent of Billed Charges 77.50% $510.73 Percent of Billed Charges 79.97% $527.00 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 49.55% $326.53 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 78.94% $520.21 Percent of Billed Charges 74.00% $487.66 Percent of Billed Charges 92.50% $609.58 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 85.00% $560.15 Percent of Billed Charges 63.00% $415.17 Percent of Billed Charges 63.00% $415.17 Percent of Billed Charges 75.00% $494.25 Percent of Billed Charges 66.24% $436.52 Percent of Billed Charges 165.81% $659.00 Fee Schedule 166.07% $996.42 Fee Schedule 176.26% " $1,057.56 " Fee Schedule 129.00% $774.00 Fee Schedule 191.24% " $1,147.44 " Fee Schedule 159.00% " $1,047.81 " Fee Schedule 145.00% $870.00 Fee Schedule 60.00% $395.40 Percent of Billed Charges HC ALPHA SUBUNIT LABCORP 300 CPT 83520 90 Outpatient $65.00 $22.28 $103.35 $65.00 $70.52 $65.00 Fee Schedule $70.52 $65.00 Fee Schedule $150.59 $65.00 Fee Schedule 74.74% $48.58 Percent of Billed Charges 68.24% $44.36 Percent of Billed Charges 65.00% $42.25 Percent of Billed Charges 67.00% $43.55 Percent of Billed Charges 77.50% $50.38 Percent of Billed Charges 79.97% $51.98 Percent of Billed Charges 55.00% $35.75 Percent of Billed Charges 49.55% $32.21 Percent of Billed Charges 55.00% $35.75 Percent of Billed Charges 55.00% $35.75 Percent of Billed Charges 78.94% $51.31 Percent of Billed Charges 74.00% $48.10 Percent of Billed Charges 92.50% $60.13 Percent of Billed Charges 55.00% $35.75 Percent of Billed Charges 85.00% $55.25 Percent of Billed Charges 63.00% $40.95 Percent of Billed Charges 63.00% $40.95 Percent of Billed Charges 75.00% $48.75 Percent of Billed Charges 66.24% $43.06 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $103.35 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $39.00 Percent of Billed Charges HC ALPHA-1 ANTITRYP MUT LABCORP 300 CPT 81332 90 Outpatient $87.00 $- $138.33 $87.00 $237.84 $87.00 Fee Schedule $237.84 $87.00 Fee Schedule $380.63 $87.00 Fee Schedule 74.74% $65.02 Percent of Billed Charges 68.24% $59.37 Percent of Billed Charges 65.00% $56.55 Percent of Billed Charges 67.00% $58.29 Percent of Billed Charges 77.50% $67.43 Percent of Billed Charges 79.97% $69.57 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 49.55% $43.11 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 78.94% $68.68 Percent of Billed Charges 74.00% $64.38 Percent of Billed Charges 92.50% $80.48 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 85.00% $73.95 Percent of Billed Charges 63.00% $54.81 Percent of Billed Charges 63.00% $54.81 Percent of Billed Charges 75.00% $65.25 Percent of Billed Charges 66.24% $57.63 Percent of Billed Charges 35.00% $30.45 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $138.33 Fee Schedule 145.00% $- Fee Schedule 60.00% $52.20 Percent of Billed Charges HC ALPHA-1 ANTITRYPSIN FECES LABC 300 CPT 82103 90 Outpatient $19.90 $9.86 $31.64 $19.90 $73.20 $19.90 Fee Schedule $73.20 $19.90 Fee Schedule $117.20 $19.90 Fee Schedule 74.74% $14.87 Percent of Billed Charges 68.24% $13.58 Percent of Billed Charges 65.00% $12.94 Percent of Billed Charges 67.00% $13.33 Percent of Billed Charges 77.50% $15.42 Percent of Billed Charges 79.97% $15.91 Percent of Billed Charges 55.00% $10.95 Percent of Billed Charges 49.55% $9.86 Percent of Billed Charges 55.00% $10.95 Percent of Billed Charges 55.00% $10.95 Percent of Billed Charges 78.94% $15.71 Percent of Billed Charges 74.00% $14.73 Percent of Billed Charges 92.50% $18.41 Percent of Billed Charges 55.00% $10.95 Percent of Billed Charges 85.00% $16.92 Percent of Billed Charges 63.00% $12.54 Percent of Billed Charges 63.00% $12.54 Percent of Billed Charges 75.00% $14.93 Percent of Billed Charges 66.24% $13.18 Percent of Billed Charges 165.81% $19.90 Fee Schedule 166.07% $22.32 Fee Schedule 176.26% $23.69 Fee Schedule 129.00% $17.34 Fee Schedule 191.24% $25.70 Fee Schedule 159.00% $31.64 Fee Schedule 145.00% $19.49 Fee Schedule 60.00% $11.94 Percent of Billed Charges HC ALPHA-2-ANTIPLASMIN ARUP 300 CPT 85410 90 Outpatient $40.13 $9.95 $63.81 $40.13 $42.00 $40.13 Fee Schedule $42.00 $40.13 Fee Schedule $67.23 $40.13 Fee Schedule 74.74% $29.99 Percent of Billed Charges 68.24% $27.38 Percent of Billed Charges 65.00% $26.08 Percent of Billed Charges 67.00% $26.89 Percent of Billed Charges 77.50% $31.10 Percent of Billed Charges 79.97% $32.09 Percent of Billed Charges 55.00% $22.07 Percent of Billed Charges 49.55% $19.88 Percent of Billed Charges 55.00% $22.07 Percent of Billed Charges 55.00% $22.07 Percent of Billed Charges 78.94% $31.68 Percent of Billed Charges 74.00% $29.70 Percent of Billed Charges 92.50% $37.12 Percent of Billed Charges 55.00% $22.07 Percent of Billed Charges 85.00% $34.11 Percent of Billed Charges 63.00% $25.28 Percent of Billed Charges 63.00% $25.28 Percent of Billed Charges 75.00% $30.10 Percent of Billed Charges 66.24% $26.58 Percent of Billed Charges 165.81% $12.78 Fee Schedule 166.07% $12.80 Fee Schedule 176.26% $13.59 Fee Schedule 129.00% $9.95 Fee Schedule 191.24% $14.74 Fee Schedule 159.00% $63.81 Fee Schedule 145.00% $11.18 Fee Schedule 60.00% $24.08 Percent of Billed Charges HC ALPHA-FETO PROTEIN/CSF ARUP 300 CPT 86316 90 Outpatient $12.73 $6.31 $39.80 $12.73 $113.40 $12.73 Fee Schedule $113.40 $12.73 Fee Schedule $181.46 $12.73 Fee Schedule 74.74% $9.51 Percent of Billed Charges 68.24% $8.69 Percent of Billed Charges 65.00% $8.27 Percent of Billed Charges 67.00% $8.53 Percent of Billed Charges 77.50% $9.87 Percent of Billed Charges 79.97% $10.18 Percent of Billed Charges 55.00% $7.00 Percent of Billed Charges 49.55% $6.31 Percent of Billed Charges 55.00% $7.00 Percent of Billed Charges 55.00% $7.00 Percent of Billed Charges 78.94% $10.05 Percent of Billed Charges 74.00% $9.42 Percent of Billed Charges 92.50% $11.78 Percent of Billed Charges 55.00% $7.00 Percent of Billed Charges 85.00% $10.82 Percent of Billed Charges 63.00% $8.02 Percent of Billed Charges 63.00% $8.02 Percent of Billed Charges 75.00% $9.55 Percent of Billed Charges 66.24% $8.43 Percent of Billed Charges 165.81% $12.73 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $20.24 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $7.64 Percent of Billed Charges HC ALPHAGLOB MULTIPLEX PCR OAKLAN 300 CPT 81257 90 Outpatient $300.00 $- $477.00 $300.00 $409.04 $300.00 Fee Schedule $409.04 $300.00 Fee Schedule $891.71 $300.00 Fee Schedule 74.74% $224.22 Percent of Billed Charges 68.24% $204.72 Percent of Billed Charges 65.00% $195.00 Percent of Billed Charges 67.00% $201.00 Percent of Billed Charges 77.50% $232.50 Percent of Billed Charges 79.97% $239.91 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 49.55% $148.65 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 78.94% $236.82 Percent of Billed Charges 74.00% $222.00 Percent of Billed Charges 92.50% $277.50 Percent of Billed Charges 55.00% $165.00 Percent of Billed Charges 85.00% $255.00 Percent of Billed Charges 63.00% $189.00 Percent of Billed Charges 63.00% $189.00 Percent of Billed Charges 75.00% $225.00 Percent of Billed Charges 66.24% $198.72 Percent of Billed Charges 35.00% $105.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $477.00 Fee Schedule 145.00% $- Fee Schedule 60.00% $180.00 Percent of Billed Charges HC ALPS PANEL T CELLS TOTAL COUNT MAYO 300 CPT 86359 90 Outpatient $120.63 $48.67 $191.80 $120.63 $205.56 $120.63 Fee Schedule $205.56 $120.63 Fee Schedule $329.01 $120.63 Fee Schedule 74.74% $90.16 Percent of Billed Charges 68.24% $82.32 Percent of Billed Charges 65.00% $78.41 Percent of Billed Charges 67.00% $80.82 Percent of Billed Charges 77.50% $93.49 Percent of Billed Charges 79.97% $96.47 Percent of Billed Charges 55.00% $66.35 Percent of Billed Charges 49.55% $59.77 Percent of Billed Charges 55.00% $66.35 Percent of Billed Charges 55.00% $66.35 Percent of Billed Charges 78.94% $95.23 Percent of Billed Charges 74.00% $89.27 Percent of Billed Charges 92.50% $111.58 Percent of Billed Charges 55.00% $66.35 Percent of Billed Charges 85.00% $102.54 Percent of Billed Charges 63.00% $76.00 Percent of Billed Charges 63.00% $76.00 Percent of Billed Charges 75.00% $90.47 Percent of Billed Charges 66.24% $79.91 Percent of Billed Charges 165.81% $62.56 Fee Schedule 166.07% $62.66 Fee Schedule 176.26% $66.50 Fee Schedule 129.00% $48.67 Fee Schedule 191.24% $72.15 Fee Schedule 159.00% $191.80 Fee Schedule 145.00% $54.71 Fee Schedule 60.00% $72.38 Percent of Billed Charges HC ALPS PANEL MONO NEUC CELL ANTIGEN MAYO 300 CPT 86356 90 Outpatient $120.36 $34.55 $191.37 $120.36 $145.88 $120.36 Fee Schedule $145.88 $120.36 Fee Schedule $233.52 $120.36 Fee Schedule 74.74% $89.96 Percent of Billed Charges 68.24% $82.13 Percent of Billed Charges 65.00% $78.23 Percent of Billed Charges 67.00% $80.64 Percent of Billed Charges 77.50% $93.28 Percent of Billed Charges 79.97% $96.25 Percent of Billed Charges 55.00% $66.20 Percent of Billed Charges 49.55% $59.64 Percent of Billed Charges 55.00% $66.20 Percent of Billed Charges 55.00% $66.20 Percent of Billed Charges 78.94% $95.01 Percent of Billed Charges 74.00% $89.07 Percent of Billed Charges 92.50% $111.33 Percent of Billed Charges 55.00% $66.20 Percent of Billed Charges 85.00% $102.31 Percent of Billed Charges 63.00% $75.83 Percent of Billed Charges 63.00% $75.83 Percent of Billed Charges 75.00% $90.27 Percent of Billed Charges 66.24% $79.73 Percent of Billed Charges 165.81% $44.40 Fee Schedule 166.07% $44.47 Fee Schedule 176.26% $47.20 Fee Schedule 129.00% $34.55 Fee Schedule 191.24% $51.21 Fee Schedule 159.00% $191.37 Fee Schedule 145.00% $38.83 Fee Schedule 60.00% $72.22 Percent of Billed Charges HC ALUMINUM LABCORP 300 CPT 82108 90 Outpatient $15.00 $7.43 $48.73 $15.00 $138.84 $15.00 Fee Schedule $138.84 $15.00 Fee Schedule $222.19 $15.00 Fee Schedule 74.74% $11.21 Percent of Billed Charges 68.24% $10.24 Percent of Billed Charges 65.00% $9.75 Percent of Billed Charges 67.00% $10.05 Percent of Billed Charges 77.50% $11.63 Percent of Billed Charges 79.97% $12.00 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 49.55% $7.43 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 78.94% $11.84 Percent of Billed Charges 74.00% $11.10 Percent of Billed Charges 92.50% $13.88 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 85.00% $12.75 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 75.00% $11.25 Percent of Billed Charges 66.24% $9.94 Percent of Billed Charges 165.81% $15.00 Fee Schedule 166.07% $42.31 Fee Schedule 176.26% $44.91 Fee Schedule 129.00% $32.87 Fee Schedule 191.24% $48.73 Fee Schedule 159.00% $23.85 Fee Schedule 145.00% $36.95 Fee Schedule 60.00% $9.00 Percent of Billed Charges HC AMEBIASIS ANTIBODIES 300 CPT 86753 90 Outpatient $8.00 $3.96 $23.69 $8.00 $67.48 $8.00 Fee Schedule $67.48 $8.00 Fee Schedule $108.04 $8.00 Fee Schedule 74.74% $5.98 Percent of Billed Charges 68.24% $5.46 Percent of Billed Charges 65.00% $5.20 Percent of Billed Charges 67.00% $5.36 Percent of Billed Charges 77.50% $6.20 Percent of Billed Charges 79.97% $6.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 49.55% $3.96 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 78.94% $6.32 Percent of Billed Charges 74.00% $5.92 Percent of Billed Charges 92.50% $7.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 85.00% $6.80 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 75.00% $6.00 Percent of Billed Charges 66.24% $5.30 Percent of Billed Charges 165.81% $8.00 Fee Schedule 166.07% $20.58 Fee Schedule 176.26% $21.84 Fee Schedule 129.00% $15.98 Fee Schedule 191.24% $23.69 Fee Schedule 159.00% $12.72 Fee Schedule 145.00% $17.97 Fee Schedule 60.00% $4.80 Percent of Billed Charges "HC AMINO ACID, BLOOD LABCORP" 300 CPT 82139 90 Outpatient $32.00 $15.86 $50.88 $32.00 $91.88 $32.00 Fee Schedule $91.88 $32.00 Fee Schedule $147.11 $32.00 Fee Schedule 74.74% $23.92 Percent of Billed Charges 68.24% $21.84 Percent of Billed Charges 65.00% $20.80 Percent of Billed Charges 67.00% $21.44 Percent of Billed Charges 77.50% $24.80 Percent of Billed Charges 79.97% $25.59 Percent of Billed Charges 55.00% $17.60 Percent of Billed Charges 49.55% $15.86 Percent of Billed Charges 55.00% $17.60 Percent of Billed Charges 55.00% $17.60 Percent of Billed Charges 78.94% $25.26 Percent of Billed Charges 74.00% $23.68 Percent of Billed Charges 92.50% $29.60 Percent of Billed Charges 55.00% $17.60 Percent of Billed Charges 85.00% $27.20 Percent of Billed Charges 63.00% $20.16 Percent of Billed Charges 63.00% $20.16 Percent of Billed Charges 75.00% $24.00 Percent of Billed Charges 66.24% $21.20 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $50.88 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $19.20 Percent of Billed Charges HC AMINO ACIDS CSF MEDNEU 300 CPT 82139 90 Outpatient $235.00 $21.76 $373.65 $235.00 $91.88 $91.88 Fee Schedule $91.88 $91.88 Fee Schedule $147.11 $139.51 Fee Schedule 74.74% $175.64 Percent of Billed Charges 68.24% $160.36 Percent of Billed Charges 65.00% $152.75 Percent of Billed Charges 67.00% $157.45 Percent of Billed Charges 77.50% $182.13 Percent of Billed Charges 79.97% $187.93 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 49.55% $116.44 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 78.94% $185.51 Percent of Billed Charges 74.00% $173.90 Percent of Billed Charges 92.50% $217.38 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 85.00% $199.75 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 75.00% $176.25 Percent of Billed Charges 66.24% $155.66 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $373.65 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $141.00 Percent of Billed Charges HC AMINO ACIDS URINE STANFORD 300 CPT 82139 90 Outpatient $74.00 $21.76 $117.66 $74.00 $91.88 $74.00 Fee Schedule $91.88 $74.00 Fee Schedule $147.11 $74.00 Fee Schedule 74.74% $55.31 Percent of Billed Charges 68.24% $50.50 Percent of Billed Charges 65.00% $48.10 Percent of Billed Charges 67.00% $49.58 Percent of Billed Charges 77.50% $57.35 Percent of Billed Charges 79.97% $59.18 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 49.55% $36.67 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 78.94% $58.42 Percent of Billed Charges 74.00% $54.76 Percent of Billed Charges 92.50% $68.45 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 85.00% $62.90 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 75.00% $55.50 Percent of Billed Charges 66.24% $49.02 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $117.66 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $44.40 Percent of Billed Charges "HC AMINO ACIDS, PLASMA STANFORD" 300 CPT 82139 90 Outpatient $78.00 $21.76 $124.02 $78.00 $91.88 $78.00 Fee Schedule $91.88 $78.00 Fee Schedule $147.11 $74.00 Fee Schedule 74.74% $58.30 Percent of Billed Charges 68.24% $53.23 Percent of Billed Charges 65.00% $50.70 Percent of Billed Charges 67.00% $52.26 Percent of Billed Charges 77.50% $60.45 Percent of Billed Charges 79.97% $62.38 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 49.55% $38.65 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 78.94% $61.57 Percent of Billed Charges 74.00% $57.72 Percent of Billed Charges 92.50% $72.15 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 85.00% $66.30 Percent of Billed Charges 63.00% $49.14 Percent of Billed Charges 63.00% $49.14 Percent of Billed Charges 75.00% $58.50 Percent of Billed Charges 66.24% $51.67 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $124.02 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $46.80 Percent of Billed Charges HC AMIODARONE 300 CPT 82542 90 Outpatient $17.46 $8.65 $46.07 $17.46 $98.40 $17.46 Fee Schedule $98.40 $17.46 Fee Schedule $210.06 $17.46 Fee Schedule 74.74% $13.05 Percent of Billed Charges 68.24% $11.91 Percent of Billed Charges 65.00% $11.35 Percent of Billed Charges 67.00% $11.70 Percent of Billed Charges 77.50% $13.53 Percent of Billed Charges 79.97% $13.96 Percent of Billed Charges 55.00% $9.60 Percent of Billed Charges 49.55% $8.65 Percent of Billed Charges 55.00% $9.60 Percent of Billed Charges 55.00% $9.60 Percent of Billed Charges 78.94% $13.78 Percent of Billed Charges 74.00% $12.92 Percent of Billed Charges 92.50% $16.15 Percent of Billed Charges 55.00% $9.60 Percent of Billed Charges 85.00% $14.84 Percent of Billed Charges 63.00% $11.00 Percent of Billed Charges 63.00% $11.00 Percent of Billed Charges 75.00% $13.10 Percent of Billed Charges 66.24% $11.57 Percent of Billed Charges 165.81% $17.46 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $27.76 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $10.48 Percent of Billed Charges HC AML PANEL BY FISH ARUP 300 CPT 88271 90 Outpatient $357.00 $27.63 $567.63 $357.00 $116.68 $116.68 Fee Schedule $116.68 $116.68 Fee Schedule $186.78 $177.14 Fee Schedule 74.74% $266.82 Percent of Billed Charges 68.24% $243.62 Percent of Billed Charges 65.00% $232.05 Percent of Billed Charges 67.00% $239.19 Percent of Billed Charges 77.50% $276.68 Percent of Billed Charges 79.97% $285.49 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 49.55% $176.89 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 78.94% $281.82 Percent of Billed Charges 74.00% $264.18 Percent of Billed Charges 92.50% $330.23 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 85.00% $303.45 Percent of Billed Charges 63.00% $224.91 Percent of Billed Charges 63.00% $224.91 Percent of Billed Charges 75.00% $267.75 Percent of Billed Charges 66.24% $236.48 Percent of Billed Charges 165.81% $35.52 Fee Schedule 166.07% $35.57 Fee Schedule 176.26% $37.75 Fee Schedule 129.00% $27.63 Fee Schedule 191.24% $40.96 Fee Schedule 159.00% $567.63 Fee Schedule 145.00% $31.06 Fee Schedule 60.00% $214.20 Percent of Billed Charges HC AML PANEL BY FISH ARUP 300 CPT 88275 90 Outpatient $357.00 $66.04 $567.63 $357.00 $218.80 $218.80 Fee Schedule $218.80 $218.80 Fee Schedule $446.38 $357.00 Fee Schedule 74.74% $266.82 Percent of Billed Charges 68.24% $243.62 Percent of Billed Charges 65.00% $232.05 Percent of Billed Charges 67.00% $239.19 Percent of Billed Charges 77.50% $276.68 Percent of Billed Charges 79.97% $285.49 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 49.55% $176.89 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 78.94% $281.82 Percent of Billed Charges 74.00% $264.18 Percent of Billed Charges 92.50% $330.23 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 85.00% $303.45 Percent of Billed Charges 63.00% $224.91 Percent of Billed Charges 63.00% $224.91 Percent of Billed Charges 75.00% $267.75 Percent of Billed Charges 66.24% $236.48 Percent of Billed Charges 165.81% $84.88 Fee Schedule 166.07% $85.01 Fee Schedule 176.26% $90.23 Fee Schedule 129.00% $66.04 Fee Schedule 191.24% $97.90 Fee Schedule 159.00% $567.63 Fee Schedule 145.00% $74.23 Fee Schedule 60.00% $214.20 Percent of Billed Charges HC AML PANEL BY FISH ARUP 300 CPT 88291 90 Outpatient $357.00 $61.06 $567.63 $357.00 $128.88 $128.88 Fee Schedule $128.88 $128.88 Fee Schedule 56.78% $202.70 Percent of Billed Charges 74.74% $266.82 Percent of Billed Charges 68.24% $243.62 Percent of Billed Charges 65.00% $232.05 Percent of Billed Charges 67.00% $239.19 Percent of Billed Charges 77.50% $276.68 Percent of Billed Charges 79.97% $285.49 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 49.55% $176.89 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 78.94% $281.82 Percent of Billed Charges 74.00% $264.18 Percent of Billed Charges 92.50% $330.23 Percent of Billed Charges 55.00% $196.35 Percent of Billed Charges 85.00% $303.45 Percent of Billed Charges 63.00% $224.91 Percent of Billed Charges 63.00% $224.91 Percent of Billed Charges 75.00% $267.75 Percent of Billed Charges 66.24% $236.48 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $567.63 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $214.20 Percent of Billed Charges "HC AMPHETAMINE CONFIRM UR, QUEST" 300 CPT G0480 90 Outpatient $35.00 $17.34 $170.85 $35.00 $319.76 $35.00 Fee Schedule $319.76 $35.00 Fee Schedule $997.83 $35.00 Fee Schedule 74.74% $26.16 Percent of Billed Charges 68.24% $23.88 Percent of Billed Charges 65.00% $22.75 Percent of Billed Charges 67.00% $23.45 Percent of Billed Charges 77.50% $27.13 Percent of Billed Charges 79.97% $27.99 Percent of Billed Charges 55.00% $19.25 Percent of Billed Charges 49.55% $17.34 Percent of Billed Charges 55.00% $19.25 Percent of Billed Charges 55.00% $19.25 Percent of Billed Charges 78.94% $27.63 Percent of Billed Charges 74.00% $25.90 Percent of Billed Charges 92.50% $32.38 Percent of Billed Charges 55.00% $19.25 Percent of Billed Charges 85.00% $29.75 Percent of Billed Charges 63.00% $22.05 Percent of Billed Charges 63.00% $22.05 Percent of Billed Charges 75.00% $26.25 Percent of Billed Charges 66.24% $23.18 Percent of Billed Charges 165.81% $35.00 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $55.65 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $21.00 Percent of Billed Charges HC AMYLASE ISOENZYMES LABCORP 300 CPT 82150 90 Outpatient $29.00 $8.36 $46.11 $29.00 $35.32 $29.00 Fee Schedule $35.32 $29.00 Fee Schedule $56.51 $29.00 Fee Schedule 74.74% $21.67 Percent of Billed Charges 68.24% $19.79 Percent of Billed Charges 65.00% $18.85 Percent of Billed Charges 67.00% $19.43 Percent of Billed Charges 77.50% $22.48 Percent of Billed Charges 79.97% $23.19 Percent of Billed Charges 55.00% $15.95 Percent of Billed Charges 49.55% $14.37 Percent of Billed Charges 55.00% $15.95 Percent of Billed Charges 55.00% $15.95 Percent of Billed Charges 78.94% $22.89 Percent of Billed Charges 74.00% $21.46 Percent of Billed Charges 92.50% $26.83 Percent of Billed Charges 55.00% $15.95 Percent of Billed Charges 85.00% $24.65 Percent of Billed Charges 63.00% $18.27 Percent of Billed Charges 63.00% $18.27 Percent of Billed Charges 75.00% $21.75 Percent of Billed Charges 66.24% $19.21 Percent of Billed Charges 165.81% $10.74 Fee Schedule 166.07% $10.76 Fee Schedule 176.26% $11.42 Fee Schedule 129.00% $8.36 Fee Schedule 191.24% $12.39 Fee Schedule 159.00% $46.11 Fee Schedule 145.00% $9.40 Fee Schedule 60.00% $17.40 Percent of Billed Charges "HC AMYLASE,BODY FLUID ARUP" 300 CPT 82150 90 Outpatient $10.70 $5.30 $17.01 $10.70 $35.32 $10.70 Fee Schedule $35.32 $10.70 Fee Schedule $56.51 $10.70 Fee Schedule 74.74% $8.00 Percent of Billed Charges 68.24% $7.30 Percent of Billed Charges 65.00% $6.96 Percent of Billed Charges 67.00% $7.17 Percent of Billed Charges 77.50% $8.29 Percent of Billed Charges 79.97% $8.56 Percent of Billed Charges 55.00% $5.89 Percent of Billed Charges 49.55% $5.30 Percent of Billed Charges 55.00% $5.89 Percent of Billed Charges 55.00% $5.89 Percent of Billed Charges 78.94% $8.45 Percent of Billed Charges 74.00% $7.92 Percent of Billed Charges 92.50% $9.90 Percent of Billed Charges 55.00% $5.89 Percent of Billed Charges 85.00% $9.10 Percent of Billed Charges 63.00% $6.74 Percent of Billed Charges 63.00% $6.74 Percent of Billed Charges 75.00% $8.03 Percent of Billed Charges 66.24% $7.09 Percent of Billed Charges 165.81% $10.70 Fee Schedule 166.07% $10.76 Fee Schedule 176.26% $11.42 Fee Schedule 129.00% $8.36 Fee Schedule 191.24% $12.39 Fee Schedule 159.00% $17.01 Fee Schedule 145.00% $9.40 Fee Schedule 60.00% $6.42 Percent of Billed Charges HC ANA ARUP 300 CPT 86038 90 Outpatient $7.28 $3.61 $23.12 $7.28 $65.88 $7.28 Fee Schedule $65.88 $7.28 Fee Schedule $105.42 $7.28 Fee Schedule 74.74% $5.44 Percent of Billed Charges 68.24% $4.97 Percent of Billed Charges 65.00% $4.73 Percent of Billed Charges 67.00% $4.88 Percent of Billed Charges 77.50% $5.64 Percent of Billed Charges 79.97% $5.82 Percent of Billed Charges 55.00% $4.00 Percent of Billed Charges 49.55% $3.61 Percent of Billed Charges 55.00% $4.00 Percent of Billed Charges 55.00% $4.00 Percent of Billed Charges 78.94% $5.75 Percent of Billed Charges 74.00% $5.39 Percent of Billed Charges 92.50% $6.73 Percent of Billed Charges 55.00% $4.00 Percent of Billed Charges 85.00% $6.19 Percent of Billed Charges 63.00% $4.59 Percent of Billed Charges 63.00% $4.59 Percent of Billed Charges 75.00% $5.46 Percent of Billed Charges 66.24% $4.82 Percent of Billed Charges 165.81% $7.28 Fee Schedule 166.07% $20.08 Fee Schedule 176.26% $21.31 Fee Schedule 129.00% $15.60 Fee Schedule 191.24% $23.12 Fee Schedule 159.00% $11.58 Fee Schedule 145.00% $17.53 Fee Schedule 60.00% $4.37 Percent of Billed Charges HC ANAEROBIC CULTURE & GRAM 300 CPT 87075 90 Outpatient $68.50 $12.22 $108.92 $68.50 $51.60 $51.60 Fee Schedule $51.60 $51.60 Fee Schedule $82.58 $68.50 Fee Schedule 74.74% $51.20 Percent of Billed Charges 68.24% $46.74 Percent of Billed Charges 65.00% $44.53 Percent of Billed Charges 67.00% $45.90 Percent of Billed Charges 77.50% $53.09 Percent of Billed Charges 79.97% $54.78 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 49.55% $33.94 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 78.94% $54.07 Percent of Billed Charges 74.00% $50.69 Percent of Billed Charges 92.50% $63.36 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 85.00% $58.23 Percent of Billed Charges 63.00% $43.16 Percent of Billed Charges 63.00% $43.16 Percent of Billed Charges 75.00% $51.38 Percent of Billed Charges 66.24% $45.37 Percent of Billed Charges 165.81% $15.70 Fee Schedule 166.07% $15.73 Fee Schedule 176.26% $16.69 Fee Schedule 129.00% $12.22 Fee Schedule 191.24% $18.11 Fee Schedule 159.00% $108.92 Fee Schedule 145.00% $13.73 Fee Schedule 60.00% $41.10 Percent of Billed Charges HC ANAEROBIC ORGANISM ID ARUP 300 CPT 87076 90 Outpatient $71.78 $10.42 $114.13 $71.78 $44.00 $44.00 Fee Schedule $44.00 $44.00 Fee Schedule $70.46 $66.82 Fee Schedule 74.74% $53.65 Percent of Billed Charges 68.24% $48.98 Percent of Billed Charges 65.00% $46.66 Percent of Billed Charges 67.00% $48.09 Percent of Billed Charges 77.50% $55.63 Percent of Billed Charges 79.97% $57.40 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 49.55% $35.57 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 78.94% $56.66 Percent of Billed Charges 74.00% $53.12 Percent of Billed Charges 92.50% $66.40 Percent of Billed Charges 55.00% $39.48 Percent of Billed Charges 85.00% $61.01 Percent of Billed Charges 63.00% $45.22 Percent of Billed Charges 63.00% $45.22 Percent of Billed Charges 75.00% $53.84 Percent of Billed Charges 66.24% $47.55 Percent of Billed Charges 165.81% $13.40 Fee Schedule 166.07% $13.42 Fee Schedule 176.26% $14.24 Fee Schedule 129.00% $10.42 Fee Schedule 191.24% $15.45 Fee Schedule 159.00% $114.13 Fee Schedule 145.00% $11.72 Fee Schedule 60.00% $43.07 Percent of Billed Charges HC ANAEROBIC SUSCEPTIBILITY ARUP 300 CPT 87186 90 Outpatient $73.50 $11.16 $116.87 $73.50 $47.12 $47.12 Fee Schedule $47.12 $47.12 Fee Schedule $75.43 $71.54 Fee Schedule 74.74% $54.93 Percent of Billed Charges 68.24% $50.16 Percent of Billed Charges 65.00% $47.78 Percent of Billed Charges 67.00% $49.25 Percent of Billed Charges 77.50% $56.96 Percent of Billed Charges 79.97% $58.78 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 49.55% $36.42 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 78.94% $58.02 Percent of Billed Charges 74.00% $54.39 Percent of Billed Charges 92.50% $67.99 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 85.00% $62.48 Percent of Billed Charges 63.00% $46.31 Percent of Billed Charges 63.00% $46.31 Percent of Billed Charges 75.00% $55.13 Percent of Billed Charges 66.24% $48.69 Percent of Billed Charges 165.81% $14.34 Fee Schedule 166.07% $14.37 Fee Schedule 176.26% $15.25 Fee Schedule 129.00% $11.16 Fee Schedule 191.24% $16.54 Fee Schedule 159.00% $116.87 Fee Schedule 145.00% $12.54 Fee Schedule 60.00% $44.10 Percent of Billed Charges HC ANAPLASMA PHAGOCYTO ABS A 300 CPT 86666 90 Outpatient $63.76 $13.13 $101.38 $63.76 $55.48 $55.48 Fee Schedule $55.48 $55.48 Fee Schedule $88.77 $63.76 Fee Schedule 74.74% $47.65 Percent of Billed Charges 68.24% $43.51 Percent of Billed Charges 65.00% $41.44 Percent of Billed Charges 67.00% $42.72 Percent of Billed Charges 77.50% $49.41 Percent of Billed Charges 79.97% $50.99 Percent of Billed Charges 55.00% $35.07 Percent of Billed Charges 49.55% $31.59 Percent of Billed Charges 55.00% $35.07 Percent of Billed Charges 55.00% $35.07 Percent of Billed Charges 78.94% $50.33 Percent of Billed Charges 74.00% $47.18 Percent of Billed Charges 92.50% $58.98 Percent of Billed Charges 55.00% $35.07 Percent of Billed Charges 85.00% $54.20 Percent of Billed Charges 63.00% $40.17 Percent of Billed Charges 63.00% $40.17 Percent of Billed Charges 75.00% $47.82 Percent of Billed Charges 66.24% $42.23 Percent of Billed Charges 165.81% $16.88 Fee Schedule 166.07% $16.91 Fee Schedule 176.26% $17.94 Fee Schedule 129.00% $13.13 Fee Schedule 191.24% $19.47 Fee Schedule 159.00% $101.38 Fee Schedule 145.00% $14.76 Fee Schedule 60.00% $38.26 Percent of Billed Charges HC ANCA ANTIBODIES ARUP 300 CPT 83516 90 Outpatient $26.06 $12.91 $41.44 $26.06 $62.84 $26.06 Fee Schedule $62.84 $26.06 Fee Schedule $100.54 $26.06 Fee Schedule 74.74% $19.48 Percent of Billed Charges 68.24% $17.78 Percent of Billed Charges 65.00% $16.94 Percent of Billed Charges 67.00% $17.46 Percent of Billed Charges 77.50% $20.20 Percent of Billed Charges 79.97% $20.84 Percent of Billed Charges 55.00% $14.33 Percent of Billed Charges 49.55% $12.91 Percent of Billed Charges 55.00% $14.33 Percent of Billed Charges 55.00% $14.33 Percent of Billed Charges 78.94% $20.57 Percent of Billed Charges 74.00% $19.28 Percent of Billed Charges 92.50% $24.11 Percent of Billed Charges 55.00% $14.33 Percent of Billed Charges 85.00% $22.15 Percent of Billed Charges 63.00% $16.42 Percent of Billed Charges 63.00% $16.42 Percent of Billed Charges 75.00% $19.55 Percent of Billed Charges 66.24% $17.26 Percent of Billed Charges 165.81% $19.12 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $41.44 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $15.64 Percent of Billed Charges HC ANDROSTANEDIOL GLUCURONDE 300 CPT 82154 90 Outpatient $75.91 $37.19 $120.70 $75.91 $157.12 $75.91 Fee Schedule $157.12 $75.91 Fee Schedule $251.40 $75.91 Fee Schedule 74.74% $56.74 Percent of Billed Charges 68.24% $51.80 Percent of Billed Charges 65.00% $49.34 Percent of Billed Charges 67.00% $50.86 Percent of Billed Charges 77.50% $58.83 Percent of Billed Charges 79.97% $60.71 Percent of Billed Charges 55.00% $41.75 Percent of Billed Charges 49.55% $37.61 Percent of Billed Charges 55.00% $41.75 Percent of Billed Charges 55.00% $41.75 Percent of Billed Charges 78.94% $59.92 Percent of Billed Charges 74.00% $56.17 Percent of Billed Charges 92.50% $70.22 Percent of Billed Charges 55.00% $41.75 Percent of Billed Charges 85.00% $64.52 Percent of Billed Charges 63.00% $47.82 Percent of Billed Charges 63.00% $47.82 Percent of Billed Charges 75.00% $56.93 Percent of Billed Charges 66.24% $50.28 Percent of Billed Charges 165.81% $47.80 Fee Schedule 166.07% $47.88 Fee Schedule 176.26% $50.82 Fee Schedule 129.00% $37.19 Fee Schedule 191.24% $55.13 Fee Schedule 159.00% $120.70 Fee Schedule 145.00% $41.80 Fee Schedule 60.00% $45.55 Percent of Billed Charges HC ANDROSTENEDIONE LABCORP 300 CPT 82157 90 Outpatient $5.50 $2.73 $56.00 $5.50 $159.52 $5.50 Fee Schedule $159.52 $5.50 Fee Schedule $255.32 $5.50 Fee Schedule 74.74% $4.11 Percent of Billed Charges 68.24% $3.75 Percent of Billed Charges 65.00% $3.58 Percent of Billed Charges 67.00% $3.69 Percent of Billed Charges 77.50% $4.26 Percent of Billed Charges 79.97% $4.40 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 49.55% $2.73 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 78.94% $4.34 Percent of Billed Charges 74.00% $4.07 Percent of Billed Charges 92.50% $5.09 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 85.00% $4.68 Percent of Billed Charges 63.00% $3.47 Percent of Billed Charges 63.00% $3.47 Percent of Billed Charges 75.00% $4.13 Percent of Billed Charges 66.24% $3.64 Percent of Billed Charges 165.81% $5.50 Fee Schedule 166.07% $48.63 Fee Schedule 176.26% $51.61 Fee Schedule 129.00% $37.77 Fee Schedule 191.24% $56.00 Fee Schedule 159.00% $8.75 Fee Schedule 145.00% $42.46 Fee Schedule 60.00% $3.30 Percent of Billed Charges HC ANGELMAN/PRADER-WILLI DNA LABCORP 300 CPT 81331 90 Outpatient $222.00 $65.88 $352.98 $222.00 $204.28 $204.28 Fee Schedule $204.28 $204.28 Fee Schedule $445.33 $222.00 Fee Schedule 74.74% $165.92 Percent of Billed Charges 68.24% $151.49 Percent of Billed Charges 65.00% $144.30 Percent of Billed Charges 67.00% $148.74 Percent of Billed Charges 77.50% $172.05 Percent of Billed Charges 79.97% $177.53 Percent of Billed Charges 55.00% $122.10 Percent of Billed Charges 49.55% $110.00 Percent of Billed Charges 55.00% $122.10 Percent of Billed Charges 55.00% $122.10 Percent of Billed Charges 78.94% $175.25 Percent of Billed Charges 74.00% $164.28 Percent of Billed Charges 92.50% $205.35 Percent of Billed Charges 55.00% $122.10 Percent of Billed Charges 85.00% $188.70 Percent of Billed Charges 63.00% $139.86 Percent of Billed Charges 63.00% $139.86 Percent of Billed Charges 75.00% $166.50 Percent of Billed Charges 66.24% $147.05 Percent of Billed Charges 165.81% $84.68 Fee Schedule 166.07% $84.81 Fee Schedule 176.26% $90.02 Fee Schedule 129.00% $65.88 Fee Schedule 191.24% $97.67 Fee Schedule 159.00% $352.98 Fee Schedule 145.00% $74.05 Fee Schedule 60.00% $133.20 Percent of Billed Charges HC ANGIOTENSIN CONV ENZ/CSF 300 CPT 82164 90 Outpatient $26.38 $13.07 $41.94 $26.38 $79.56 $26.38 Fee Schedule $79.56 $26.38 Fee Schedule $127.31 $26.38 Fee Schedule 74.74% $19.72 Percent of Billed Charges 68.24% $18.00 Percent of Billed Charges 65.00% $17.15 Percent of Billed Charges 67.00% $17.67 Percent of Billed Charges 77.50% $20.44 Percent of Billed Charges 79.97% $21.10 Percent of Billed Charges 55.00% $14.51 Percent of Billed Charges 49.55% $13.07 Percent of Billed Charges 55.00% $14.51 Percent of Billed Charges 55.00% $14.51 Percent of Billed Charges 78.94% $20.82 Percent of Billed Charges 74.00% $19.52 Percent of Billed Charges 92.50% $24.40 Percent of Billed Charges 55.00% $14.51 Percent of Billed Charges 85.00% $22.42 Percent of Billed Charges 63.00% $16.62 Percent of Billed Charges 63.00% $16.62 Percent of Billed Charges 75.00% $19.79 Percent of Billed Charges 66.24% $17.47 Percent of Billed Charges 165.81% $24.21 Fee Schedule 166.07% $24.25 Fee Schedule 176.26% $25.73 Fee Schedule 129.00% $18.83 Fee Schedule 191.24% $27.92 Fee Schedule 159.00% $41.94 Fee Schedule 145.00% $21.17 Fee Schedule 60.00% $15.83 Percent of Billed Charges HC ANIT-MULLERIAN HORMONE LABCORP 300 CPT 82397 90 Outpatient $42.50 $18.21 $67.58 $42.50 $76.96 $42.50 Fee Schedule $76.96 $42.50 Fee Schedule $123.13 $42.50 Fee Schedule 74.74% $31.76 Percent of Billed Charges 68.24% $29.00 Percent of Billed Charges 65.00% $27.63 Percent of Billed Charges 67.00% $28.48 Percent of Billed Charges 77.50% $32.94 Percent of Billed Charges 79.97% $33.99 Percent of Billed Charges 55.00% $23.38 Percent of Billed Charges 49.55% $21.06 Percent of Billed Charges 55.00% $23.38 Percent of Billed Charges 55.00% $23.38 Percent of Billed Charges 78.94% $33.55 Percent of Billed Charges 74.00% $31.45 Percent of Billed Charges 92.50% $39.31 Percent of Billed Charges 55.00% $23.38 Percent of Billed Charges 85.00% $36.13 Percent of Billed Charges 63.00% $26.78 Percent of Billed Charges 63.00% $26.78 Percent of Billed Charges 75.00% $31.88 Percent of Billed Charges 66.24% $28.15 Percent of Billed Charges 165.81% $23.41 Fee Schedule 166.07% $23.45 Fee Schedule 176.26% $24.89 Fee Schedule 129.00% $18.21 Fee Schedule 191.24% $27.00 Fee Schedule 159.00% $67.58 Fee Schedule 145.00% $20.47 Fee Schedule 60.00% $25.50 Percent of Billed Charges HC ANSER PROMETHEUS 300 CPT 84999 90 Outpatient $400.00 $- $636.00 $400.00 50.00% $200.00 Percent of Billed Charges 50.00% $200.00 Percent of Billed Charges 56.78% $227.12 Percent of Billed Charges 74.74% $298.96 Percent of Billed Charges 68.24% $272.96 Percent of Billed Charges 65.00% $260.00 Percent of Billed Charges 67.00% $268.00 Percent of Billed Charges 77.50% $310.00 Percent of Billed Charges 79.97% $319.88 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 49.55% $198.20 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 78.94% $315.76 Percent of Billed Charges 74.00% $296.00 Percent of Billed Charges 92.50% $370.00 Percent of Billed Charges 55.00% $220.00 Percent of Billed Charges 85.00% $340.00 Percent of Billed Charges 63.00% $252.00 Percent of Billed Charges 63.00% $252.00 Percent of Billed Charges 75.00% $300.00 Percent of Billed Charges 66.24% $264.96 Percent of Billed Charges 35.00% $140.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $636.00 Fee Schedule 145.00% $- Fee Schedule 60.00% $240.00 Percent of Billed Charges HC ANTI DNASE B AB LABCORP 300 CPT 86215 90 Outpatient $7.00 $3.47 $25.34 $7.00 $72.20 $7.00 Fee Schedule $72.20 $7.00 Fee Schedule $115.54 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $22.00 Fee Schedule 176.26% $23.35 Fee Schedule 129.00% $17.09 Fee Schedule 191.24% $25.34 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $19.21 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC ANTI DS DNA AB LABCORP 300 CPT 86225 90 Outpatient $4.00 $1.98 $26.28 $4.00 $74.84 $4.00 Fee Schedule $74.84 $4.00 Fee Schedule $119.81 $4.00 Fee Schedule 74.74% $2.99 Percent of Billed Charges 68.24% $2.73 Percent of Billed Charges 65.00% $2.60 Percent of Billed Charges 67.00% $2.68 Percent of Billed Charges 77.50% $3.10 Percent of Billed Charges 79.97% $3.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 49.55% $1.98 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 78.94% $3.16 Percent of Billed Charges 74.00% $2.96 Percent of Billed Charges 92.50% $3.70 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 85.00% $3.40 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 75.00% $3.00 Percent of Billed Charges 66.24% $2.65 Percent of Billed Charges 165.81% $4.00 Fee Schedule 166.07% $22.82 Fee Schedule 176.26% $24.22 Fee Schedule 129.00% $17.72 Fee Schedule 191.24% $26.28 Fee Schedule 159.00% $6.36 Fee Schedule 145.00% $19.92 Fee Schedule 60.00% $2.40 Percent of Billed Charges HC ANTI T4 AUTOANTIBODY QUEST 300 CPT 83519 90 Outpatient $90.40 $23.74 $143.74 $90.40 $73.60 $73.60 Fee Schedule $73.60 $73.60 Fee Schedule $160.45 $90.40 Fee Schedule 74.74% $67.56 Percent of Billed Charges 68.24% $61.69 Percent of Billed Charges 65.00% $58.76 Percent of Billed Charges 67.00% $60.57 Percent of Billed Charges 77.50% $70.06 Percent of Billed Charges 79.97% $72.29 Percent of Billed Charges 55.00% $49.72 Percent of Billed Charges 49.55% $44.79 Percent of Billed Charges 55.00% $49.72 Percent of Billed Charges 55.00% $49.72 Percent of Billed Charges 78.94% $71.36 Percent of Billed Charges 74.00% $66.90 Percent of Billed Charges 92.50% $83.62 Percent of Billed Charges 55.00% $49.72 Percent of Billed Charges 85.00% $76.84 Percent of Billed Charges 63.00% $56.95 Percent of Billed Charges 63.00% $56.95 Percent of Billed Charges 75.00% $67.80 Percent of Billed Charges 66.24% $59.88 Percent of Billed Charges 165.81% $30.51 Fee Schedule 166.07% $30.56 Fee Schedule 176.26% $32.43 Fee Schedule 129.00% $23.74 Fee Schedule 191.24% $35.19 Fee Schedule 159.00% $143.74 Fee Schedule 145.00% $26.68 Fee Schedule 60.00% $54.24 Percent of Billed Charges HC ANTI THYROGLOBULIN LABCORP 300 CPT 86800 90 Outpatient $3.00 $1.49 $30.43 $3.00 $86.68 $3.00 Fee Schedule $86.68 $3.00 Fee Schedule $138.74 $3.00 Fee Schedule 74.74% $2.24 Percent of Billed Charges 68.24% $2.05 Percent of Billed Charges 65.00% $1.95 Percent of Billed Charges 67.00% $2.01 Percent of Billed Charges 77.50% $2.33 Percent of Billed Charges 79.97% $2.40 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 49.55% $1.49 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 78.94% $2.37 Percent of Billed Charges 74.00% $2.22 Percent of Billed Charges 92.50% $2.78 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 85.00% $2.55 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 75.00% $2.25 Percent of Billed Charges 66.24% $1.99 Percent of Billed Charges 165.81% $3.00 Fee Schedule 166.07% $26.42 Fee Schedule 176.26% $28.04 Fee Schedule 129.00% $20.52 Fee Schedule 191.24% $30.43 Fee Schedule 159.00% $4.77 Fee Schedule 145.00% $23.07 Fee Schedule 60.00% $1.80 Percent of Billed Charges HC ANTIBODY ELUTION 300 CPT 86860 Outpatient $588.00 $58.93 $934.92 $588.00 $412.08 $412.08 Fee Schedule $412.08 $412.08 Fee Schedule 56.78% $333.87 Percent of Billed Charges 74.74% $439.47 Percent of Billed Charges 68.24% $401.25 Percent of Billed Charges 65.00% $382.20 Percent of Billed Charges 67.00% $393.96 Percent of Billed Charges 77.50% $455.70 Percent of Billed Charges 79.97% $470.22 Percent of Billed Charges 55.00% $323.40 Percent of Billed Charges 49.55% $291.35 Percent of Billed Charges 55.00% $323.40 Percent of Billed Charges 55.00% $323.40 Percent of Billed Charges 78.94% $464.17 Percent of Billed Charges 74.00% $435.12 Percent of Billed Charges 92.50% $543.90 Percent of Billed Charges 55.00% $323.40 Percent of Billed Charges 85.00% $499.80 Percent of Billed Charges 63.00% $370.44 Percent of Billed Charges 63.00% $370.44 Percent of Billed Charges 75.00% $441.00 Percent of Billed Charges 66.24% $389.49 Percent of Billed Charges 165.81% $75.74 Fee Schedule 166.07% $75.86 Fee Schedule 176.26% $80.52 Fee Schedule 129.00% $58.93 Fee Schedule 191.24% $87.36 Fee Schedule 159.00% $934.92 Fee Schedule 145.00% $66.24 Fee Schedule 60.00% $352.80 Percent of Billed Charges "HC ANTIBODY IDENTIFICATION, RBC, CAPTURE-R" 300 CPT 86870 Outpatient $705.00 $49.11 " $1,120.95 " $705.00 $837.68 $705.00 Fee Schedule $837.68 $705.00 Fee Schedule 56.78% $400.30 Percent of Billed Charges 74.74% $526.92 Percent of Billed Charges 68.24% $481.09 Percent of Billed Charges 65.00% $458.25 Percent of Billed Charges 67.00% $472.35 Percent of Billed Charges 77.50% $546.38 Percent of Billed Charges 79.97% $563.79 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 49.55% $349.33 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 78.94% $556.53 Percent of Billed Charges 74.00% $521.70 Percent of Billed Charges 92.50% $652.13 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 85.00% $599.25 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 75.00% $528.75 Percent of Billed Charges 66.24% $466.99 Percent of Billed Charges 165.81% $63.12 Fee Schedule 166.07% $63.22 Fee Schedule 176.26% $67.10 Fee Schedule 129.00% $49.11 Fee Schedule 191.24% $72.81 Fee Schedule 159.00% " $1,120.95 " Fee Schedule 145.00% $55.20 Fee Schedule 60.00% $423.00 Percent of Billed Charges "HC ANTIBODY IDENTIFICATION, RBC, EXTEND I" 300 CPT 86870 Outpatient $705.00 $49.11 " $1,120.95 " $705.00 $837.68 $705.00 Fee Schedule $837.68 $705.00 Fee Schedule 56.78% $400.30 Percent of Billed Charges 74.74% $526.92 Percent of Billed Charges 68.24% $481.09 Percent of Billed Charges 65.00% $458.25 Percent of Billed Charges 67.00% $472.35 Percent of Billed Charges 77.50% $546.38 Percent of Billed Charges 79.97% $563.79 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 49.55% $349.33 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 78.94% $556.53 Percent of Billed Charges 74.00% $521.70 Percent of Billed Charges 92.50% $652.13 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 85.00% $599.25 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 75.00% $528.75 Percent of Billed Charges 66.24% $466.99 Percent of Billed Charges 165.81% $63.12 Fee Schedule 166.07% $63.22 Fee Schedule 176.26% $67.10 Fee Schedule 129.00% $49.11 Fee Schedule 191.24% $72.81 Fee Schedule 159.00% " $1,120.95 " Fee Schedule 145.00% $55.20 Fee Schedule 60.00% $423.00 Percent of Billed Charges "HC ANTIBODY IDENTIFICATION, RBC, EXTEND II" 300 CPT 86870 Outpatient $705.00 $49.11 " $1,120.95 " $705.00 $837.68 $705.00 Fee Schedule $837.68 $705.00 Fee Schedule 56.78% $400.30 Percent of Billed Charges 74.74% $526.92 Percent of Billed Charges 68.24% $481.09 Percent of Billed Charges 65.00% $458.25 Percent of Billed Charges 67.00% $472.35 Percent of Billed Charges 77.50% $546.38 Percent of Billed Charges 79.97% $563.79 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 49.55% $349.33 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 78.94% $556.53 Percent of Billed Charges 74.00% $521.70 Percent of Billed Charges 92.50% $652.13 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 85.00% $599.25 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 75.00% $528.75 Percent of Billed Charges 66.24% $466.99 Percent of Billed Charges 165.81% $63.12 Fee Schedule 166.07% $63.22 Fee Schedule 176.26% $67.10 Fee Schedule 129.00% $49.11 Fee Schedule 191.24% $72.81 Fee Schedule 159.00% " $1,120.95 " Fee Schedule 145.00% $55.20 Fee Schedule 60.00% $423.00 Percent of Billed Charges "HC ANTIBODY IDENTIFICATION, RBC, TUBE" 300 CPT 86870 Outpatient $705.00 $49.11 " $1,120.95 " $705.00 $837.68 $705.00 Fee Schedule $837.68 $705.00 Fee Schedule 56.78% $400.30 Percent of Billed Charges 74.74% $526.92 Percent of Billed Charges 68.24% $481.09 Percent of Billed Charges 65.00% $458.25 Percent of Billed Charges 67.00% $472.35 Percent of Billed Charges 77.50% $546.38 Percent of Billed Charges 79.97% $563.79 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 49.55% $349.33 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 78.94% $556.53 Percent of Billed Charges 74.00% $521.70 Percent of Billed Charges 92.50% $652.13 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 85.00% $599.25 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 75.00% $528.75 Percent of Billed Charges 66.24% $466.99 Percent of Billed Charges 165.81% $63.12 Fee Schedule 166.07% $63.22 Fee Schedule 176.26% $67.10 Fee Schedule 129.00% $49.11 Fee Schedule 191.24% $72.81 Fee Schedule 159.00% " $1,120.95 " Fee Schedule 145.00% $55.20 Fee Schedule 60.00% $423.00 Percent of Billed Charges "HC ANTIBODY SCREEN, RBC, LISS TUBE" 300 CPT 86850 Outpatient $292.00 $12.60 $464.28 $292.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $85.19 $80.80 Fee Schedule 74.74% $218.24 Percent of Billed Charges 68.24% $199.26 Percent of Billed Charges 65.00% $189.80 Percent of Billed Charges 67.00% $195.64 Percent of Billed Charges 77.50% $226.30 Percent of Billed Charges 79.97% $233.51 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 49.55% $144.69 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 78.94% $230.50 Percent of Billed Charges 74.00% $216.08 Percent of Billed Charges 92.50% $270.10 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 85.00% $248.20 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 75.00% $219.00 Percent of Billed Charges 66.24% $193.42 Percent of Billed Charges 165.81% $16.20 Fee Schedule 166.07% $16.23 Fee Schedule 176.26% $17.22 Fee Schedule 129.00% $12.60 Fee Schedule 191.24% $18.68 Fee Schedule 159.00% $464.28 Fee Schedule 145.00% $14.17 Fee Schedule 60.00% $175.20 Percent of Billed Charges "HC ANTIBODY SCREEN, RBC, PEG TUBE" 300 CPT 86850 Outpatient $292.00 $12.60 $464.28 $292.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $85.19 $80.80 Fee Schedule 74.74% $218.24 Percent of Billed Charges 68.24% $199.26 Percent of Billed Charges 65.00% $189.80 Percent of Billed Charges 67.00% $195.64 Percent of Billed Charges 77.50% $226.30 Percent of Billed Charges 79.97% $233.51 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 49.55% $144.69 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 78.94% $230.50 Percent of Billed Charges 74.00% $216.08 Percent of Billed Charges 92.50% $270.10 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 85.00% $248.20 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 75.00% $219.00 Percent of Billed Charges 66.24% $193.42 Percent of Billed Charges 165.81% $16.20 Fee Schedule 166.07% $16.23 Fee Schedule 176.26% $17.22 Fee Schedule 129.00% $12.60 Fee Schedule 191.24% $18.68 Fee Schedule 159.00% $464.28 Fee Schedule 145.00% $14.17 Fee Schedule 60.00% $175.20 Percent of Billed Charges "HC ANTIBODY SCREEN, RBC, PREWARM TUBE" 300 CPT 86850 Outpatient $292.00 $12.60 $464.28 $292.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $85.19 $80.80 Fee Schedule 74.74% $218.24 Percent of Billed Charges 68.24% $199.26 Percent of Billed Charges 65.00% $189.80 Percent of Billed Charges 67.00% $195.64 Percent of Billed Charges 77.50% $226.30 Percent of Billed Charges 79.97% $233.51 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 49.55% $144.69 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 78.94% $230.50 Percent of Billed Charges 74.00% $216.08 Percent of Billed Charges 92.50% $270.10 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 85.00% $248.20 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 75.00% $219.00 Percent of Billed Charges 66.24% $193.42 Percent of Billed Charges 165.81% $16.20 Fee Schedule 166.07% $16.23 Fee Schedule 176.26% $17.22 Fee Schedule 129.00% $12.60 Fee Schedule 191.24% $18.68 Fee Schedule 159.00% $464.28 Fee Schedule 145.00% $14.17 Fee Schedule 60.00% $175.20 Percent of Billed Charges "HC ANTIBODY SCREEN, RBC, SOLID PHASE" 300 CPT 86850 Outpatient $292.00 $12.60 $464.28 $292.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $85.19 $80.80 Fee Schedule 74.74% $218.24 Percent of Billed Charges 68.24% $199.26 Percent of Billed Charges 65.00% $189.80 Percent of Billed Charges 67.00% $195.64 Percent of Billed Charges 77.50% $226.30 Percent of Billed Charges 79.97% $233.51 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 49.55% $144.69 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 78.94% $230.50 Percent of Billed Charges 74.00% $216.08 Percent of Billed Charges 92.50% $270.10 Percent of Billed Charges 55.00% $160.60 Percent of Billed Charges 85.00% $248.20 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 63.00% $183.96 Percent of Billed Charges 75.00% $219.00 Percent of Billed Charges 66.24% $193.42 Percent of Billed Charges 165.81% $16.20 Fee Schedule 166.07% $16.23 Fee Schedule 176.26% $17.22 Fee Schedule 129.00% $12.60 Fee Schedule 191.24% $18.68 Fee Schedule 159.00% $464.28 Fee Schedule 145.00% $14.17 Fee Schedule 60.00% $175.20 Percent of Billed Charges HC ANTICARDIOLIPIN ABS LABCORP 300 CPT 86147 90 Outpatient $5.50 $2.73 $48.67 $5.50 $138.64 $5.50 Fee Schedule $138.64 $5.50 Fee Schedule $221.92 $5.50 Fee Schedule 74.74% $4.11 Percent of Billed Charges 68.24% $3.75 Percent of Billed Charges 65.00% $3.58 Percent of Billed Charges 67.00% $3.69 Percent of Billed Charges 77.50% $4.26 Percent of Billed Charges 79.97% $4.40 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 49.55% $2.73 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 78.94% $4.34 Percent of Billed Charges 74.00% $4.07 Percent of Billed Charges 92.50% $5.09 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 85.00% $4.68 Percent of Billed Charges 63.00% $3.47 Percent of Billed Charges 63.00% $3.47 Percent of Billed Charges 75.00% $4.13 Percent of Billed Charges 66.24% $3.64 Percent of Billed Charges 165.81% $5.50 Fee Schedule 166.07% $42.26 Fee Schedule 176.26% $44.86 Fee Schedule 129.00% $32.83 Fee Schedule 191.24% $48.67 Fee Schedule 159.00% $8.75 Fee Schedule 145.00% $36.90 Fee Schedule 60.00% $3.30 Percent of Billed Charges HC ANTIEXTRACT NUC AG LABCORP 300 CPT 86235 90 Outpatient $6.00 $2.97 $34.29 $6.00 $97.72 $6.00 Fee Schedule $97.72 $6.00 Fee Schedule $156.35 $6.00 Fee Schedule 74.74% $4.48 Percent of Billed Charges 68.24% $4.09 Percent of Billed Charges 65.00% $3.90 Percent of Billed Charges 67.00% $4.02 Percent of Billed Charges 77.50% $4.65 Percent of Billed Charges 79.97% $4.80 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 49.55% $2.97 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 78.94% $4.74 Percent of Billed Charges 74.00% $4.44 Percent of Billed Charges 92.50% $5.55 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 85.00% $5.10 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 75.00% $4.50 Percent of Billed Charges 66.24% $3.97 Percent of Billed Charges 165.81% $6.00 Fee Schedule 166.07% $29.78 Fee Schedule 176.26% $31.60 Fee Schedule 129.00% $23.13 Fee Schedule 191.24% $34.29 Fee Schedule 159.00% $9.54 Fee Schedule 145.00% $26.00 Fee Schedule 60.00% $3.60 Percent of Billed Charges HC ANTIFUNGAL DRUG - FUNGUS LAB 300 CPT 82542 90 Outpatient $120.00 $31.08 $190.80 $120.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $120.00 Fee Schedule 74.74% $89.69 Percent of Billed Charges 68.24% $81.89 Percent of Billed Charges 65.00% $78.00 Percent of Billed Charges 67.00% $80.40 Percent of Billed Charges 77.50% $93.00 Percent of Billed Charges 79.97% $95.96 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 49.55% $59.46 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 78.94% $94.73 Percent of Billed Charges 74.00% $88.80 Percent of Billed Charges 92.50% $111.00 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 85.00% $102.00 Percent of Billed Charges 63.00% $75.60 Percent of Billed Charges 63.00% $75.60 Percent of Billed Charges 75.00% $90.00 Percent of Billed Charges 66.24% $79.49 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $190.80 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $72.00 Percent of Billed Charges "HC ANTIGEN TESTING, DONOR BLOOD, EACH ANTIGEN" 300 CPT 86902 Outpatient $113.00 $5.91 $179.67 $113.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $55.37 $52.51 Fee Schedule 74.74% $84.46 Percent of Billed Charges 68.24% $77.11 Percent of Billed Charges 65.00% $73.45 Percent of Billed Charges 67.00% $75.71 Percent of Billed Charges 77.50% $87.58 Percent of Billed Charges 79.97% $90.37 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 49.55% $55.99 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 78.94% $89.20 Percent of Billed Charges 74.00% $83.62 Percent of Billed Charges 92.50% $104.53 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 85.00% $96.05 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 75.00% $84.75 Percent of Billed Charges 66.24% $74.85 Percent of Billed Charges 165.81% $7.59 Fee Schedule 166.07% $7.61 Fee Schedule 176.26% $8.07 Fee Schedule 129.00% $5.91 Fee Schedule 191.24% $8.76 Fee Schedule 159.00% $179.67 Fee Schedule 145.00% $6.64 Fee Schedule 60.00% $67.80 Percent of Billed Charges "HC ANTIGEN TESTING, DONOR BLOOD, HISTORICAL-1/UNIT" 300 CPT 86902 Outpatient $113.00 $5.91 $179.67 $113.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $55.37 $52.51 Fee Schedule 74.74% $84.46 Percent of Billed Charges 68.24% $77.11 Percent of Billed Charges 65.00% $73.45 Percent of Billed Charges 67.00% $75.71 Percent of Billed Charges 77.50% $87.58 Percent of Billed Charges 79.97% $90.37 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 49.55% $55.99 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 78.94% $89.20 Percent of Billed Charges 74.00% $83.62 Percent of Billed Charges 92.50% $104.53 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 85.00% $96.05 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 75.00% $84.75 Percent of Billed Charges 66.24% $74.85 Percent of Billed Charges 165.81% $7.59 Fee Schedule 166.07% $7.61 Fee Schedule 176.26% $8.07 Fee Schedule 129.00% $5.91 Fee Schedule 191.24% $8.76 Fee Schedule 159.00% $179.67 Fee Schedule 145.00% $6.64 Fee Schedule 60.00% $67.80 Percent of Billed Charges "HC ANTIGEN TESTING, DONOR BLOOD, HISTORICAL-3/UNIT" 300 CPT 86902 Outpatient $113.00 $5.91 $179.67 $113.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $55.37 $52.51 Fee Schedule 74.74% $84.46 Percent of Billed Charges 68.24% $77.11 Percent of Billed Charges 65.00% $73.45 Percent of Billed Charges 67.00% $75.71 Percent of Billed Charges 77.50% $87.58 Percent of Billed Charges 79.97% $90.37 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 49.55% $55.99 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 78.94% $89.20 Percent of Billed Charges 74.00% $83.62 Percent of Billed Charges 92.50% $104.53 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 85.00% $96.05 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 75.00% $84.75 Percent of Billed Charges 66.24% $74.85 Percent of Billed Charges 165.81% $7.59 Fee Schedule 166.07% $7.61 Fee Schedule 176.26% $8.07 Fee Schedule 129.00% $5.91 Fee Schedule 191.24% $8.76 Fee Schedule 159.00% $179.67 Fee Schedule 145.00% $6.64 Fee Schedule 60.00% $67.80 Percent of Billed Charges "HC ANTIGEN TESTING, DONOR BLOOD, Jk,MNSs,L,P EACH ANTIGEN" 300 CPT 86902 Outpatient $113.00 $5.91 $179.67 $113.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $55.37 $52.51 Fee Schedule 74.74% $84.46 Percent of Billed Charges 68.24% $77.11 Percent of Billed Charges 65.00% $73.45 Percent of Billed Charges 67.00% $75.71 Percent of Billed Charges 77.50% $87.58 Percent of Billed Charges 79.97% $90.37 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 49.55% $55.99 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 78.94% $89.20 Percent of Billed Charges 74.00% $83.62 Percent of Billed Charges 92.50% $104.53 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 85.00% $96.05 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 75.00% $84.75 Percent of Billed Charges 66.24% $74.85 Percent of Billed Charges 165.81% $7.59 Fee Schedule 166.07% $7.61 Fee Schedule 176.26% $8.07 Fee Schedule 129.00% $5.91 Fee Schedule 191.24% $8.76 Fee Schedule 159.00% $179.67 Fee Schedule 145.00% $6.64 Fee Schedule 60.00% $67.80 Percent of Billed Charges "HC ANTIGEN TESTING, DONOR BLOOD, RH,K,Fy EACH ANTIGE" 300 CPT 86902 Outpatient $113.00 $5.91 $179.67 $113.00 $20.84 $20.84 Fee Schedule $20.84 $20.84 Fee Schedule $55.37 $52.51 Fee Schedule 74.74% $84.46 Percent of Billed Charges 68.24% $77.11 Percent of Billed Charges 65.00% $73.45 Percent of Billed Charges 67.00% $75.71 Percent of Billed Charges 77.50% $87.58 Percent of Billed Charges 79.97% $90.37 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 49.55% $55.99 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 78.94% $89.20 Percent of Billed Charges 74.00% $83.62 Percent of Billed Charges 92.50% $104.53 Percent of Billed Charges 55.00% $62.15 Percent of Billed Charges 85.00% $96.05 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 63.00% $71.19 Percent of Billed Charges 75.00% $84.75 Percent of Billed Charges 66.24% $74.85 Percent of Billed Charges 165.81% $7.59 Fee Schedule 166.07% $7.61 Fee Schedule 176.26% $8.07 Fee Schedule 129.00% $5.91 Fee Schedule 191.24% $8.76 Fee Schedule 159.00% $179.67 Fee Schedule 145.00% $6.64 Fee Schedule 60.00% $67.80 Percent of Billed Charges HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER 300 CPT 86886 Outpatient $410.00 $6.68 $651.90 $410.00 $28.20 $28.20 Fee Schedule $28.20 $28.20 Fee Schedule $45.17 $42.84 Fee Schedule 74.74% $306.43 Percent of Billed Charges 68.24% $279.78 Percent of Billed Charges 65.00% $266.50 Percent of Billed Charges 67.00% $274.70 Percent of Billed Charges 77.50% $317.75 Percent of Billed Charges 79.97% $327.88 Percent of Billed Charges 55.00% $225.50 Percent of Billed Charges 49.55% $203.16 Percent of Billed Charges 55.00% $225.50 Percent of Billed Charges 55.00% $225.50 Percent of Billed Charges 78.94% $323.65 Percent of Billed Charges 74.00% $303.40 Percent of Billed Charges 92.50% $379.25 Percent of Billed Charges 55.00% $225.50 Percent of Billed Charges 85.00% $348.50 Percent of Billed Charges 63.00% $258.30 Percent of Billed Charges 63.00% $258.30 Percent of Billed Charges 75.00% $307.50 Percent of Billed Charges 66.24% $271.58 Percent of Billed Charges 165.81% $8.59 Fee Schedule 166.07% $8.60 Fee Schedule 176.26% $9.13 Fee Schedule 129.00% $6.68 Fee Schedule 191.24% $9.91 Fee Schedule 159.00% $651.90 Fee Schedule 145.00% $7.51 Fee Schedule 60.00% $246.00 Percent of Billed Charges "HC ANTIHUMAN GLOBULIN TEST, DIRECT, C3d" 300 CPT 86880 Outpatient $246.00 $6.95 $391.14 $246.00 $29.32 $29.32 Fee Schedule $29.32 $29.32 Fee Schedule $47.00 $44.58 Fee Schedule 74.74% $183.86 Percent of Billed Charges 68.24% $167.87 Percent of Billed Charges 65.00% $159.90 Percent of Billed Charges 67.00% $164.82 Percent of Billed Charges 77.50% $190.65 Percent of Billed Charges 79.97% $196.73 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 49.55% $121.89 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 78.94% $194.19 Percent of Billed Charges 74.00% $182.04 Percent of Billed Charges 92.50% $227.55 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 85.00% $209.10 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 75.00% $184.50 Percent of Billed Charges 66.24% $162.95 Percent of Billed Charges 165.81% $8.94 Fee Schedule 166.07% $8.95 Fee Schedule 176.26% $9.50 Fee Schedule 129.00% $6.95 Fee Schedule 191.24% $10.31 Fee Schedule 159.00% $391.14 Fee Schedule 145.00% $7.82 Fee Schedule 60.00% $147.60 Percent of Billed Charges "HC ANTIHUMAN GLOBULIN TEST, DIRECT, IgG" 300 CPT 86880 Outpatient $246.00 $6.95 $391.14 $246.00 $29.32 $29.32 Fee Schedule $29.32 $29.32 Fee Schedule $47.00 $44.58 Fee Schedule 74.74% $183.86 Percent of Billed Charges 68.24% $167.87 Percent of Billed Charges 65.00% $159.90 Percent of Billed Charges 67.00% $164.82 Percent of Billed Charges 77.50% $190.65 Percent of Billed Charges 79.97% $196.73 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 49.55% $121.89 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 78.94% $194.19 Percent of Billed Charges 74.00% $182.04 Percent of Billed Charges 92.50% $227.55 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 85.00% $209.10 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 75.00% $184.50 Percent of Billed Charges 66.24% $162.95 Percent of Billed Charges 165.81% $8.94 Fee Schedule 166.07% $8.95 Fee Schedule 176.26% $9.50 Fee Schedule 129.00% $6.95 Fee Schedule 191.24% $10.31 Fee Schedule 159.00% $391.14 Fee Schedule 145.00% $7.82 Fee Schedule 60.00% $147.60 Percent of Billed Charges "HC ANTIHUMAN GLOBULIN TEST, DIRECT, POLY" 300 CPT 86880 Outpatient $246.00 $6.95 $391.14 $246.00 $29.32 $29.32 Fee Schedule $29.32 $29.32 Fee Schedule $47.00 $44.58 Fee Schedule 74.74% $183.86 Percent of Billed Charges 68.24% $167.87 Percent of Billed Charges 65.00% $159.90 Percent of Billed Charges 67.00% $164.82 Percent of Billed Charges 77.50% $190.65 Percent of Billed Charges 79.97% $196.73 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 49.55% $121.89 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 78.94% $194.19 Percent of Billed Charges 74.00% $182.04 Percent of Billed Charges 92.50% $227.55 Percent of Billed Charges 55.00% $135.30 Percent of Billed Charges 85.00% $209.10 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 63.00% $154.98 Percent of Billed Charges 75.00% $184.50 Percent of Billed Charges 66.24% $162.95 Percent of Billed Charges 165.81% $8.94 Fee Schedule 166.07% $8.95 Fee Schedule 176.26% $9.50 Fee Schedule 129.00% $6.95 Fee Schedule 191.24% $10.31 Fee Schedule 159.00% $391.14 Fee Schedule 145.00% $7.82 Fee Schedule 60.00% $147.60 Percent of Billed Charges HC ANTI-NEUTROPHIL AB ARUP 300 CPT 86021 90 Outpatient $71.43 $19.41 $113.57 $71.43 $82.04 $71.43 Fee Schedule $82.04 $71.43 Fee Schedule $131.24 $71.43 Fee Schedule 74.74% $53.39 Percent of Billed Charges 68.24% $48.74 Percent of Billed Charges 65.00% $46.43 Percent of Billed Charges 67.00% $47.86 Percent of Billed Charges 77.50% $55.36 Percent of Billed Charges 79.97% $57.12 Percent of Billed Charges 55.00% $39.29 Percent of Billed Charges 49.55% $35.39 Percent of Billed Charges 55.00% $39.29 Percent of Billed Charges 55.00% $39.29 Percent of Billed Charges 78.94% $56.39 Percent of Billed Charges 74.00% $52.86 Percent of Billed Charges 92.50% $66.07 Percent of Billed Charges 55.00% $39.29 Percent of Billed Charges 85.00% $60.72 Percent of Billed Charges 63.00% $45.00 Percent of Billed Charges 63.00% $45.00 Percent of Billed Charges 75.00% $53.57 Percent of Billed Charges 66.24% $47.32 Percent of Billed Charges 165.81% $24.95 Fee Schedule 166.07% $24.99 Fee Schedule 176.26% $26.53 Fee Schedule 129.00% $19.41 Fee Schedule 191.24% $28.78 Fee Schedule 159.00% $113.57 Fee Schedule 145.00% $21.82 Fee Schedule 60.00% $42.86 Percent of Billed Charges HC ANTIPHOSPHATIDYLSERINE LABCORP 300 CPT 86148 90 Outpatient $16.00 $7.93 $30.73 $16.00 $87.56 $16.00 Fee Schedule $87.56 $16.00 Fee Schedule $140.13 $16.00 Fee Schedule 74.74% $11.96 Percent of Billed Charges 68.24% $10.92 Percent of Billed Charges 65.00% $10.40 Percent of Billed Charges 67.00% $10.72 Percent of Billed Charges 77.50% $12.40 Percent of Billed Charges 79.97% $12.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 49.55% $7.93 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 78.94% $12.63 Percent of Billed Charges 74.00% $11.84 Percent of Billed Charges 92.50% $14.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 85.00% $13.60 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 75.00% $12.00 Percent of Billed Charges 66.24% $10.60 Percent of Billed Charges 165.81% $16.00 Fee Schedule 166.07% $26.69 Fee Schedule 176.26% $28.32 Fee Schedule 129.00% $20.73 Fee Schedule 191.24% $30.73 Fee Schedule 159.00% $25.44 Fee Schedule 145.00% $23.30 Fee Schedule 60.00% $9.60 Percent of Billed Charges HC ANTI-PLA2R LABCORP 300 CPT 83516 90 Outpatient $200.00 $14.87 $318.00 $200.00 $62.84 $62.84 Fee Schedule $62.84 $62.84 Fee Schedule $100.54 $95.35 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 165.81% $19.12 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $120.00 Percent of Billed Charges HC ANTISCLERODERMA -70 AB LABCORP 300 CPT 86235 90 Outpatient $4.00 $1.98 $34.29 $4.00 $97.72 $4.00 Fee Schedule $97.72 $4.00 Fee Schedule $156.35 $4.00 Fee Schedule 74.74% $2.99 Percent of Billed Charges 68.24% $2.73 Percent of Billed Charges 65.00% $2.60 Percent of Billed Charges 67.00% $2.68 Percent of Billed Charges 77.50% $3.10 Percent of Billed Charges 79.97% $3.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 49.55% $1.98 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 78.94% $3.16 Percent of Billed Charges 74.00% $2.96 Percent of Billed Charges 92.50% $3.70 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 85.00% $3.40 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 75.00% $3.00 Percent of Billed Charges 66.24% $2.65 Percent of Billed Charges 165.81% $4.00 Fee Schedule 166.07% $29.78 Fee Schedule 176.26% $31.60 Fee Schedule 129.00% $23.13 Fee Schedule 191.24% $34.29 Fee Schedule 159.00% $6.36 Fee Schedule 145.00% $26.00 Fee Schedule 60.00% $2.40 Percent of Billed Charges HC APC RESISTANCE PROFILE ARUP 300 CPT 85307 90 Outpatient $22.03 $10.92 $35.03 $22.03 $83.52 $22.03 Fee Schedule $83.52 $22.03 Fee Schedule $133.59 $22.03 Fee Schedule 74.74% $16.47 Percent of Billed Charges 68.24% $15.03 Percent of Billed Charges 65.00% $14.32 Percent of Billed Charges 67.00% $14.76 Percent of Billed Charges 77.50% $17.07 Percent of Billed Charges 79.97% $17.62 Percent of Billed Charges 55.00% $12.12 Percent of Billed Charges 49.55% $10.92 Percent of Billed Charges 55.00% $12.12 Percent of Billed Charges 55.00% $12.12 Percent of Billed Charges 78.94% $17.39 Percent of Billed Charges 74.00% $16.30 Percent of Billed Charges 92.50% $20.38 Percent of Billed Charges 55.00% $12.12 Percent of Billed Charges 85.00% $18.73 Percent of Billed Charges 63.00% $13.88 Percent of Billed Charges 63.00% $13.88 Percent of Billed Charges 75.00% $16.52 Percent of Billed Charges 66.24% $14.59 Percent of Billed Charges 165.81% $22.03 Fee Schedule 166.07% $25.44 Fee Schedule 176.26% $27.00 Fee Schedule 129.00% $19.76 Fee Schedule 191.24% $29.30 Fee Schedule 159.00% $35.03 Fee Schedule 145.00% $22.21 Fee Schedule 60.00% $13.22 Percent of Billed Charges HC APOLIPROTEIN B LABCORP 300 CPT 82172 90 Outpatient $4.00 $1.98 $40.33 $4.00 $84.44 $4.00 Fee Schedule $84.44 $4.00 Fee Schedule $183.90 $4.00 Fee Schedule 74.74% $2.99 Percent of Billed Charges 68.24% $2.73 Percent of Billed Charges 65.00% $2.60 Percent of Billed Charges 67.00% $2.68 Percent of Billed Charges 77.50% $3.10 Percent of Billed Charges 79.97% $3.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 49.55% $1.98 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 78.94% $3.16 Percent of Billed Charges 74.00% $2.96 Percent of Billed Charges 92.50% $3.70 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 85.00% $3.40 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 75.00% $3.00 Percent of Billed Charges 66.24% $2.65 Percent of Billed Charges 165.81% $4.00 Fee Schedule 166.07% $35.02 Fee Schedule 176.26% $37.17 Fee Schedule 129.00% $27.21 Fee Schedule 191.24% $40.33 Fee Schedule 159.00% $6.36 Fee Schedule 145.00% $30.58 Fee Schedule 60.00% $2.40 Percent of Billed Charges "HC ARBOVIRUS ABS, IGG/IGM ARUP" 300 CPT 86651 90 Outpatient $210.00 $17.02 $333.90 $210.00 $71.88 $71.88 Fee Schedule $71.88 $71.88 Fee Schedule $115.02 $109.08 Fee Schedule 74.74% $156.95 Percent of Billed Charges 68.24% $143.30 Percent of Billed Charges 65.00% $136.50 Percent of Billed Charges 67.00% $140.70 Percent of Billed Charges 77.50% $162.75 Percent of Billed Charges 79.97% $167.94 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 49.55% $104.06 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 78.94% $165.77 Percent of Billed Charges 74.00% $155.40 Percent of Billed Charges 92.50% $194.25 Percent of Billed Charges 55.00% $115.50 Percent of Billed Charges 85.00% $178.50 Percent of Billed Charges 63.00% $132.30 Percent of Billed Charges 63.00% $132.30 Percent of Billed Charges 75.00% $157.50 Percent of Billed Charges 66.24% $139.10 Percent of Billed Charges 165.81% $21.87 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $333.90 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $126.00 Percent of Billed Charges HC ARBOVIRUS ANTIBODY AB; ENCEPHALITIS CALIF 300 CPT 86651 90 Outpatient $19.13 $9.48 $30.42 $19.13 $71.88 $19.13 Fee Schedule $71.88 $19.13 Fee Schedule $115.02 $19.13 Fee Schedule 74.74% $14.30 Percent of Billed Charges 68.24% $13.05 Percent of Billed Charges 65.00% $12.43 Percent of Billed Charges 67.00% $12.82 Percent of Billed Charges 77.50% $14.83 Percent of Billed Charges 79.97% $15.30 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 49.55% $9.48 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 78.94% $15.10 Percent of Billed Charges 74.00% $14.16 Percent of Billed Charges 92.50% $17.70 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 85.00% $16.26 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 75.00% $14.35 Percent of Billed Charges 66.24% $12.67 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $30.42 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $11.48 Percent of Billed Charges HC ARBOVIRUS ANTIBODY AB; ENCEPHALITIS ST. LOUIS 300 CPT 86653 90 Outpatient $19.13 $9.48 $30.42 $19.13 $71.88 $19.13 Fee Schedule $71.88 $19.13 Fee Schedule $115.02 $19.13 Fee Schedule 74.74% $14.30 Percent of Billed Charges 68.24% $13.05 Percent of Billed Charges 65.00% $12.43 Percent of Billed Charges 67.00% $12.82 Percent of Billed Charges 77.50% $14.83 Percent of Billed Charges 79.97% $15.30 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 49.55% $9.48 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 78.94% $15.10 Percent of Billed Charges 74.00% $14.16 Percent of Billed Charges 92.50% $17.70 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 85.00% $16.26 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 75.00% $14.35 Percent of Billed Charges 66.24% $12.67 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $30.42 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $11.48 Percent of Billed Charges HC ARBOVIRUS ANTIBODY AB; ENCEPHALITIS W EQUINE 300 CPT 86654 90 Outpatient $19.13 $9.48 $30.42 $19.13 $71.88 $19.13 Fee Schedule $71.88 $19.13 Fee Schedule $115.02 $19.13 Fee Schedule 74.74% $14.30 Percent of Billed Charges 68.24% $13.05 Percent of Billed Charges 65.00% $12.43 Percent of Billed Charges 67.00% $12.82 Percent of Billed Charges 77.50% $14.83 Percent of Billed Charges 79.97% $15.30 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 49.55% $9.48 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 78.94% $15.10 Percent of Billed Charges 74.00% $14.16 Percent of Billed Charges 92.50% $17.70 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 85.00% $16.26 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 75.00% $14.35 Percent of Billed Charges 66.24% $12.67 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $30.42 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $11.48 Percent of Billed Charges HC ARBOVIRUS WEST NILE VIRUS AB IGM 300 CPT 86788 90 Outpatient $19.13 $9.48 $32.22 $19.13 $91.80 $19.13 Fee Schedule $91.80 $19.13 Fee Schedule $146.93 $19.13 Fee Schedule 74.74% $14.30 Percent of Billed Charges 68.24% $13.05 Percent of Billed Charges 65.00% $12.43 Percent of Billed Charges 67.00% $12.82 Percent of Billed Charges 77.50% $14.83 Percent of Billed Charges 79.97% $15.30 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 49.55% $9.48 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 78.94% $15.10 Percent of Billed Charges 74.00% $14.16 Percent of Billed Charges 92.50% $17.70 Percent of Billed Charges 55.00% $10.52 Percent of Billed Charges 85.00% $16.26 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 63.00% $12.05 Percent of Billed Charges 75.00% $14.35 Percent of Billed Charges 66.24% $12.67 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $27.98 Fee Schedule 176.26% $29.70 Fee Schedule 129.00% $21.74 Fee Schedule 191.24% $32.22 Fee Schedule 159.00% $30.42 Fee Schedule 145.00% $24.43 Fee Schedule 60.00% $11.48 Percent of Billed Charges HC ARSENIC LEVEL QUANT LA 300 CPT 82175 90 Outpatient $16.00 $7.93 $36.28 $16.00 $103.36 $16.00 Fee Schedule $103.36 $16.00 Fee Schedule $165.42 $16.00 Fee Schedule 74.74% $11.96 Percent of Billed Charges 68.24% $10.92 Percent of Billed Charges 65.00% $10.40 Percent of Billed Charges 67.00% $10.72 Percent of Billed Charges 77.50% $12.40 Percent of Billed Charges 79.97% $12.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 49.55% $7.93 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 78.94% $12.63 Percent of Billed Charges 74.00% $11.84 Percent of Billed Charges 92.50% $14.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 85.00% $13.60 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 75.00% $12.00 Percent of Billed Charges 66.24% $10.60 Percent of Billed Charges 165.81% $16.00 Fee Schedule 166.07% $31.50 Fee Schedule 176.26% $33.44 Fee Schedule 129.00% $24.47 Fee Schedule 191.24% $36.28 Fee Schedule 159.00% $25.44 Fee Schedule 145.00% $27.51 Fee Schedule 60.00% $9.60 Percent of Billed Charges HC ASO AB LABCORP 300 CPT 86060 90 Outpatient $3.50 $1.73 $13.96 $3.50 $39.80 $3.50 Fee Schedule $39.80 $3.50 Fee Schedule $63.66 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $12.12 Fee Schedule 176.26% $12.87 Fee Schedule 129.00% $9.42 Fee Schedule 191.24% $13.96 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $10.59 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC ASP FUM IGG VIRACOR 300 CPT 86001 90 Outpatient $17.52 $8.68 $27.86 $17.52 $28.44 $17.52 Fee Schedule $28.44 $17.52 Fee Schedule $68.19 $17.52 Fee Schedule 74.74% $13.09 Percent of Billed Charges 68.24% $11.96 Percent of Billed Charges 65.00% $11.39 Percent of Billed Charges 67.00% $11.74 Percent of Billed Charges 77.50% $13.58 Percent of Billed Charges 79.97% $14.01 Percent of Billed Charges 55.00% $9.64 Percent of Billed Charges 49.55% $8.68 Percent of Billed Charges 55.00% $9.64 Percent of Billed Charges 55.00% $9.64 Percent of Billed Charges 78.94% $13.83 Percent of Billed Charges 74.00% $12.96 Percent of Billed Charges 92.50% $16.21 Percent of Billed Charges 55.00% $9.64 Percent of Billed Charges 85.00% $14.89 Percent of Billed Charges 63.00% $11.04 Percent of Billed Charges 63.00% $11.04 Percent of Billed Charges 75.00% $13.14 Percent of Billed Charges 66.24% $11.61 Percent of Billed Charges 165.81% $12.97 Fee Schedule 166.07% $12.99 Fee Schedule 176.26% $13.78 Fee Schedule 129.00% $10.09 Fee Schedule 191.24% $14.95 Fee Schedule 159.00% $27.86 Fee Schedule 145.00% $11.34 Fee Schedule 60.00% $10.51 Percent of Billed Charges HC ASP FUMIGATUS IGG LABCORP 300 CPT 86606 90 Outpatient $25.00 $12.39 $39.75 $25.00 $82.04 $25.00 Fee Schedule $82.04 $25.00 Fee Schedule $131.24 $25.00 Fee Schedule 74.74% $18.69 Percent of Billed Charges 68.24% $17.06 Percent of Billed Charges 65.00% $16.25 Percent of Billed Charges 67.00% $16.75 Percent of Billed Charges 77.50% $19.38 Percent of Billed Charges 79.97% $19.99 Percent of Billed Charges 55.00% $13.75 Percent of Billed Charges 49.55% $12.39 Percent of Billed Charges 55.00% $13.75 Percent of Billed Charges 55.00% $13.75 Percent of Billed Charges 78.94% $19.74 Percent of Billed Charges 74.00% $18.50 Percent of Billed Charges 92.50% $23.13 Percent of Billed Charges 55.00% $13.75 Percent of Billed Charges 85.00% $21.25 Percent of Billed Charges 63.00% $15.75 Percent of Billed Charges 63.00% $15.75 Percent of Billed Charges 75.00% $18.75 Percent of Billed Charges 66.24% $16.56 Percent of Billed Charges 165.81% $24.95 Fee Schedule 166.07% $24.99 Fee Schedule 176.26% $26.53 Fee Schedule 129.00% $19.41 Fee Schedule 191.24% $28.78 Fee Schedule 159.00% $39.75 Fee Schedule 145.00% $21.82 Fee Schedule 60.00% $15.00 Percent of Billed Charges HC ASPERGILLUS ABS QUEST 300 CPT 86606 90 Outpatient $15.98 $7.92 $28.78 $15.98 $82.04 $15.98 Fee Schedule $82.04 $15.98 Fee Schedule $131.24 $15.98 Fee Schedule 74.74% $11.94 Percent of Billed Charges 68.24% $10.90 Percent of Billed Charges 65.00% $10.39 Percent of Billed Charges 67.00% $10.71 Percent of Billed Charges 77.50% $12.38 Percent of Billed Charges 79.97% $12.78 Percent of Billed Charges 55.00% $8.79 Percent of Billed Charges 49.55% $7.92 Percent of Billed Charges 55.00% $8.79 Percent of Billed Charges 55.00% $8.79 Percent of Billed Charges 78.94% $12.61 Percent of Billed Charges 74.00% $11.83 Percent of Billed Charges 92.50% $14.78 Percent of Billed Charges 55.00% $8.79 Percent of Billed Charges 85.00% $13.58 Percent of Billed Charges 63.00% $10.07 Percent of Billed Charges 63.00% $10.07 Percent of Billed Charges 75.00% $11.99 Percent of Billed Charges 66.24% $10.59 Percent of Billed Charges 165.81% $15.98 Fee Schedule 166.07% $24.99 Fee Schedule 176.26% $26.53 Fee Schedule 129.00% $19.41 Fee Schedule 191.24% $28.78 Fee Schedule 159.00% $25.41 Fee Schedule 145.00% $21.82 Fee Schedule 60.00% $9.59 Percent of Billed Charges HC ASPERGILLUS ANTIGEN LABCORP 300 CPT 87305 90 Outpatient $40.00 $15.45 $63.60 $40.00 $65.32 $40.00 Fee Schedule $65.32 $40.00 Fee Schedule $104.47 $40.00 Fee Schedule 74.74% $29.90 Percent of Billed Charges 68.24% $27.30 Percent of Billed Charges 65.00% $26.00 Percent of Billed Charges 67.00% $26.80 Percent of Billed Charges 77.50% $31.00 Percent of Billed Charges 79.97% $31.99 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 49.55% $19.82 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 78.94% $31.58 Percent of Billed Charges 74.00% $29.60 Percent of Billed Charges 92.50% $37.00 Percent of Billed Charges 55.00% $22.00 Percent of Billed Charges 85.00% $34.00 Percent of Billed Charges 63.00% $25.20 Percent of Billed Charges 63.00% $25.20 Percent of Billed Charges 75.00% $30.00 Percent of Billed Charges 66.24% $26.50 Percent of Billed Charges 165.81% $19.86 Fee Schedule 166.07% $19.90 Fee Schedule 176.26% $21.12 Fee Schedule 129.00% $15.45 Fee Schedule 191.24% $22.91 Fee Schedule 159.00% $63.60 Fee Schedule 145.00% $17.37 Fee Schedule 60.00% $24.00 Percent of Billed Charges HC ASPERGILLUS FLAVUS IGE VIRACOR 300 CPT 86003 90 Outpatient $39.51 $6.73 $62.82 $39.51 $28.44 $28.44 Fee Schedule $28.44 $28.44 Fee Schedule $45.52 $39.51 Fee Schedule 74.74% $29.53 Percent of Billed Charges 68.24% $26.96 Percent of Billed Charges 65.00% $25.68 Percent of Billed Charges 67.00% $26.47 Percent of Billed Charges 77.50% $30.62 Percent of Billed Charges 79.97% $31.60 Percent of Billed Charges 55.00% $21.73 Percent of Billed Charges 49.55% $19.58 Percent of Billed Charges 55.00% $21.73 Percent of Billed Charges 55.00% $21.73 Percent of Billed Charges 78.94% $31.19 Percent of Billed Charges 74.00% $29.24 Percent of Billed Charges 92.50% $36.55 Percent of Billed Charges 55.00% $21.73 Percent of Billed Charges 85.00% $33.58 Percent of Billed Charges 63.00% $24.89 Percent of Billed Charges 63.00% $24.89 Percent of Billed Charges 75.00% $29.63 Percent of Billed Charges 66.24% $26.17 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $62.82 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $23.71 Percent of Billed Charges "HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS" 300 CPT 82784 Outpatient $215.00 $12.00 $341.85 $215.00 $50.68 $50.68 Fee Schedule $50.68 $50.68 Fee Schedule $81.10 $76.91 Fee Schedule 74.74% $160.69 Percent of Billed Charges 68.24% $146.72 Percent of Billed Charges 65.00% $139.75 Percent of Billed Charges 67.00% $144.05 Percent of Billed Charges 77.50% $166.63 Percent of Billed Charges 79.97% $171.94 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 49.55% $106.53 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 78.94% $169.72 Percent of Billed Charges 74.00% $159.10 Percent of Billed Charges 92.50% $198.88 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 85.00% $182.75 Percent of Billed Charges 63.00% $135.45 Percent of Billed Charges 63.00% $135.45 Percent of Billed Charges 75.00% $161.25 Percent of Billed Charges 66.24% $142.42 Percent of Billed Charges 165.81% $15.42 Fee Schedule 166.07% $15.44 Fee Schedule 176.26% $16.39 Fee Schedule 129.00% $12.00 Fee Schedule 191.24% $17.79 Fee Schedule 159.00% $341.85 Fee Schedule 145.00% $13.49 Fee Schedule 60.00% $129.00 Percent of Billed Charges HC ASSAY OF GAMMAGLOBULIN IGE - IMMUNOGLOBULIN IGE 300 CPT 82785 Outpatient $604.00 $21.23 $960.36 $604.00 $89.72 $89.72 Fee Schedule $89.72 $89.72 Fee Schedule $143.53 $136.12 Fee Schedule 74.74% $451.43 Percent of Billed Charges 68.24% $412.17 Percent of Billed Charges 65.00% $392.60 Percent of Billed Charges 67.00% $404.68 Percent of Billed Charges 77.50% $468.10 Percent of Billed Charges 79.97% $483.02 Percent of Billed Charges 55.00% $332.20 Percent of Billed Charges 49.55% $299.28 Percent of Billed Charges 55.00% $332.20 Percent of Billed Charges 55.00% $332.20 Percent of Billed Charges 78.94% $476.80 Percent of Billed Charges 74.00% $446.96 Percent of Billed Charges 92.50% $558.70 Percent of Billed Charges 55.00% $332.20 Percent of Billed Charges 85.00% $513.40 Percent of Billed Charges 63.00% $380.52 Percent of Billed Charges 63.00% $380.52 Percent of Billed Charges 75.00% $453.00 Percent of Billed Charges 66.24% $400.09 Percent of Billed Charges 165.81% $27.29 Fee Schedule 166.07% $27.34 Fee Schedule 176.26% $29.01 Fee Schedule 129.00% $21.23 Fee Schedule 191.24% $31.48 Fee Schedule 159.00% $960.36 Fee Schedule 145.00% $23.87 Fee Schedule 60.00% $362.40 Percent of Billed Charges HC ASSAY OF TOTAL THYROXINE - T4 (THYROID HORMONE) 300 CPT 84436 Outpatient $315.00 $8.86 $500.85 $315.00 $37.40 $37.40 Fee Schedule $37.40 $37.40 Fee Schedule $59.91 $56.81 Fee Schedule 74.74% $235.43 Percent of Billed Charges 68.24% $214.96 Percent of Billed Charges 65.00% $204.75 Percent of Billed Charges 67.00% $211.05 Percent of Billed Charges 77.50% $244.13 Percent of Billed Charges 79.97% $251.91 Percent of Billed Charges 55.00% $173.25 Percent of Billed Charges 49.55% $156.08 Percent of Billed Charges 55.00% $173.25 Percent of Billed Charges 55.00% $173.25 Percent of Billed Charges 78.94% $248.66 Percent of Billed Charges 74.00% $233.10 Percent of Billed Charges 92.50% $291.38 Percent of Billed Charges 55.00% $173.25 Percent of Billed Charges 85.00% $267.75 Percent of Billed Charges 63.00% $198.45 Percent of Billed Charges 63.00% $198.45 Percent of Billed Charges 75.00% $236.25 Percent of Billed Charges 66.24% $208.66 Percent of Billed Charges 165.81% $11.39 Fee Schedule 166.07% $11.41 Fee Schedule 176.26% $12.11 Fee Schedule 129.00% $8.86 Fee Schedule 191.24% $13.14 Fee Schedule 159.00% $500.85 Fee Schedule 145.00% $9.96 Fee Schedule 60.00% $189.00 Percent of Billed Charges HC ASSAY OTHER FLUID CHLORIDES - CHLORIDE BODY FLUID 300 CPT 82438 Outpatient $188.00 $6.45 $298.92 $188.00 $26.64 $26.64 Fee Schedule $26.64 $26.64 Fee Schedule $43.60 $41.35 Fee Schedule 74.74% $140.51 Percent of Billed Charges 68.24% $128.29 Percent of Billed Charges 65.00% $122.20 Percent of Billed Charges 67.00% $125.96 Percent of Billed Charges 77.50% $145.70 Percent of Billed Charges 79.97% $150.34 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 49.55% $93.15 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 78.94% $148.41 Percent of Billed Charges 74.00% $139.12 Percent of Billed Charges 92.50% $173.90 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 85.00% $159.80 Percent of Billed Charges 63.00% $118.44 Percent of Billed Charges 63.00% $118.44 Percent of Billed Charges 75.00% $141.00 Percent of Billed Charges 66.24% $124.53 Percent of Billed Charges 165.81% $8.29 Fee Schedule 166.07% $8.30 Fee Schedule 176.26% $8.81 Fee Schedule 129.00% $6.45 Fee Schedule 191.24% $9.56 Fee Schedule 159.00% $298.92 Fee Schedule 145.00% $7.25 Fee Schedule 60.00% $112.80 Percent of Billed Charges HC A-THROMBIN III AG ARUP 300 CPT 85301 90 Outpatient $21.18 $10.49 $33.68 $21.18 $58.92 $21.18 Fee Schedule $58.92 $21.18 Fee Schedule $94.26 $21.18 Fee Schedule 74.74% $15.83 Percent of Billed Charges 68.24% $14.45 Percent of Billed Charges 65.00% $13.77 Percent of Billed Charges 67.00% $14.19 Percent of Billed Charges 77.50% $16.41 Percent of Billed Charges 79.97% $16.94 Percent of Billed Charges 55.00% $11.65 Percent of Billed Charges 49.55% $10.49 Percent of Billed Charges 55.00% $11.65 Percent of Billed Charges 55.00% $11.65 Percent of Billed Charges 78.94% $16.72 Percent of Billed Charges 74.00% $15.67 Percent of Billed Charges 92.50% $19.59 Percent of Billed Charges 55.00% $11.65 Percent of Billed Charges 85.00% $18.00 Percent of Billed Charges 63.00% $13.34 Percent of Billed Charges 63.00% $13.34 Percent of Billed Charges 75.00% $15.89 Percent of Billed Charges 66.24% $14.03 Percent of Billed Charges 165.81% $17.92 Fee Schedule 166.07% $17.95 Fee Schedule 176.26% $19.05 Fee Schedule 129.00% $13.94 Fee Schedule 191.24% $20.67 Fee Schedule 159.00% $33.68 Fee Schedule 145.00% $15.67 Fee Schedule 60.00% $12.71 Percent of Billed Charges "HC B CELLS, TOTAL COUNT - B CELLS, TOTAL COUNT" 300 CPT 86355 Outpatient $764.00 $48.67 " $1,214.76 " $764.00 $205.56 $205.56 Fee Schedule $205.56 $205.56 Fee Schedule $329.01 $312.03 Fee Schedule 74.74% $571.01 Percent of Billed Charges 68.24% $521.35 Percent of Billed Charges 65.00% $496.60 Percent of Billed Charges 67.00% $511.88 Percent of Billed Charges 77.50% $592.10 Percent of Billed Charges 79.97% $610.97 Percent of Billed Charges 55.00% $420.20 Percent of Billed Charges 49.55% $378.56 Percent of Billed Charges 55.00% $420.20 Percent of Billed Charges 55.00% $420.20 Percent of Billed Charges 78.94% $603.10 Percent of Billed Charges 74.00% $565.36 Percent of Billed Charges 92.50% $706.70 Percent of Billed Charges 55.00% $420.20 Percent of Billed Charges 85.00% $649.40 Percent of Billed Charges 63.00% $481.32 Percent of Billed Charges 63.00% $481.32 Percent of Billed Charges 75.00% $573.00 Percent of Billed Charges 66.24% $506.07 Percent of Billed Charges 165.81% $62.56 Fee Schedule 166.07% $62.66 Fee Schedule 176.26% $66.50 Fee Schedule 129.00% $48.67 Fee Schedule 191.24% $72.15 Fee Schedule 159.00% " $1,214.76 " Fee Schedule 145.00% $54.71 Fee Schedule 60.00% $458.40 Percent of Billed Charges HC B. PERTUSSIS AB ARUP 300 CPT 86615 90 Outpatient $14.03 $6.95 $25.22 $14.03 $71.88 $14.03 Fee Schedule $71.88 $14.03 Fee Schedule $115.02 $14.03 Fee Schedule 74.74% $10.49 Percent of Billed Charges 68.24% $9.57 Percent of Billed Charges 65.00% $9.12 Percent of Billed Charges 67.00% $9.40 Percent of Billed Charges 77.50% $10.87 Percent of Billed Charges 79.97% $11.22 Percent of Billed Charges 55.00% $7.72 Percent of Billed Charges 49.55% $6.95 Percent of Billed Charges 55.00% $7.72 Percent of Billed Charges 55.00% $7.72 Percent of Billed Charges 78.94% $11.08 Percent of Billed Charges 74.00% $10.38 Percent of Billed Charges 92.50% $12.98 Percent of Billed Charges 55.00% $7.72 Percent of Billed Charges 85.00% $11.93 Percent of Billed Charges 63.00% $8.84 Percent of Billed Charges 63.00% $8.84 Percent of Billed Charges 75.00% $10.52 Percent of Billed Charges 66.24% $9.29 Percent of Billed Charges 165.81% $14.03 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $22.31 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $8.42 Percent of Billed Charges HC B2-GLYCOPROTEIN ABS LABCORP 300 CPT 86146 90 Outpatient $9.50 $4.71 $48.67 $9.50 $138.64 $9.50 Fee Schedule $138.64 $9.50 Fee Schedule $221.92 $9.50 Fee Schedule 74.74% $7.10 Percent of Billed Charges 68.24% $6.48 Percent of Billed Charges 65.00% $6.18 Percent of Billed Charges 67.00% $6.37 Percent of Billed Charges 77.50% $7.36 Percent of Billed Charges 79.97% $7.60 Percent of Billed Charges 55.00% $5.23 Percent of Billed Charges 49.55% $4.71 Percent of Billed Charges 55.00% $5.23 Percent of Billed Charges 55.00% $5.23 Percent of Billed Charges 78.94% $7.50 Percent of Billed Charges 74.00% $7.03 Percent of Billed Charges 92.50% $8.79 Percent of Billed Charges 55.00% $5.23 Percent of Billed Charges 85.00% $8.08 Percent of Billed Charges 63.00% $5.99 Percent of Billed Charges 63.00% $5.99 Percent of Billed Charges 75.00% $7.13 Percent of Billed Charges 66.24% $6.29 Percent of Billed Charges 165.81% $9.50 Fee Schedule 166.07% $42.26 Fee Schedule 176.26% $44.86 Fee Schedule 129.00% $32.83 Fee Schedule 191.24% $48.67 Fee Schedule 159.00% $15.11 Fee Schedule 145.00% $36.90 Fee Schedule 60.00% $5.70 Percent of Billed Charges HC BABESIA MICROTI DNA PCR Q 300 CPT 87798 90 Outpatient $264.20 $45.27 $420.08 $264.20 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $264.20 Fee Schedule 74.74% $197.46 Percent of Billed Charges 68.24% $180.29 Percent of Billed Charges 65.00% $171.73 Percent of Billed Charges 67.00% $177.01 Percent of Billed Charges 77.50% $204.76 Percent of Billed Charges 79.97% $211.28 Percent of Billed Charges 55.00% $145.31 Percent of Billed Charges 49.55% $130.91 Percent of Billed Charges 55.00% $145.31 Percent of Billed Charges 55.00% $145.31 Percent of Billed Charges 78.94% $208.56 Percent of Billed Charges 74.00% $195.51 Percent of Billed Charges 92.50% $244.39 Percent of Billed Charges 55.00% $145.31 Percent of Billed Charges 85.00% $224.57 Percent of Billed Charges 63.00% $166.45 Percent of Billed Charges 63.00% $166.45 Percent of Billed Charges 75.00% $198.15 Percent of Billed Charges 66.24% $175.01 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $420.08 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $158.52 Percent of Billed Charges HC BACTERIAL AG DETECT QUEST 300 CPT 86403 90 Outpatient $20.21 $10.01 $32.13 $20.21 $55.52 $20.21 Fee Schedule $55.52 $20.21 Fee Schedule $100.63 $20.21 Fee Schedule 74.74% $15.10 Percent of Billed Charges 68.24% $13.79 Percent of Billed Charges 65.00% $13.14 Percent of Billed Charges 67.00% $13.54 Percent of Billed Charges 77.50% $15.66 Percent of Billed Charges 79.97% $16.16 Percent of Billed Charges 55.00% $11.12 Percent of Billed Charges 49.55% $10.01 Percent of Billed Charges 55.00% $11.12 Percent of Billed Charges 55.00% $11.12 Percent of Billed Charges 78.94% $15.95 Percent of Billed Charges 74.00% $14.96 Percent of Billed Charges 92.50% $18.69 Percent of Billed Charges 55.00% $11.12 Percent of Billed Charges 85.00% $17.18 Percent of Billed Charges 63.00% $12.73 Percent of Billed Charges 63.00% $12.73 Percent of Billed Charges 75.00% $15.16 Percent of Billed Charges 66.24% $13.39 Percent of Billed Charges 165.81% $19.13 Fee Schedule 166.07% $19.16 Fee Schedule 176.26% $20.34 Fee Schedule 129.00% $14.89 Fee Schedule 191.24% $22.07 Fee Schedule 159.00% $32.13 Fee Schedule 145.00% $16.73 Fee Schedule 60.00% $12.13 Percent of Billed Charges HC BACTERIAL PCR UW MOLECULAR LAB 300 CPT 87801 90 Outpatient $343.25 $69.92 $545.77 $343.25 $382.48 $343.25 Fee Schedule $382.48 $343.25 Fee Schedule $612.14 $275.96 Fee Schedule 74.74% $256.55 Percent of Billed Charges 68.24% $234.23 Percent of Billed Charges 65.00% $223.11 Percent of Billed Charges 67.00% $229.98 Percent of Billed Charges 77.50% $266.02 Percent of Billed Charges 79.97% $274.50 Percent of Billed Charges 55.00% $188.79 Percent of Billed Charges 49.55% $170.08 Percent of Billed Charges 55.00% $188.79 Percent of Billed Charges 55.00% $188.79 Percent of Billed Charges 78.94% $270.96 Percent of Billed Charges 74.00% $254.01 Percent of Billed Charges 92.50% $317.51 Percent of Billed Charges 55.00% $188.79 Percent of Billed Charges 85.00% $291.76 Percent of Billed Charges 63.00% $216.25 Percent of Billed Charges 63.00% $216.25 Percent of Billed Charges 75.00% $257.44 Percent of Billed Charges 66.24% $227.37 Percent of Billed Charges 165.81% $89.87 Fee Schedule 166.07% $90.01 Fee Schedule 176.26% $95.53 Fee Schedule 129.00% $69.92 Fee Schedule 191.24% $103.65 Fee Schedule 159.00% $545.77 Fee Schedule 145.00% $78.59 Fee Schedule 60.00% $205.95 Percent of Billed Charges HC BARBITURATES CONFRIM UR QUEST 300 CPT 80307 90 Outpatient $33.11 $16.41 $118.84 $33.11 $319.24 $33.11 Fee Schedule $319.24 $33.11 Fee Schedule $541.86 $33.11 Fee Schedule 74.74% $24.75 Percent of Billed Charges 68.24% $22.59 Percent of Billed Charges 65.00% $21.52 Percent of Billed Charges 67.00% $22.18 Percent of Billed Charges 77.50% $25.66 Percent of Billed Charges 79.97% $26.48 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 49.55% $16.41 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 78.94% $26.14 Percent of Billed Charges 74.00% $24.50 Percent of Billed Charges 92.50% $30.63 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 85.00% $28.14 Percent of Billed Charges 63.00% $20.86 Percent of Billed Charges 63.00% $20.86 Percent of Billed Charges 75.00% $24.83 Percent of Billed Charges 66.24% $21.93 Percent of Billed Charges 165.81% $33.11 Fee Schedule 166.07% $103.20 Fee Schedule 176.26% $109.53 Fee Schedule 129.00% $80.16 Fee Schedule 191.24% $118.84 Fee Schedule 159.00% $52.64 Fee Schedule 145.00% $90.10 Fee Schedule 60.00% $19.87 Percent of Billed Charges HC BARTONELLA AB LABCORP 300 CPT 86611 90 Outpatient $20.00 $9.91 $31.80 $20.00 $55.48 $20.00 Fee Schedule $55.48 $20.00 Fee Schedule $88.77 $20.00 Fee Schedule 74.74% $14.95 Percent of Billed Charges 68.24% $13.65 Percent of Billed Charges 65.00% $13.00 Percent of Billed Charges 67.00% $13.40 Percent of Billed Charges 77.50% $15.50 Percent of Billed Charges 79.97% $15.99 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 49.55% $9.91 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 78.94% $15.79 Percent of Billed Charges 74.00% $14.80 Percent of Billed Charges 92.50% $18.50 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 85.00% $17.00 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 75.00% $15.00 Percent of Billed Charges 66.24% $13.25 Percent of Billed Charges 165.81% $16.88 Fee Schedule 166.07% $16.91 Fee Schedule 176.26% $17.94 Fee Schedule 129.00% $13.13 Fee Schedule 191.24% $19.47 Fee Schedule 159.00% $31.80 Fee Schedule 145.00% $14.76 Fee Schedule 60.00% $12.00 Percent of Billed Charges HC BARTONELLA DNA PCR LABCORP 300 CPT 87471 90 Outpatient $202.50 $45.27 $321.98 $202.50 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $202.50 Fee Schedule 74.74% $151.35 Percent of Billed Charges 68.24% $138.19 Percent of Billed Charges 65.00% $131.63 Percent of Billed Charges 67.00% $135.68 Percent of Billed Charges 77.50% $156.94 Percent of Billed Charges 79.97% $161.94 Percent of Billed Charges 55.00% $111.38 Percent of Billed Charges 49.55% $100.34 Percent of Billed Charges 55.00% $111.38 Percent of Billed Charges 55.00% $111.38 Percent of Billed Charges 78.94% $159.85 Percent of Billed Charges 74.00% $149.85 Percent of Billed Charges 92.50% $187.31 Percent of Billed Charges 55.00% $111.38 Percent of Billed Charges 85.00% $172.13 Percent of Billed Charges 63.00% $127.58 Percent of Billed Charges 63.00% $127.58 Percent of Billed Charges 75.00% $151.88 Percent of Billed Charges 66.24% $134.14 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $321.98 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $121.50 Percent of Billed Charges HC BBK PHYSICIAN WRITTEN REPORT – ANTIBODY ID 300 CPT 86077 Outpatient $47.00 $23.29 $176.71 $47.00 $122.04 $47.00 Fee Schedule $122.04 $47.00 Fee Schedule 56.78% $26.69 Percent of Billed Charges 74.74% $35.13 Percent of Billed Charges 68.24% $32.07 Percent of Billed Charges 65.00% $30.55 Percent of Billed Charges 67.00% $31.49 Percent of Billed Charges 77.50% $36.43 Percent of Billed Charges 79.97% $37.59 Percent of Billed Charges 55.00% $25.85 Percent of Billed Charges 49.55% $23.29 Percent of Billed Charges 55.00% $25.85 Percent of Billed Charges 55.00% $25.85 Percent of Billed Charges 78.94% $37.10 Percent of Billed Charges 74.00% $34.78 Percent of Billed Charges 92.50% $43.48 Percent of Billed Charges 55.00% $25.85 Percent of Billed Charges 85.00% $39.95 Percent of Billed Charges 63.00% $29.61 Percent of Billed Charges 63.00% $29.61 Percent of Billed Charges 75.00% $35.25 Percent of Billed Charges 66.24% $31.13 Percent of Billed Charges 165.81% $47.00 Fee Schedule 166.07% $153.45 Fee Schedule 176.26% $162.86 Fee Schedule 129.00% $119.20 Fee Schedule 191.24% $176.71 Fee Schedule 159.00% $74.73 Fee Schedule 145.00% $133.98 Fee Schedule 60.00% $28.20 Percent of Billed Charges HC BCR-ABL1 ARUP 300 CPT 81206 90 Outpatient $260.00 $128.83 $413.40 $260.00 $893.40 $260.00 Fee Schedule $893.40 $260.00 Fee Schedule " $1,429.73 " $260.00 Fee Schedule 74.74% $194.32 Percent of Billed Charges 68.24% $177.42 Percent of Billed Charges 65.00% $169.00 Percent of Billed Charges 67.00% $174.20 Percent of Billed Charges 77.50% $201.50 Percent of Billed Charges 79.97% $207.92 Percent of Billed Charges 55.00% $143.00 Percent of Billed Charges 49.55% $128.83 Percent of Billed Charges 55.00% $143.00 Percent of Billed Charges 55.00% $143.00 Percent of Billed Charges 78.94% $205.24 Percent of Billed Charges 74.00% $192.40 Percent of Billed Charges 92.50% $240.50 Percent of Billed Charges 55.00% $143.00 Percent of Billed Charges 85.00% $221.00 Percent of Billed Charges 63.00% $163.80 Percent of Billed Charges 63.00% $163.80 Percent of Billed Charges 75.00% $195.00 Percent of Billed Charges 66.24% $172.22 Percent of Billed Charges 165.81% $200.83 Fee Schedule 166.07% $201.14 Fee Schedule 176.26% $213.49 Fee Schedule 129.00% $156.24 Fee Schedule 191.24% $231.63 Fee Schedule 159.00% $413.40 Fee Schedule 145.00% $175.62 Fee Schedule 60.00% $156.00 Percent of Billed Charges HC BCR-ABL1 QUAL REFX TO QNT 81206 ARUP 300 CPT 81206 90 Outpatient $95.00 $47.07 $231.63 $95.00 $893.40 $95.00 Fee Schedule $893.40 $95.00 Fee Schedule " $1,429.73 " $95.00 Fee Schedule 74.74% $71.00 Percent of Billed Charges 68.24% $64.83 Percent of Billed Charges 65.00% $61.75 Percent of Billed Charges 67.00% $63.65 Percent of Billed Charges 77.50% $73.63 Percent of Billed Charges 79.97% $75.97 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 49.55% $47.07 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 78.94% $74.99 Percent of Billed Charges 74.00% $70.30 Percent of Billed Charges 92.50% $87.88 Percent of Billed Charges 55.00% $52.25 Percent of Billed Charges 85.00% $80.75 Percent of Billed Charges 63.00% $59.85 Percent of Billed Charges 63.00% $59.85 Percent of Billed Charges 75.00% $71.25 Percent of Billed Charges 66.24% $62.93 Percent of Billed Charges 165.81% $95.00 Fee Schedule 166.07% $201.14 Fee Schedule 176.26% $213.49 Fee Schedule 129.00% $156.24 Fee Schedule 191.24% $231.63 Fee Schedule 159.00% $151.05 Fee Schedule 145.00% $175.62 Fee Schedule 60.00% $57.00 Percent of Billed Charges HC BCR-ABL1 QUAL REFX TO QNT 81207 ARUP 300 CPT 81207 90 Outpatient $95.25 $47.20 $193.15 $95.25 $789.20 $95.25 Fee Schedule $789.20 $95.25 Fee Schedule " $1,263.00 " $95.25 Fee Schedule 74.74% $71.19 Percent of Billed Charges 68.24% $65.00 Percent of Billed Charges 65.00% $61.91 Percent of Billed Charges 67.00% $63.82 Percent of Billed Charges 77.50% $73.82 Percent of Billed Charges 79.97% $76.17 Percent of Billed Charges 55.00% $52.39 Percent of Billed Charges 49.55% $47.20 Percent of Billed Charges 55.00% $52.39 Percent of Billed Charges 55.00% $52.39 Percent of Billed Charges 78.94% $75.19 Percent of Billed Charges 74.00% $70.49 Percent of Billed Charges 92.50% $88.11 Percent of Billed Charges 55.00% $52.39 Percent of Billed Charges 85.00% $80.96 Percent of Billed Charges 63.00% $60.01 Percent of Billed Charges 63.00% $60.01 Percent of Billed Charges 75.00% $71.44 Percent of Billed Charges 66.24% $63.09 Percent of Billed Charges 165.81% $95.25 Fee Schedule 166.07% $167.73 Fee Schedule 176.26% $178.02 Fee Schedule 129.00% $130.29 Fee Schedule 191.24% $193.15 Fee Schedule 159.00% $151.45 Fee Schedule 145.00% $146.45 Fee Schedule 60.00% $57.15 Percent of Billed Charges "HC BCR-ABL1, PCR LABCORP RTP" 300 CPT 81206 90 Outpatient $191.25 $94.76 $304.09 $191.25 $893.40 $191.25 Fee Schedule $893.40 $191.25 Fee Schedule " $1,429.73 " $191.25 Fee Schedule 74.74% $142.94 Percent of Billed Charges 68.24% $130.51 Percent of Billed Charges 65.00% $124.31 Percent of Billed Charges 67.00% $128.14 Percent of Billed Charges 77.50% $148.22 Percent of Billed Charges 79.97% $152.94 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 49.55% $94.76 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 78.94% $150.97 Percent of Billed Charges 74.00% $141.53 Percent of Billed Charges 92.50% $176.91 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 85.00% $162.56 Percent of Billed Charges 63.00% $120.49 Percent of Billed Charges 63.00% $120.49 Percent of Billed Charges 75.00% $143.44 Percent of Billed Charges 66.24% $126.68 Percent of Billed Charges 165.81% $191.25 Fee Schedule 166.07% $201.14 Fee Schedule 176.26% $213.49 Fee Schedule 129.00% $156.24 Fee Schedule 191.24% $231.63 Fee Schedule 159.00% $304.09 Fee Schedule 145.00% $175.62 Fee Schedule 60.00% $114.75 Percent of Billed Charges "HC BCR-ABL1, PCR LABCORP RTP" 300 CPT 81207 90 Outpatient $191.25 $94.76 $304.09 $191.25 $789.20 $191.25 Fee Schedule $789.20 $191.25 Fee Schedule " $1,263.00 " $191.25 Fee Schedule 74.74% $142.94 Percent of Billed Charges 68.24% $130.51 Percent of Billed Charges 65.00% $124.31 Percent of Billed Charges 67.00% $128.14 Percent of Billed Charges 77.50% $148.22 Percent of Billed Charges 79.97% $152.94 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 49.55% $94.76 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 78.94% $150.97 Percent of Billed Charges 74.00% $141.53 Percent of Billed Charges 92.50% $176.91 Percent of Billed Charges 55.00% $105.19 Percent of Billed Charges 85.00% $162.56 Percent of Billed Charges 63.00% $120.49 Percent of Billed Charges 63.00% $120.49 Percent of Billed Charges 75.00% $143.44 Percent of Billed Charges 66.24% $126.68 Percent of Billed Charges 165.81% $167.47 Fee Schedule 166.07% $167.73 Fee Schedule 176.26% $178.02 Fee Schedule 129.00% $130.29 Fee Schedule 191.24% $193.15 Fee Schedule 159.00% $304.09 Fee Schedule 145.00% $146.45 Fee Schedule 60.00% $114.75 Percent of Billed Charges "HC BENZO CONFIRM UR, QUEST" 300 CPT G0480 90 Outpatient $77.27 $38.29 $170.85 $77.27 $319.76 $77.27 Fee Schedule $319.76 $77.27 Fee Schedule $997.83 $77.27 Fee Schedule 74.74% $57.75 Percent of Billed Charges 68.24% $52.73 Percent of Billed Charges 65.00% $50.23 Percent of Billed Charges 67.00% $51.77 Percent of Billed Charges 77.50% $59.88 Percent of Billed Charges 79.97% $61.79 Percent of Billed Charges 55.00% $42.50 Percent of Billed Charges 49.55% $38.29 Percent of Billed Charges 55.00% $42.50 Percent of Billed Charges 55.00% $42.50 Percent of Billed Charges 78.94% $61.00 Percent of Billed Charges 74.00% $57.18 Percent of Billed Charges 92.50% $71.47 Percent of Billed Charges 55.00% $42.50 Percent of Billed Charges 85.00% $65.68 Percent of Billed Charges 63.00% $48.68 Percent of Billed Charges 63.00% $48.68 Percent of Billed Charges 75.00% $57.95 Percent of Billed Charges 66.24% $51.18 Percent of Billed Charges 165.81% $77.27 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $122.86 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $46.36 Percent of Billed Charges "HC BENZOIC ACID,SERUM" 300 CPT 82542 90 Outpatient $150.00 $31.08 $238.50 $150.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $150.00 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $90.00 Percent of Billed Charges "HC BETA 2 MICROGLOBULIN," 300 CPT 82232 90 Outpatient $14.38 $7.13 $30.94 $14.38 $88.16 $14.38 Fee Schedule $88.16 $14.38 Fee Schedule $141.09 $14.38 Fee Schedule 74.74% $10.75 Percent of Billed Charges 68.24% $9.81 Percent of Billed Charges 65.00% $9.35 Percent of Billed Charges 67.00% $9.63 Percent of Billed Charges 77.50% $11.14 Percent of Billed Charges 79.97% $11.50 Percent of Billed Charges 55.00% $7.91 Percent of Billed Charges 49.55% $7.13 Percent of Billed Charges 55.00% $7.91 Percent of Billed Charges 55.00% $7.91 Percent of Billed Charges 78.94% $11.35 Percent of Billed Charges 74.00% $10.64 Percent of Billed Charges 92.50% $13.30 Percent of Billed Charges 55.00% $7.91 Percent of Billed Charges 85.00% $12.22 Percent of Billed Charges 63.00% $9.06 Percent of Billed Charges 63.00% $9.06 Percent of Billed Charges 75.00% $10.79 Percent of Billed Charges 66.24% $9.53 Percent of Billed Charges 165.81% $14.38 Fee Schedule 166.07% $26.87 Fee Schedule 176.26% $28.52 Fee Schedule 129.00% $20.87 Fee Schedule 191.24% $30.94 Fee Schedule 159.00% $22.86 Fee Schedule 145.00% $23.46 Fee Schedule 60.00% $8.63 Percent of Billed Charges HC BETA 2 TRANSFERRIN ARUP 300 CPT 86335 90 Outpatient $80.50 $37.86 $128.00 $80.50 $159.88 $80.50 Fee Schedule $159.88 $80.50 Fee Schedule $255.93 $80.50 Fee Schedule 74.74% $60.17 Percent of Billed Charges 68.24% $54.93 Percent of Billed Charges 65.00% $52.33 Percent of Billed Charges 67.00% $53.94 Percent of Billed Charges 77.50% $62.39 Percent of Billed Charges 79.97% $64.38 Percent of Billed Charges 55.00% $44.28 Percent of Billed Charges 49.55% $39.89 Percent of Billed Charges 55.00% $44.28 Percent of Billed Charges 55.00% $44.28 Percent of Billed Charges 78.94% $63.55 Percent of Billed Charges 74.00% $59.57 Percent of Billed Charges 92.50% $74.46 Percent of Billed Charges 55.00% $44.28 Percent of Billed Charges 85.00% $68.43 Percent of Billed Charges 63.00% $50.72 Percent of Billed Charges 63.00% $50.72 Percent of Billed Charges 75.00% $60.38 Percent of Billed Charges 66.24% $53.32 Percent of Billed Charges 165.81% $48.67 Fee Schedule 166.07% $48.74 Fee Schedule 176.26% $51.73 Fee Schedule 129.00% $37.86 Fee Schedule 191.24% $56.13 Fee Schedule 159.00% $128.00 Fee Schedule 145.00% $42.56 Fee Schedule 60.00% $48.30 Percent of Billed Charges HC BETA GLOBIN CLUSTERS MAYO 300 CPT 81363 90 Outpatient $350.00 $173.43 $556.50 $350.00 $809.60 $350.00 Fee Schedule $809.60 $350.00 Fee Schedule " $1,764.93 " $350.00 Fee Schedule 74.74% $261.59 Percent of Billed Charges 68.24% $238.84 Percent of Billed Charges 65.00% $227.50 Percent of Billed Charges 67.00% $234.50 Percent of Billed Charges 77.50% $271.25 Percent of Billed Charges 79.97% $279.90 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 49.55% $173.43 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 78.94% $276.29 Percent of Billed Charges 74.00% $259.00 Percent of Billed Charges 92.50% $323.75 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 85.00% $297.50 Percent of Billed Charges 63.00% $220.50 Percent of Billed Charges 63.00% $220.50 Percent of Billed Charges 75.00% $262.50 Percent of Billed Charges 66.24% $231.84 Percent of Billed Charges 165.81% $335.60 Fee Schedule 166.07% $336.13 Fee Schedule 176.26% $356.75 Fee Schedule 129.00% $261.10 Fee Schedule 191.24% $387.07 Fee Schedule 159.00% $556.50 Fee Schedule 145.00% $293.48 Fee Schedule 60.00% $210.00 Percent of Billed Charges HC BETA GLOBIN GENE SEQ MAYO 300 CPT 81364 90 Outpatient $659.00 $326.53 " $1,047.81 " $659.00 " $1,298.32 " $659.00 Fee Schedule " $1,298.32 " $659.00 Fee Schedule " $2,830.34 " $659.00 Fee Schedule 74.74% $492.54 Percent of Billed Charges 68.24% $449.70 Percent of Billed Charges 65.00% $428.35 Percent of Billed Charges 67.00% $441.53 Percent of Billed Charges 77.50% $510.73 Percent of Billed Charges 79.97% $527.00 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 49.55% $326.53 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 78.94% $520.21 Percent of Billed Charges 74.00% $487.66 Percent of Billed Charges 92.50% $609.58 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 85.00% $560.15 Percent of Billed Charges 63.00% $415.17 Percent of Billed Charges 63.00% $415.17 Percent of Billed Charges 75.00% $494.25 Percent of Billed Charges 66.24% $436.52 Percent of Billed Charges 165.81% $538.19 Fee Schedule 166.07% $539.03 Fee Schedule 176.26% $572.10 Fee Schedule 129.00% $418.71 Fee Schedule 191.24% $620.73 Fee Schedule 159.00% " $1,047.81 " Fee Schedule 145.00% $470.64 Fee Schedule 60.00% $395.40 Percent of Billed Charges "HC BETA HCG,QUANT,TUMOR MKR ARUP" 300 CPT 84702 90 Outpatient $16.05 $7.95 $28.78 $16.05 $82.04 $16.05 Fee Schedule $82.04 $16.05 Fee Schedule $131.24 $16.05 Fee Schedule 74.74% $12.00 Percent of Billed Charges 68.24% $10.95 Percent of Billed Charges 65.00% $10.43 Percent of Billed Charges 67.00% $10.75 Percent of Billed Charges 77.50% $12.44 Percent of Billed Charges 79.97% $12.84 Percent of Billed Charges 55.00% $8.83 Percent of Billed Charges 49.55% $7.95 Percent of Billed Charges 55.00% $8.83 Percent of Billed Charges 55.00% $8.83 Percent of Billed Charges 78.94% $12.67 Percent of Billed Charges 74.00% $11.88 Percent of Billed Charges 92.50% $14.85 Percent of Billed Charges 55.00% $8.83 Percent of Billed Charges 85.00% $13.64 Percent of Billed Charges 63.00% $10.11 Percent of Billed Charges 63.00% $10.11 Percent of Billed Charges 75.00% $12.04 Percent of Billed Charges 66.24% $10.63 Percent of Billed Charges 165.81% $16.05 Fee Schedule 166.07% $24.99 Fee Schedule 176.26% $26.53 Fee Schedule 129.00% $19.41 Fee Schedule 191.24% $28.78 Fee Schedule 159.00% $25.52 Fee Schedule 145.00% $21.82 Fee Schedule 60.00% $9.63 Percent of Billed Charges HC BETA-2-MICROGLOBULIN LABC 300 CPT 82232 90 Outpatient $10.00 $4.96 $30.94 $10.00 $88.16 $10.00 Fee Schedule $88.16 $10.00 Fee Schedule $141.09 $10.00 Fee Schedule 74.74% $7.47 Percent of Billed Charges 68.24% $6.82 Percent of Billed Charges 65.00% $6.50 Percent of Billed Charges 67.00% $6.70 Percent of Billed Charges 77.50% $7.75 Percent of Billed Charges 79.97% $8.00 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 49.55% $4.96 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 78.94% $7.89 Percent of Billed Charges 74.00% $7.40 Percent of Billed Charges 92.50% $9.25 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 85.00% $8.50 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 75.00% $7.50 Percent of Billed Charges 66.24% $6.62 Percent of Billed Charges 165.81% $10.00 Fee Schedule 166.07% $26.87 Fee Schedule 176.26% $28.52 Fee Schedule 129.00% $20.87 Fee Schedule 191.24% $30.94 Fee Schedule 159.00% $15.90 Fee Schedule 145.00% $23.46 Fee Schedule 60.00% $6.00 Percent of Billed Charges HC BETHESDA QT FACTOR 8 BILL 300 CPT 85335 90 Outpatient $105.13 $16.60 $167.16 $105.13 $70.12 $70.12 Fee Schedule $70.12 $70.12 Fee Schedule $112.23 $105.13 Fee Schedule 74.74% $78.57 Percent of Billed Charges 68.24% $71.74 Percent of Billed Charges 65.00% $68.33 Percent of Billed Charges 67.00% $70.44 Percent of Billed Charges 77.50% $81.48 Percent of Billed Charges 79.97% $84.07 Percent of Billed Charges 55.00% $57.82 Percent of Billed Charges 49.55% $52.09 Percent of Billed Charges 55.00% $57.82 Percent of Billed Charges 55.00% $57.82 Percent of Billed Charges 78.94% $82.99 Percent of Billed Charges 74.00% $77.80 Percent of Billed Charges 92.50% $97.25 Percent of Billed Charges 55.00% $57.82 Percent of Billed Charges 85.00% $89.36 Percent of Billed Charges 63.00% $66.23 Percent of Billed Charges 63.00% $66.23 Percent of Billed Charges 75.00% $78.85 Percent of Billed Charges 66.24% $69.64 Percent of Billed Charges 165.81% $21.34 Fee Schedule 166.07% $21.37 Fee Schedule 176.26% $22.68 Fee Schedule 129.00% $16.60 Fee Schedule 191.24% $24.61 Fee Schedule 159.00% $167.16 Fee Schedule 145.00% $18.66 Fee Schedule 60.00% $63.08 Percent of Billed Charges HC BILE ACIDS LABCORP 300 CPT 82239 90 Outpatient $3.40 $1.68 $32.74 $3.40 $93.32 $3.40 Fee Schedule $93.32 $3.40 Fee Schedule $149.29 $3.40 Fee Schedule 74.74% $2.54 Percent of Billed Charges 68.24% $2.32 Percent of Billed Charges 65.00% $2.21 Percent of Billed Charges 67.00% $2.28 Percent of Billed Charges 77.50% $2.64 Percent of Billed Charges 79.97% $2.72 Percent of Billed Charges 55.00% $1.87 Percent of Billed Charges 49.55% $1.68 Percent of Billed Charges 55.00% $1.87 Percent of Billed Charges 55.00% $1.87 Percent of Billed Charges 78.94% $2.68 Percent of Billed Charges 74.00% $2.52 Percent of Billed Charges 92.50% $3.15 Percent of Billed Charges 55.00% $1.87 Percent of Billed Charges 85.00% $2.89 Percent of Billed Charges 63.00% $2.14 Percent of Billed Charges 63.00% $2.14 Percent of Billed Charges 75.00% $2.55 Percent of Billed Charges 66.24% $2.25 Percent of Billed Charges 165.81% $3.40 Fee Schedule 166.07% $28.43 Fee Schedule 176.26% $30.18 Fee Schedule 129.00% $22.08 Fee Schedule 191.24% $32.74 Fee Schedule 159.00% $5.41 Fee Schedule 145.00% $24.82 Fee Schedule 60.00% $2.04 Percent of Billed Charges "HC BILE ACIDS, FRAC & TOT ARUP" 300 CPT 83789 90 Outpatient $100.50 $31.10 $159.80 $100.50 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.24 $100.50 Fee Schedule 74.74% $75.11 Percent of Billed Charges 68.24% $68.58 Percent of Billed Charges 65.00% $65.33 Percent of Billed Charges 67.00% $67.34 Percent of Billed Charges 77.50% $77.89 Percent of Billed Charges 79.97% $80.37 Percent of Billed Charges 55.00% $55.28 Percent of Billed Charges 49.55% $49.80 Percent of Billed Charges 55.00% $55.28 Percent of Billed Charges 55.00% $55.28 Percent of Billed Charges 78.94% $79.33 Percent of Billed Charges 74.00% $74.37 Percent of Billed Charges 92.50% $92.96 Percent of Billed Charges 55.00% $55.28 Percent of Billed Charges 85.00% $85.43 Percent of Billed Charges 63.00% $63.32 Percent of Billed Charges 63.00% $63.32 Percent of Billed Charges 75.00% $75.38 Percent of Billed Charges 66.24% $66.57 Percent of Billed Charges 165.81% $39.98 Fee Schedule 166.07% $40.04 Fee Schedule 176.26% $42.50 Fee Schedule 129.00% $31.10 Fee Schedule 191.24% $46.11 Fee Schedule 159.00% $159.80 Fee Schedule 145.00% $34.96 Fee Schedule 60.00% $60.30 Percent of Billed Charges "HC BILIRUBIN,TOTAL,BODY ARUP" 300 CPT 82247 90 Outpatient $8.35 $4.14 $13.28 $8.35 $27.32 $8.35 Fee Schedule $27.32 $8.35 Fee Schedule $43.77 $8.35 Fee Schedule 74.74% $6.24 Percent of Billed Charges 68.24% $5.70 Percent of Billed Charges 65.00% $5.43 Percent of Billed Charges 67.00% $5.59 Percent of Billed Charges 77.50% $6.47 Percent of Billed Charges 79.97% $6.68 Percent of Billed Charges 55.00% $4.59 Percent of Billed Charges 49.55% $4.14 Percent of Billed Charges 55.00% $4.59 Percent of Billed Charges 55.00% $4.59 Percent of Billed Charges 78.94% $6.59 Percent of Billed Charges 74.00% $6.18 Percent of Billed Charges 92.50% $7.72 Percent of Billed Charges 55.00% $4.59 Percent of Billed Charges 85.00% $7.10 Percent of Billed Charges 63.00% $5.26 Percent of Billed Charges 63.00% $5.26 Percent of Billed Charges 75.00% $6.26 Percent of Billed Charges 66.24% $5.53 Percent of Billed Charges 165.81% $8.32 Fee Schedule 166.07% $8.34 Fee Schedule 176.26% $8.85 Fee Schedule 129.00% $6.48 Fee Schedule 191.24% $9.60 Fee Schedule 159.00% $13.28 Fee Schedule 145.00% $7.28 Fee Schedule 60.00% $5.01 Percent of Billed Charges HC BIOTINIDASE QUEST 300 CPT 82261 90 Outpatient $88.17 $21.76 $140.19 $88.17 $91.88 $88.17 Fee Schedule $91.88 $88.17 Fee Schedule $147.11 $88.17 Fee Schedule 74.74% $65.90 Percent of Billed Charges 68.24% $60.17 Percent of Billed Charges 65.00% $57.31 Percent of Billed Charges 67.00% $59.07 Percent of Billed Charges 77.50% $68.33 Percent of Billed Charges 79.97% $70.51 Percent of Billed Charges 55.00% $48.49 Percent of Billed Charges 49.55% $43.69 Percent of Billed Charges 55.00% $48.49 Percent of Billed Charges 55.00% $48.49 Percent of Billed Charges 78.94% $69.60 Percent of Billed Charges 74.00% $65.25 Percent of Billed Charges 92.50% $81.56 Percent of Billed Charges 55.00% $48.49 Percent of Billed Charges 85.00% $74.94 Percent of Billed Charges 63.00% $55.55 Percent of Billed Charges 63.00% $55.55 Percent of Billed Charges 75.00% $66.13 Percent of Billed Charges 66.24% $58.40 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $140.19 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $52.90 Percent of Billed Charges HC BK RT DNA PCR BLD LABCORP 300 CPT 87799 90 Outpatient $190.00 $55.26 $302.10 $190.00 $233.40 $190.00 Fee Schedule $233.40 $190.00 Fee Schedule $373.56 $190.00 Fee Schedule 74.74% $142.01 Percent of Billed Charges 68.24% $129.66 Percent of Billed Charges 65.00% $123.50 Percent of Billed Charges 67.00% $127.30 Percent of Billed Charges 77.50% $147.25 Percent of Billed Charges 79.97% $151.94 Percent of Billed Charges 55.00% $104.50 Percent of Billed Charges 49.55% $94.15 Percent of Billed Charges 55.00% $104.50 Percent of Billed Charges 55.00% $104.50 Percent of Billed Charges 78.94% $149.99 Percent of Billed Charges 74.00% $140.60 Percent of Billed Charges 92.50% $175.75 Percent of Billed Charges 55.00% $104.50 Percent of Billed Charges 85.00% $161.50 Percent of Billed Charges 63.00% $119.70 Percent of Billed Charges 63.00% $119.70 Percent of Billed Charges 75.00% $142.50 Percent of Billed Charges 66.24% $125.86 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $302.10 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $114.00 Percent of Billed Charges HC BK RT PCR URINE LABCORP 300 CPT 87799 90 Outpatient $175.00 $55.26 $278.25 $175.00 $233.40 $175.00 Fee Schedule $233.40 $175.00 Fee Schedule $373.56 $175.00 Fee Schedule 74.74% $130.80 Percent of Billed Charges 68.24% $119.42 Percent of Billed Charges 65.00% $113.75 Percent of Billed Charges 67.00% $117.25 Percent of Billed Charges 77.50% $135.63 Percent of Billed Charges 79.97% $139.95 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 49.55% $86.71 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 78.94% $138.15 Percent of Billed Charges 74.00% $129.50 Percent of Billed Charges 92.50% $161.88 Percent of Billed Charges 55.00% $96.25 Percent of Billed Charges 85.00% $148.75 Percent of Billed Charges 63.00% $110.25 Percent of Billed Charges 63.00% $110.25 Percent of Billed Charges 75.00% $131.25 Percent of Billed Charges 66.24% $115.92 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $278.25 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $105.00 Percent of Billed Charges HC BLASTOMCYCES ABS EIA 300 CPT 86612 90 Outpatient $13.70 $6.79 $24.67 $13.70 $70.32 $13.70 Fee Schedule $70.32 $13.70 Fee Schedule $112.49 $13.70 Fee Schedule 74.74% $10.24 Percent of Billed Charges 68.24% $9.35 Percent of Billed Charges 65.00% $8.91 Percent of Billed Charges 67.00% $9.18 Percent of Billed Charges 77.50% $10.62 Percent of Billed Charges 79.97% $10.96 Percent of Billed Charges 55.00% $7.54 Percent of Billed Charges 49.55% $6.79 Percent of Billed Charges 55.00% $7.54 Percent of Billed Charges 55.00% $7.54 Percent of Billed Charges 78.94% $10.81 Percent of Billed Charges 74.00% $10.14 Percent of Billed Charges 92.50% $12.67 Percent of Billed Charges 55.00% $7.54 Percent of Billed Charges 85.00% $11.65 Percent of Billed Charges 63.00% $8.63 Percent of Billed Charges 63.00% $8.63 Percent of Billed Charges 75.00% $10.28 Percent of Billed Charges 66.24% $9.07 Percent of Billed Charges 165.81% $13.70 Fee Schedule 166.07% $21.42 Fee Schedule 176.26% $22.74 Fee Schedule 129.00% $16.64 Fee Schedule 191.24% $24.67 Fee Schedule 159.00% $21.78 Fee Schedule 145.00% $18.71 Fee Schedule 60.00% $8.22 Percent of Billed Charges HC BLOOD COOLER OFF SITE TRANSPORT 300 CPT 99001 Outpatient $149.00 $- $236.91 $149.00 $27.20 $27.20 Fee Schedule $27.20 $27.20 Fee Schedule 56.78% $84.60 Percent of Billed Charges 74.74% $111.36 Percent of Billed Charges 68.24% $101.68 Percent of Billed Charges 65.00% $96.85 Percent of Billed Charges 67.00% $99.83 Percent of Billed Charges 77.50% $115.48 Percent of Billed Charges 79.97% $119.16 Percent of Billed Charges 55.00% $81.95 Percent of Billed Charges 49.55% $73.83 Percent of Billed Charges 55.00% $81.95 Percent of Billed Charges 55.00% $81.95 Percent of Billed Charges 78.94% $117.62 Percent of Billed Charges 74.00% $110.26 Percent of Billed Charges 92.50% $137.83 Percent of Billed Charges 55.00% $81.95 Percent of Billed Charges 85.00% $126.65 Percent of Billed Charges 63.00% $93.87 Percent of Billed Charges 63.00% $93.87 Percent of Billed Charges 75.00% $111.75 Percent of Billed Charges 66.24% $98.70 Percent of Billed Charges 35.00% $52.15 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $236.91 Fee Schedule 145.00% $- Fee Schedule 60.00% $89.40 Percent of Billed Charges "HC BLOOD TYPING, SEROLOGIC, ABO" 300 CPT 86900 Outpatient $132.00 $3.86 $209.88 $132.00 $16.28 $16.28 Fee Schedule $16.28 $16.28 Fee Schedule $26.07 $24.73 Fee Schedule 74.74% $98.66 Percent of Billed Charges 68.24% $90.08 Percent of Billed Charges 65.00% $85.80 Percent of Billed Charges 67.00% $88.44 Percent of Billed Charges 77.50% $102.30 Percent of Billed Charges 79.97% $105.56 Percent of Billed Charges 55.00% $72.60 Percent of Billed Charges 49.55% $65.41 Percent of Billed Charges 55.00% $72.60 Percent of Billed Charges 55.00% $72.60 Percent of Billed Charges 78.94% $104.20 Percent of Billed Charges 74.00% $97.68 Percent of Billed Charges 92.50% $122.10 Percent of Billed Charges 55.00% $72.60 Percent of Billed Charges 85.00% $112.20 Percent of Billed Charges 63.00% $83.16 Percent of Billed Charges 63.00% $83.16 Percent of Billed Charges 75.00% $99.00 Percent of Billed Charges 66.24% $87.44 Percent of Billed Charges 165.81% $4.96 Fee Schedule 166.07% $4.97 Fee Schedule 176.26% $5.27 Fee Schedule 129.00% $3.86 Fee Schedule 191.24% $5.72 Fee Schedule 159.00% $209.88 Fee Schedule 145.00% $4.34 Fee Schedule 60.00% $79.20 Percent of Billed Charges "HC BLOOD TYPING, SEROLOGIC, RH (D)" 300 CPT 86901 Outpatient $138.00 $3.86 $219.42 $138.00 $16.28 $16.28 Fee Schedule $16.28 $16.28 Fee Schedule $26.07 $24.73 Fee Schedule 74.74% $103.14 Percent of Billed Charges 68.24% $94.17 Percent of Billed Charges 65.00% $89.70 Percent of Billed Charges 67.00% $92.46 Percent of Billed Charges 77.50% $106.95 Percent of Billed Charges 79.97% $110.36 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 49.55% $68.38 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 78.94% $108.94 Percent of Billed Charges 74.00% $102.12 Percent of Billed Charges 92.50% $127.65 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 85.00% $117.30 Percent of Billed Charges 63.00% $86.94 Percent of Billed Charges 63.00% $86.94 Percent of Billed Charges 75.00% $103.50 Percent of Billed Charges 66.24% $91.41 Percent of Billed Charges 165.81% $4.96 Fee Schedule 166.07% $4.97 Fee Schedule 176.26% $5.27 Fee Schedule 129.00% $3.86 Fee Schedule 191.24% $5.72 Fee Schedule 159.00% $219.42 Fee Schedule 145.00% $4.34 Fee Schedule 60.00% $82.80 Percent of Billed Charges HC BODY FLUID CELL COUNT W DIFF - SYNOVIAL FLUID CELL COUNT 300 CPT 89051 Outpatient $257.00 $7.22 $408.63 $257.00 $30.00 $30.00 Fee Schedule $30.00 $30.00 Fee Schedule $48.83 $46.31 Fee Schedule 74.74% $192.08 Percent of Billed Charges 68.24% $175.38 Percent of Billed Charges 65.00% $167.05 Percent of Billed Charges 67.00% $172.19 Percent of Billed Charges 77.50% $199.18 Percent of Billed Charges 79.97% $205.52 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 49.55% $127.34 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 78.94% $202.88 Percent of Billed Charges 74.00% $190.18 Percent of Billed Charges 92.50% $237.73 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 85.00% $218.45 Percent of Billed Charges 63.00% $161.91 Percent of Billed Charges 63.00% $161.91 Percent of Billed Charges 75.00% $192.75 Percent of Billed Charges 66.24% $170.24 Percent of Billed Charges 165.81% $9.29 Fee Schedule 166.07% $9.30 Fee Schedule 176.26% $9.87 Fee Schedule 129.00% $7.22 Fee Schedule 191.24% $10.71 Fee Schedule 159.00% $408.63 Fee Schedule 145.00% $8.12 Fee Schedule 60.00% $154.20 Percent of Billed Charges HC BONE MARROW FAILURE CINCINNATI 300 CPT 81216 90 Outpatient $900.00 $238.80 " $1,431.00 " $900.00 $740.48 $740.48 Fee Schedule $740.48 $740.48 Fee Schedule " $1,614.25 " $900.00 Fee Schedule 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 165.81% $306.95 Fee Schedule 166.07% $307.43 Fee Schedule 176.26% $326.29 Fee Schedule 129.00% $238.80 Fee Schedule 191.24% $354.02 Fee Schedule 159.00% " $1,431.00 " Fee Schedule 145.00% $268.42 Fee Schedule 60.00% $540.00 Percent of Billed Charges HC BONE MARROW FAILURE CINCINNATI 300 CPT 81405 90 Outpatient $900.00 $- " $1,431.00 " $900.00 " $1,205.40 " $900.00 Fee Schedule " $1,205.40 " $900.00 Fee Schedule " $2,627.77 " $900.00 Fee Schedule 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,431.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $540.00 Percent of Billed Charges HC BONE MARROW FAILURE CINCINNATI 300 CPT 81406 90 Outpatient $900.00 $- " $1,431.00 " $900.00 " $1,131.52 " $900.00 Fee Schedule " $1,131.52 " $900.00 Fee Schedule " $2,466.71 " $900.00 Fee Schedule 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,431.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $540.00 Percent of Billed Charges HC BONE MARROW FAILURE CINCINNATI 300 CPT 81408 90 Outpatient $900.00 $- " $1,431.00 " $900.00 " $8,000.00 " $900.00 Fee Schedule " $8,000.00 " $900.00 Fee Schedule " $17,440.00 " $900.00 Fee Schedule 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,431.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $540.00 Percent of Billed Charges HC BONE MARROW FAILURE CINCINNATI 300 CPT 81479 90 Outpatient $900.00 $- " $1,431.00 " $900.00 50.00% $450.00 Percent of Billed Charges 50.00% $450.00 Percent of Billed Charges 56.78% $511.02 Percent of Billed Charges 74.74% $672.66 Percent of Billed Charges 68.24% $614.16 Percent of Billed Charges 65.00% $585.00 Percent of Billed Charges 67.00% $603.00 Percent of Billed Charges 77.50% $697.50 Percent of Billed Charges 79.97% $719.73 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 49.55% $445.95 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 78.94% $710.46 Percent of Billed Charges 74.00% $666.00 Percent of Billed Charges 92.50% $832.50 Percent of Billed Charges 55.00% $495.00 Percent of Billed Charges 85.00% $765.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 63.00% $567.00 Percent of Billed Charges 75.00% $675.00 Percent of Billed Charges 66.24% $596.16 Percent of Billed Charges 35.00% $315.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,431.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $540.00 Percent of Billed Charges HC BONE SPECIFIC ALK PHOS LABCORP 300 CPT 84080 90 Outpatient $15.00 $7.43 $28.27 $15.00 $80.56 $15.00 Fee Schedule $80.56 $15.00 Fee Schedule $128.88 $15.00 Fee Schedule 74.74% $11.21 Percent of Billed Charges 68.24% $10.24 Percent of Billed Charges 65.00% $9.75 Percent of Billed Charges 67.00% $10.05 Percent of Billed Charges 77.50% $11.63 Percent of Billed Charges 79.97% $12.00 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 49.55% $7.43 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 78.94% $11.84 Percent of Billed Charges 74.00% $11.10 Percent of Billed Charges 92.50% $13.88 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 85.00% $12.75 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 75.00% $11.25 Percent of Billed Charges 66.24% $9.94 Percent of Billed Charges 165.81% $15.00 Fee Schedule 166.07% $24.55 Fee Schedule 176.26% $26.05 Fee Schedule 129.00% $19.07 Fee Schedule 191.24% $28.27 Fee Schedule 159.00% $23.85 Fee Schedule 145.00% $21.43 Fee Schedule 60.00% $9.00 Percent of Billed Charges HC BPGM FULL GENE SEQ MAYO 300 CPT 81479 90 Outpatient $634.30 $- " $1,008.54 " $634.30 50.00% $317.15 Percent of Billed Charges 50.00% $317.15 Percent of Billed Charges 56.78% $360.16 Percent of Billed Charges 74.74% $474.08 Percent of Billed Charges 68.24% $432.85 Percent of Billed Charges 65.00% $412.30 Percent of Billed Charges 67.00% $424.98 Percent of Billed Charges 77.50% $491.58 Percent of Billed Charges 79.97% $507.25 Percent of Billed Charges 55.00% $348.87 Percent of Billed Charges 49.55% $314.30 Percent of Billed Charges 55.00% $348.87 Percent of Billed Charges 55.00% $348.87 Percent of Billed Charges 78.94% $500.72 Percent of Billed Charges 74.00% $469.38 Percent of Billed Charges 92.50% $586.73 Percent of Billed Charges 55.00% $348.87 Percent of Billed Charges 85.00% $539.16 Percent of Billed Charges 63.00% $399.61 Percent of Billed Charges 63.00% $399.61 Percent of Billed Charges 75.00% $475.73 Percent of Billed Charges 66.24% $420.16 Percent of Billed Charges 35.00% $222.01 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,008.54 " Fee Schedule 145.00% $- Fee Schedule 60.00% $380.58 Percent of Billed Charges HC BRCAVANTAGE COMPREHENSIVE 300 CPT 81162 90 Outpatient " $2,150.00 " " $1,065.33 " " $3,489.90 " " $2,150.00 " " $9,943.44 " " $2,150.00 " Fee Schedule " $9,943.44 " " $2,150.00 " Fee Schedule " $15,912.95 " " $2,150.00 " Fee Schedule 74.74% " $1,606.91 " Percent of Billed Charges 68.24% " $1,467.16 " Percent of Billed Charges 65.00% " $1,397.50 " Percent of Billed Charges 67.00% " $1,440.50 " Percent of Billed Charges 77.50% " $1,666.25 " Percent of Billed Charges 79.97% " $1,719.36 " Percent of Billed Charges 55.00% " $1,182.50 " Percent of Billed Charges 49.55% " $1,065.33 " Percent of Billed Charges 55.00% " $1,182.50 " Percent of Billed Charges 55.00% " $1,182.50 " Percent of Billed Charges 78.94% " $1,697.21 " Percent of Billed Charges 74.00% " $1,591.00 " Percent of Billed Charges 92.50% " $1,988.75 " Percent of Billed Charges 55.00% " $1,182.50 " Percent of Billed Charges 85.00% " $1,827.50 " Percent of Billed Charges 63.00% " $1,354.50 " Percent of Billed Charges 63.00% " $1,354.50 " Percent of Billed Charges 75.00% " $1,612.50 " Percent of Billed Charges 66.24% " $1,424.16 " Percent of Billed Charges 165.81% " $2,150.00 " Fee Schedule 166.07% " $3,030.58 " Fee Schedule 176.26% " $3,216.53 " Fee Schedule 129.00% " $2,354.10 " Fee Schedule 191.24% " $3,489.90 " Fee Schedule 159.00% " $3,418.50 " Fee Schedule 145.00% " $2,646.08 " Fee Schedule 60.00% " $1,290.00 " Percent of Billed Charges HC BRUCELLA ANTIBODY LABCORP 300 CPT 86622 90 Outpatient $16.00 $7.93 $25.44 $16.00 $48.68 $16.00 Fee Schedule $48.68 $16.00 Fee Schedule $77.87 $16.00 Fee Schedule 74.74% $11.96 Percent of Billed Charges 68.24% $10.92 Percent of Billed Charges 65.00% $10.40 Percent of Billed Charges 67.00% $10.72 Percent of Billed Charges 77.50% $12.40 Percent of Billed Charges 79.97% $12.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 49.55% $7.93 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 78.94% $12.63 Percent of Billed Charges 74.00% $11.84 Percent of Billed Charges 92.50% $14.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 85.00% $13.60 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 75.00% $12.00 Percent of Billed Charges 66.24% $10.60 Percent of Billed Charges 165.81% $14.81 Fee Schedule 166.07% $14.83 Fee Schedule 176.26% $15.74 Fee Schedule 129.00% $11.52 Fee Schedule 191.24% $17.08 Fee Schedule 159.00% $25.44 Fee Schedule 145.00% $12.95 Fee Schedule 60.00% $9.60 Percent of Billed Charges HC BUPRENORPHINE URINE QUEST 300 CPT 80307 90 Outpatient $132.56 $65.68 $210.77 $132.56 $319.24 $132.56 Fee Schedule $319.24 $132.56 Fee Schedule $541.86 $132.56 Fee Schedule 74.74% $99.08 Percent of Billed Charges 68.24% $90.46 Percent of Billed Charges 65.00% $86.16 Percent of Billed Charges 67.00% $88.82 Percent of Billed Charges 77.50% $102.73 Percent of Billed Charges 79.97% $106.01 Percent of Billed Charges 55.00% $72.91 Percent of Billed Charges 49.55% $65.68 Percent of Billed Charges 55.00% $72.91 Percent of Billed Charges 55.00% $72.91 Percent of Billed Charges 78.94% $104.64 Percent of Billed Charges 74.00% $98.09 Percent of Billed Charges 92.50% $122.62 Percent of Billed Charges 55.00% $72.91 Percent of Billed Charges 85.00% $112.68 Percent of Billed Charges 63.00% $83.51 Percent of Billed Charges 63.00% $83.51 Percent of Billed Charges 75.00% $99.42 Percent of Billed Charges 66.24% $87.81 Percent of Billed Charges 165.81% $103.03 Fee Schedule 166.07% $103.20 Fee Schedule 176.26% $109.53 Fee Schedule 129.00% $80.16 Fee Schedule 191.24% $118.84 Fee Schedule 159.00% $210.77 Fee Schedule 145.00% $90.10 Fee Schedule 60.00% $79.54 Percent of Billed Charges HC C DIFFICILE CYTOTOXICITY ARUP 300 CPT 87230 90 Outpatient $28.05 $13.90 $44.60 $28.05 $107.60 $28.05 Fee Schedule $107.60 $28.05 Fee Schedule $172.13 $28.05 Fee Schedule 74.74% $20.96 Percent of Billed Charges 68.24% $19.14 Percent of Billed Charges 65.00% $18.23 Percent of Billed Charges 67.00% $18.79 Percent of Billed Charges 77.50% $21.74 Percent of Billed Charges 79.97% $22.43 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 49.55% $13.90 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 78.94% $22.14 Percent of Billed Charges 74.00% $20.76 Percent of Billed Charges 92.50% $25.95 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 85.00% $23.84 Percent of Billed Charges 63.00% $17.67 Percent of Billed Charges 63.00% $17.67 Percent of Billed Charges 75.00% $21.04 Percent of Billed Charges 66.24% $18.58 Percent of Billed Charges 165.81% $28.05 Fee Schedule 166.07% $32.78 Fee Schedule 176.26% $34.79 Fee Schedule 129.00% $25.46 Fee Schedule 191.24% $37.75 Fee Schedule 159.00% $44.60 Fee Schedule 145.00% $28.62 Fee Schedule 60.00% $16.83 Percent of Billed Charges HC C TRACH AMP PROBE LABCORP 300 CPT 87491 90 Outpatient $37.75 $18.71 $67.11 $37.75 $191.20 $37.75 Fee Schedule $191.20 $37.75 Fee Schedule $305.98 $37.75 Fee Schedule 74.74% $28.21 Percent of Billed Charges 68.24% $25.76 Percent of Billed Charges 65.00% $24.54 Percent of Billed Charges 67.00% $25.29 Percent of Billed Charges 77.50% $29.26 Percent of Billed Charges 79.97% $30.19 Percent of Billed Charges 55.00% $20.76 Percent of Billed Charges 49.55% $18.71 Percent of Billed Charges 55.00% $20.76 Percent of Billed Charges 55.00% $20.76 Percent of Billed Charges 78.94% $29.80 Percent of Billed Charges 74.00% $27.94 Percent of Billed Charges 92.50% $34.92 Percent of Billed Charges 55.00% $20.76 Percent of Billed Charges 85.00% $32.09 Percent of Billed Charges 63.00% $23.78 Percent of Billed Charges 63.00% $23.78 Percent of Billed Charges 75.00% $28.31 Percent of Billed Charges 66.24% $25.01 Percent of Billed Charges 165.81% $37.75 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $60.02 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $22.65 Percent of Billed Charges HC C TRACH AMPLIFIED LABCORP 300 CPT 87491 90 Outpatient $18.83 $9.33 $67.11 $18.83 $191.20 $18.83 Fee Schedule $191.20 $18.83 Fee Schedule $305.98 $18.83 Fee Schedule 74.74% $14.07 Percent of Billed Charges 68.24% $12.85 Percent of Billed Charges 65.00% $12.24 Percent of Billed Charges 67.00% $12.62 Percent of Billed Charges 77.50% $14.59 Percent of Billed Charges 79.97% $15.06 Percent of Billed Charges 55.00% $10.36 Percent of Billed Charges 49.55% $9.33 Percent of Billed Charges 55.00% $10.36 Percent of Billed Charges 55.00% $10.36 Percent of Billed Charges 78.94% $14.86 Percent of Billed Charges 74.00% $13.93 Percent of Billed Charges 92.50% $17.42 Percent of Billed Charges 55.00% $10.36 Percent of Billed Charges 85.00% $16.01 Percent of Billed Charges 63.00% $11.86 Percent of Billed Charges 63.00% $11.86 Percent of Billed Charges 75.00% $14.12 Percent of Billed Charges 66.24% $12.47 Percent of Billed Charges 165.81% $18.83 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $29.94 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $11.30 Percent of Billed Charges HC C1 ESTERASE INHIB FUNC LABCORP 300 CPT 86161 90 Outpatient $23.75 $11.77 $37.76 $23.75 $65.40 $23.75 Fee Schedule $65.40 $23.75 Fee Schedule $104.64 $23.75 Fee Schedule 74.74% $17.75 Percent of Billed Charges 68.24% $16.21 Percent of Billed Charges 65.00% $15.44 Percent of Billed Charges 67.00% $15.91 Percent of Billed Charges 77.50% $18.41 Percent of Billed Charges 79.97% $18.99 Percent of Billed Charges 55.00% $13.06 Percent of Billed Charges 49.55% $11.77 Percent of Billed Charges 55.00% $13.06 Percent of Billed Charges 55.00% $13.06 Percent of Billed Charges 78.94% $18.75 Percent of Billed Charges 74.00% $17.58 Percent of Billed Charges 92.50% $21.97 Percent of Billed Charges 55.00% $13.06 Percent of Billed Charges 85.00% $20.19 Percent of Billed Charges 63.00% $14.96 Percent of Billed Charges 63.00% $14.96 Percent of Billed Charges 75.00% $17.81 Percent of Billed Charges 66.24% $15.73 Percent of Billed Charges 165.81% $19.90 Fee Schedule 166.07% $19.93 Fee Schedule 176.26% $21.15 Fee Schedule 129.00% $15.48 Fee Schedule 191.24% $22.95 Fee Schedule 159.00% $37.76 Fee Schedule 145.00% $17.40 Fee Schedule 60.00% $14.25 Percent of Billed Charges "HC C1 INHIBITOR, PROTEIN LABCORP" 300 CPT 86160 90 Outpatient $9.00 $4.46 $22.95 $9.00 $65.40 $9.00 Fee Schedule $65.40 $9.00 Fee Schedule $104.64 $9.00 Fee Schedule 74.74% $6.73 Percent of Billed Charges 68.24% $6.14 Percent of Billed Charges 65.00% $5.85 Percent of Billed Charges 67.00% $6.03 Percent of Billed Charges 77.50% $6.98 Percent of Billed Charges 79.97% $7.20 Percent of Billed Charges 55.00% $4.95 Percent of Billed Charges 49.55% $4.46 Percent of Billed Charges 55.00% $4.95 Percent of Billed Charges 55.00% $4.95 Percent of Billed Charges 78.94% $7.10 Percent of Billed Charges 74.00% $6.66 Percent of Billed Charges 92.50% $8.33 Percent of Billed Charges 55.00% $4.95 Percent of Billed Charges 85.00% $7.65 Percent of Billed Charges 63.00% $5.67 Percent of Billed Charges 63.00% $5.67 Percent of Billed Charges 75.00% $6.75 Percent of Billed Charges 66.24% $5.96 Percent of Billed Charges 165.81% $9.00 Fee Schedule 166.07% $19.93 Fee Schedule 176.26% $21.15 Fee Schedule 129.00% $15.48 Fee Schedule 191.24% $22.95 Fee Schedule 159.00% $14.31 Fee Schedule 145.00% $17.40 Fee Schedule 60.00% $5.40 Percent of Billed Charges HC C4 BINDING PROTEIN 300 CPT 86329 90 Outpatient $58.37 $18.12 $92.81 $58.37 $76.52 $58.37 Fee Schedule $76.52 $58.37 Fee Schedule $122.52 $58.37 Fee Schedule 74.74% $43.63 Percent of Billed Charges 68.24% $39.83 Percent of Billed Charges 65.00% $37.94 Percent of Billed Charges 67.00% $39.11 Percent of Billed Charges 77.50% $45.24 Percent of Billed Charges 79.97% $46.68 Percent of Billed Charges 55.00% $32.10 Percent of Billed Charges 49.55% $28.92 Percent of Billed Charges 55.00% $32.10 Percent of Billed Charges 55.00% $32.10 Percent of Billed Charges 78.94% $46.08 Percent of Billed Charges 74.00% $43.19 Percent of Billed Charges 92.50% $53.99 Percent of Billed Charges 55.00% $32.10 Percent of Billed Charges 85.00% $49.61 Percent of Billed Charges 63.00% $36.77 Percent of Billed Charges 63.00% $36.77 Percent of Billed Charges 75.00% $43.78 Percent of Billed Charges 66.24% $38.66 Percent of Billed Charges 165.81% $23.30 Fee Schedule 166.07% $23.33 Fee Schedule 176.26% $24.76 Fee Schedule 129.00% $18.12 Fee Schedule 191.24% $26.87 Fee Schedule 159.00% $92.81 Fee Schedule 145.00% $20.37 Fee Schedule 60.00% $35.02 Percent of Billed Charges "HC CADMIUM, WHOLE BLOOD LABCORP" 300 CPT 82300 90 Outpatient $60.02 $29.74 $95.43 $60.02 $126.08 $60.02 Fee Schedule $126.08 $60.02 Fee Schedule $206.14 $60.02 Fee Schedule 74.74% $44.86 Percent of Billed Charges 68.24% $40.96 Percent of Billed Charges 65.00% $39.01 Percent of Billed Charges 67.00% $40.21 Percent of Billed Charges 77.50% $46.52 Percent of Billed Charges 79.97% $48.00 Percent of Billed Charges 55.00% $33.01 Percent of Billed Charges 49.55% $29.74 Percent of Billed Charges 55.00% $33.01 Percent of Billed Charges 55.00% $33.01 Percent of Billed Charges 78.94% $47.38 Percent of Billed Charges 74.00% $44.41 Percent of Billed Charges 92.50% $55.52 Percent of Billed Charges 55.00% $33.01 Percent of Billed Charges 85.00% $51.02 Percent of Billed Charges 63.00% $37.81 Percent of Billed Charges 63.00% $37.81 Percent of Billed Charges 75.00% $45.02 Percent of Billed Charges 66.24% $39.76 Percent of Billed Charges 165.81% $39.20 Fee Schedule 166.07% $39.26 Fee Schedule 176.26% $41.67 Fee Schedule 129.00% $30.50 Fee Schedule 191.24% $45.21 Fee Schedule 159.00% $95.43 Fee Schedule 145.00% $34.28 Fee Schedule 60.00% $36.01 Percent of Billed Charges HC CAFFEINE LABCORP 300 CPT 80155 90 Outpatient $10.00 $4.96 $41.14 $10.00 $77.08 $10.00 Fee Schedule $77.08 $10.00 Fee Schedule $336.33 $10.00 Fee Schedule 74.74% $7.47 Percent of Billed Charges 68.24% $6.82 Percent of Billed Charges 65.00% $6.50 Percent of Billed Charges 67.00% $6.70 Percent of Billed Charges 77.50% $7.75 Percent of Billed Charges 79.97% $8.00 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 49.55% $4.96 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 78.94% $7.89 Percent of Billed Charges 74.00% $7.40 Percent of Billed Charges 92.50% $9.25 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 85.00% $8.50 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 75.00% $7.50 Percent of Billed Charges 66.24% $6.62 Percent of Billed Charges 165.81% $10.00 Fee Schedule 166.07% $35.72 Fee Schedule 176.26% $37.91 Fee Schedule 129.00% $27.75 Fee Schedule 191.24% $41.14 Fee Schedule 159.00% $15.90 Fee Schedule 145.00% $31.19 Fee Schedule 60.00% $6.00 Percent of Billed Charges HC CAH PROFILE 6B QUEST 300 CPT 82157 90 Outpatient $478.55 $37.77 $760.89 $478.55 $159.52 $159.52 Fee Schedule $159.52 $159.52 Fee Schedule $255.32 $242.15 Fee Schedule 74.74% $357.67 Percent of Billed Charges 68.24% $326.56 Percent of Billed Charges 65.00% $311.06 Percent of Billed Charges 67.00% $320.63 Percent of Billed Charges 77.50% $370.88 Percent of Billed Charges 79.97% $382.70 Percent of Billed Charges 55.00% $263.20 Percent of Billed Charges 49.55% $237.12 Percent of Billed Charges 55.00% $263.20 Percent of Billed Charges 55.00% $263.20 Percent of Billed Charges 78.94% $377.77 Percent of Billed Charges 74.00% $354.13 Percent of Billed Charges 92.50% $442.66 Percent of Billed Charges 55.00% $263.20 Percent of Billed Charges 85.00% $406.77 Percent of Billed Charges 63.00% $301.49 Percent of Billed Charges 63.00% $301.49 Percent of Billed Charges 75.00% $358.91 Percent of Billed Charges 66.24% $316.99 Percent of Billed Charges 165.81% $48.55 Fee Schedule 166.07% $48.63 Fee Schedule 176.26% $51.61 Fee Schedule 129.00% $37.77 Fee Schedule 191.24% $56.00 Fee Schedule 159.00% $760.89 Fee Schedule 145.00% $42.46 Fee Schedule 60.00% $287.13 Percent of Billed Charges HC CALCITONIN LABCORP 300 CPT 82308 90 Outpatient $8.00 $3.96 $51.23 $8.00 $145.96 $8.00 Fee Schedule $145.96 $8.00 Fee Schedule $233.61 $8.00 Fee Schedule 74.74% $5.98 Percent of Billed Charges 68.24% $5.46 Percent of Billed Charges 65.00% $5.20 Percent of Billed Charges 67.00% $5.36 Percent of Billed Charges 77.50% $6.20 Percent of Billed Charges 79.97% $6.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 49.55% $3.96 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 78.94% $6.32 Percent of Billed Charges 74.00% $5.92 Percent of Billed Charges 92.50% $7.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 85.00% $6.80 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 75.00% $6.00 Percent of Billed Charges 66.24% $5.30 Percent of Billed Charges 165.81% $8.00 Fee Schedule 166.07% $44.49 Fee Schedule 176.26% $47.22 Fee Schedule 129.00% $34.56 Fee Schedule 191.24% $51.23 Fee Schedule 159.00% $12.72 Fee Schedule 145.00% $38.85 Fee Schedule 60.00% $4.80 Percent of Billed Charges HC CALCULI ANALYSIS ARUP 300 CPT 82365 90 Outpatient $22.50 $11.15 $35.78 $22.50 $70.24 $22.50 Fee Schedule $70.24 $22.50 Fee Schedule $112.49 $22.50 Fee Schedule 74.74% $16.82 Percent of Billed Charges 68.24% $15.35 Percent of Billed Charges 65.00% $14.63 Percent of Billed Charges 67.00% $15.08 Percent of Billed Charges 77.50% $17.44 Percent of Billed Charges 79.97% $17.99 Percent of Billed Charges 55.00% $12.38 Percent of Billed Charges 49.55% $11.15 Percent of Billed Charges 55.00% $12.38 Percent of Billed Charges 55.00% $12.38 Percent of Billed Charges 78.94% $17.76 Percent of Billed Charges 74.00% $16.65 Percent of Billed Charges 92.50% $20.81 Percent of Billed Charges 55.00% $12.38 Percent of Billed Charges 85.00% $19.13 Percent of Billed Charges 63.00% $14.18 Percent of Billed Charges 63.00% $14.18 Percent of Billed Charges 75.00% $16.88 Percent of Billed Charges 66.24% $14.90 Percent of Billed Charges 165.81% $21.39 Fee Schedule 166.07% $21.42 Fee Schedule 176.26% $22.74 Fee Schedule 129.00% $16.64 Fee Schedule 191.24% $24.67 Fee Schedule 159.00% $35.78 Fee Schedule 145.00% $18.71 Fee Schedule 60.00% $13.50 Percent of Billed Charges HC CALPROTECTIN MAYO 300 CPT 83993 90 Outpatient $145.00 $25.32 $230.55 $145.00 $106.96 $106.96 Fee Schedule $106.96 $106.96 Fee Schedule $171.17 $145.00 Fee Schedule 74.74% $108.37 Percent of Billed Charges 68.24% $98.95 Percent of Billed Charges 65.00% $94.25 Percent of Billed Charges 67.00% $97.15 Percent of Billed Charges 77.50% $112.38 Percent of Billed Charges 79.97% $115.96 Percent of Billed Charges 55.00% $79.75 Percent of Billed Charges 49.55% $71.85 Percent of Billed Charges 55.00% $79.75 Percent of Billed Charges 55.00% $79.75 Percent of Billed Charges 78.94% $114.46 Percent of Billed Charges 74.00% $107.30 Percent of Billed Charges 92.50% $134.13 Percent of Billed Charges 55.00% $79.75 Percent of Billed Charges 85.00% $123.25 Percent of Billed Charges 63.00% $91.35 Percent of Billed Charges 63.00% $91.35 Percent of Billed Charges 75.00% $108.75 Percent of Billed Charges 66.24% $96.05 Percent of Billed Charges 165.81% $32.55 Fee Schedule 166.07% $32.60 Fee Schedule 176.26% $34.60 Fee Schedule 129.00% $25.32 Fee Schedule 191.24% $37.54 Fee Schedule 159.00% $230.55 Fee Schedule 145.00% $28.46 Fee Schedule 60.00% $87.00 Percent of Billed Charges HC CANCER AG 15-3 LABCORP 300 CPT 86300 90 Outpatient $11.89 $5.89 $39.80 $11.89 $113.40 $11.89 Fee Schedule $113.40 $11.89 Fee Schedule $181.46 $11.89 Fee Schedule 74.74% $8.89 Percent of Billed Charges 68.24% $8.11 Percent of Billed Charges 65.00% $7.73 Percent of Billed Charges 67.00% $7.97 Percent of Billed Charges 77.50% $9.21 Percent of Billed Charges 79.97% $9.51 Percent of Billed Charges 55.00% $6.54 Percent of Billed Charges 49.55% $5.89 Percent of Billed Charges 55.00% $6.54 Percent of Billed Charges 55.00% $6.54 Percent of Billed Charges 78.94% $9.39 Percent of Billed Charges 74.00% $8.80 Percent of Billed Charges 92.50% $11.00 Percent of Billed Charges 55.00% $6.54 Percent of Billed Charges 85.00% $10.11 Percent of Billed Charges 63.00% $7.49 Percent of Billed Charges 63.00% $7.49 Percent of Billed Charges 75.00% $8.92 Percent of Billed Charges 66.24% $7.88 Percent of Billed Charges 165.81% $11.89 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $18.91 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $7.13 Percent of Billed Charges HC CANCER AG 19-9 ARUP 300 CPT 86301 90 Outpatient $14.58 $7.22 $39.80 $14.58 $113.40 $14.58 Fee Schedule $113.40 $14.58 Fee Schedule $181.46 $14.58 Fee Schedule 74.74% $10.90 Percent of Billed Charges 68.24% $9.95 Percent of Billed Charges 65.00% $9.48 Percent of Billed Charges 67.00% $9.77 Percent of Billed Charges 77.50% $11.30 Percent of Billed Charges 79.97% $11.66 Percent of Billed Charges 55.00% $8.02 Percent of Billed Charges 49.55% $7.22 Percent of Billed Charges 55.00% $8.02 Percent of Billed Charges 55.00% $8.02 Percent of Billed Charges 78.94% $11.51 Percent of Billed Charges 74.00% $10.79 Percent of Billed Charges 92.50% $13.49 Percent of Billed Charges 55.00% $8.02 Percent of Billed Charges 85.00% $12.39 Percent of Billed Charges 63.00% $9.19 Percent of Billed Charges 63.00% $9.19 Percent of Billed Charges 75.00% $10.94 Percent of Billed Charges 66.24% $9.66 Percent of Billed Charges 165.81% $14.58 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $23.18 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $8.75 Percent of Billed Charges HC CANCER AG 27.29 LABCORP 300 CPT 86300 90 Outpatient $10.73 $5.32 $39.80 $10.73 $113.40 $10.73 Fee Schedule $113.40 $10.73 Fee Schedule $181.46 $10.73 Fee Schedule 74.74% $8.02 Percent of Billed Charges 68.24% $7.32 Percent of Billed Charges 65.00% $6.97 Percent of Billed Charges 67.00% $7.19 Percent of Billed Charges 77.50% $8.32 Percent of Billed Charges 79.97% $8.58 Percent of Billed Charges 55.00% $5.90 Percent of Billed Charges 49.55% $5.32 Percent of Billed Charges 55.00% $5.90 Percent of Billed Charges 55.00% $5.90 Percent of Billed Charges 78.94% $8.47 Percent of Billed Charges 74.00% $7.94 Percent of Billed Charges 92.50% $9.93 Percent of Billed Charges 55.00% $5.90 Percent of Billed Charges 85.00% $9.12 Percent of Billed Charges 63.00% $6.76 Percent of Billed Charges 63.00% $6.76 Percent of Billed Charges 75.00% $8.05 Percent of Billed Charges 66.24% $7.11 Percent of Billed Charges 165.81% $10.73 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $17.06 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $6.44 Percent of Billed Charges HC CANCER ANTIGEN 125 LABCORP 300 CPT 86304 90 Outpatient $6.00 $2.97 $39.80 $6.00 $113.40 $6.00 Fee Schedule $113.40 $6.00 Fee Schedule $181.46 $6.00 Fee Schedule 74.74% $4.48 Percent of Billed Charges 68.24% $4.09 Percent of Billed Charges 65.00% $3.90 Percent of Billed Charges 67.00% $4.02 Percent of Billed Charges 77.50% $4.65 Percent of Billed Charges 79.97% $4.80 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 49.55% $2.97 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 78.94% $4.74 Percent of Billed Charges 74.00% $4.44 Percent of Billed Charges 92.50% $5.55 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 85.00% $5.10 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 75.00% $4.50 Percent of Billed Charges 66.24% $3.97 Percent of Billed Charges 165.81% $6.00 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $9.54 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $3.60 Percent of Billed Charges HC CARBOXYLASE 300 CPT 82658 90 Outpatient $550.00 $56.80 $874.50 $550.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $383.94 $364.13 Fee Schedule 74.74% $411.07 Percent of Billed Charges 68.24% $375.32 Percent of Billed Charges 65.00% $357.50 Percent of Billed Charges 67.00% $368.50 Percent of Billed Charges 77.50% $426.25 Percent of Billed Charges 79.97% $439.84 Percent of Billed Charges 55.00% $302.50 Percent of Billed Charges 49.55% $272.53 Percent of Billed Charges 55.00% $302.50 Percent of Billed Charges 55.00% $302.50 Percent of Billed Charges 78.94% $434.17 Percent of Billed Charges 74.00% $407.00 Percent of Billed Charges 92.50% $508.75 Percent of Billed Charges 55.00% $302.50 Percent of Billed Charges 85.00% $467.50 Percent of Billed Charges 63.00% $346.50 Percent of Billed Charges 63.00% $346.50 Percent of Billed Charges 75.00% $412.50 Percent of Billed Charges 66.24% $364.32 Percent of Billed Charges 165.81% $73.01 Fee Schedule 166.07% $73.12 Fee Schedule 176.26% $77.61 Fee Schedule 129.00% $56.80 Fee Schedule 191.24% $84.20 Fee Schedule 159.00% $874.50 Fee Schedule 145.00% $63.84 Fee Schedule 60.00% $330.00 Percent of Billed Charges HC CARDIO IQ 82172 300 CPT 82172 90 Outpatient $28.30 $14.02 $45.00 $28.30 $84.44 $28.30 Fee Schedule $84.44 $28.30 Fee Schedule $183.90 $28.30 Fee Schedule 74.74% $21.15 Percent of Billed Charges 68.24% $19.31 Percent of Billed Charges 65.00% $18.40 Percent of Billed Charges 67.00% $18.96 Percent of Billed Charges 77.50% $21.93 Percent of Billed Charges 79.97% $22.63 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 49.55% $14.02 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 78.94% $22.34 Percent of Billed Charges 74.00% $20.94 Percent of Billed Charges 92.50% $26.18 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 85.00% $24.06 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 75.00% $21.23 Percent of Billed Charges 66.24% $18.75 Percent of Billed Charges 165.81% $28.30 Fee Schedule 166.07% $35.02 Fee Schedule 176.26% $37.17 Fee Schedule 129.00% $27.21 Fee Schedule 191.24% $40.33 Fee Schedule 159.00% $45.00 Fee Schedule 145.00% $30.58 Fee Schedule 60.00% $16.98 Percent of Billed Charges HC CARDIO IQ 82465 300 CPT 82465 90 Outpatient $28.30 $5.61 $45.00 $28.30 $23.68 $23.68 Fee Schedule $23.68 $23.68 Fee Schedule $37.93 $28.30 Fee Schedule 74.74% $21.15 Percent of Billed Charges 68.24% $19.31 Percent of Billed Charges 65.00% $18.40 Percent of Billed Charges 67.00% $18.96 Percent of Billed Charges 77.50% $21.93 Percent of Billed Charges 79.97% $22.63 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 49.55% $14.02 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 78.94% $22.34 Percent of Billed Charges 74.00% $20.94 Percent of Billed Charges 92.50% $26.18 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 85.00% $24.06 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 75.00% $21.23 Percent of Billed Charges 66.24% $18.75 Percent of Billed Charges 165.81% $7.21 Fee Schedule 166.07% $7.22 Fee Schedule 176.26% $7.67 Fee Schedule 129.00% $5.61 Fee Schedule 191.24% $8.32 Fee Schedule 159.00% $45.00 Fee Schedule 145.00% $6.31 Fee Schedule 60.00% $16.98 Percent of Billed Charges HC CARDIO IQ 83695 300 CPT 83695 90 Outpatient $28.30 $14.02 $45.00 $28.30 $70.52 $28.30 Fee Schedule $70.52 $28.30 Fee Schedule $124.87 $28.30 Fee Schedule 74.74% $21.15 Percent of Billed Charges 68.24% $19.31 Percent of Billed Charges 65.00% $18.40 Percent of Billed Charges 67.00% $18.96 Percent of Billed Charges 77.50% $21.93 Percent of Billed Charges 79.97% $22.63 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 49.55% $14.02 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 78.94% $22.34 Percent of Billed Charges 74.00% $20.94 Percent of Billed Charges 92.50% $26.18 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 85.00% $24.06 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 75.00% $21.23 Percent of Billed Charges 66.24% $18.75 Percent of Billed Charges 165.81% $23.74 Fee Schedule 166.07% $23.78 Fee Schedule 176.26% $25.24 Fee Schedule 129.00% $18.47 Fee Schedule 191.24% $27.39 Fee Schedule 159.00% $45.00 Fee Schedule 145.00% $20.76 Fee Schedule 60.00% $16.98 Percent of Billed Charges HC CARDIO IQ 83704 300 CPT 83704 90 Outpatient $28.30 $14.02 $65.38 $28.30 $171.92 $28.30 Fee Schedule $171.92 $28.30 Fee Schedule $298.14 $28.30 Fee Schedule 74.74% $21.15 Percent of Billed Charges 68.24% $19.31 Percent of Billed Charges 65.00% $18.40 Percent of Billed Charges 67.00% $18.96 Percent of Billed Charges 77.50% $21.93 Percent of Billed Charges 79.97% $22.63 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 49.55% $14.02 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 78.94% $22.34 Percent of Billed Charges 74.00% $20.94 Percent of Billed Charges 92.50% $26.18 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 85.00% $24.06 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 75.00% $21.23 Percent of Billed Charges 66.24% $18.75 Percent of Billed Charges 165.81% $28.30 Fee Schedule 166.07% $56.78 Fee Schedule 176.26% $60.26 Fee Schedule 129.00% $44.11 Fee Schedule 191.24% $65.38 Fee Schedule 159.00% $45.00 Fee Schedule 145.00% $49.58 Fee Schedule 60.00% $16.98 Percent of Billed Charges HC CARDIO IQ 83718 300 CPT 83718 90 Outpatient $28.30 $10.57 $45.00 $28.30 $44.64 $28.30 Fee Schedule $44.64 $28.30 Fee Schedule $71.42 $28.30 Fee Schedule 74.74% $21.15 Percent of Billed Charges 68.24% $19.31 Percent of Billed Charges 65.00% $18.40 Percent of Billed Charges 67.00% $18.96 Percent of Billed Charges 77.50% $21.93 Percent of Billed Charges 79.97% $22.63 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 49.55% $14.02 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 78.94% $22.34 Percent of Billed Charges 74.00% $20.94 Percent of Billed Charges 92.50% $26.18 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 85.00% $24.06 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 75.00% $21.23 Percent of Billed Charges 66.24% $18.75 Percent of Billed Charges 165.81% $13.58 Fee Schedule 166.07% $13.60 Fee Schedule 176.26% $14.44 Fee Schedule 129.00% $10.57 Fee Schedule 191.24% $15.66 Fee Schedule 159.00% $45.00 Fee Schedule 145.00% $11.88 Fee Schedule 60.00% $16.98 Percent of Billed Charges HC CARDIO IQ 84478 300 CPT 84478 90 Outpatient $28.30 $7.40 $45.00 $28.30 $31.32 $28.30 Fee Schedule $31.32 $28.30 Fee Schedule $50.05 $28.30 Fee Schedule 74.74% $21.15 Percent of Billed Charges 68.24% $19.31 Percent of Billed Charges 65.00% $18.40 Percent of Billed Charges 67.00% $18.96 Percent of Billed Charges 77.50% $21.93 Percent of Billed Charges 79.97% $22.63 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 49.55% $14.02 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 78.94% $22.34 Percent of Billed Charges 74.00% $20.94 Percent of Billed Charges 92.50% $26.18 Percent of Billed Charges 55.00% $15.57 Percent of Billed Charges 85.00% $24.06 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 63.00% $17.83 Percent of Billed Charges 75.00% $21.23 Percent of Billed Charges 66.24% $18.75 Percent of Billed Charges 165.81% $9.52 Fee Schedule 166.07% $9.53 Fee Schedule 176.26% $10.12 Fee Schedule 129.00% $7.40 Fee Schedule 191.24% $10.98 Fee Schedule 159.00% $45.00 Fee Schedule 145.00% $8.32 Fee Schedule 60.00% $16.98 Percent of Billed Charges HC CARNITINE LABCORP 300 CPT 82379 90 Outpatient $50.00 $21.76 $79.50 $50.00 $91.88 $50.00 Fee Schedule $91.88 $50.00 Fee Schedule $147.11 $50.00 Fee Schedule 74.74% $37.37 Percent of Billed Charges 68.24% $34.12 Percent of Billed Charges 65.00% $32.50 Percent of Billed Charges 67.00% $33.50 Percent of Billed Charges 77.50% $38.75 Percent of Billed Charges 79.97% $39.99 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 49.55% $24.78 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 78.94% $39.47 Percent of Billed Charges 74.00% $37.00 Percent of Billed Charges 92.50% $46.25 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 85.00% $42.50 Percent of Billed Charges 63.00% $31.50 Percent of Billed Charges 63.00% $31.50 Percent of Billed Charges 75.00% $37.50 Percent of Billed Charges 66.24% $33.12 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $79.50 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $30.00 Percent of Billed Charges HC CARNITINE STANFORD 300 CPT 82379 90 Outpatient $78.00 $21.76 $124.02 $78.00 $91.88 $78.00 Fee Schedule $91.88 $78.00 Fee Schedule $147.11 $74.00 Fee Schedule 74.74% $58.30 Percent of Billed Charges 68.24% $53.23 Percent of Billed Charges 65.00% $50.70 Percent of Billed Charges 67.00% $52.26 Percent of Billed Charges 77.50% $60.45 Percent of Billed Charges 79.97% $62.38 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 49.55% $38.65 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 78.94% $61.57 Percent of Billed Charges 74.00% $57.72 Percent of Billed Charges 92.50% $72.15 Percent of Billed Charges 55.00% $42.90 Percent of Billed Charges 85.00% $66.30 Percent of Billed Charges 63.00% $49.14 Percent of Billed Charges 63.00% $49.14 Percent of Billed Charges 75.00% $58.50 Percent of Billed Charges 66.24% $51.67 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $124.02 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $46.80 Percent of Billed Charges HC CARNITINE URINE STANFORD 300 CPT 82379 90 Outpatient $74.00 $21.76 $117.66 $74.00 $91.88 $74.00 Fee Schedule $91.88 $74.00 Fee Schedule $147.11 $74.00 Fee Schedule 74.74% $55.31 Percent of Billed Charges 68.24% $50.50 Percent of Billed Charges 65.00% $48.10 Percent of Billed Charges 67.00% $49.58 Percent of Billed Charges 77.50% $57.35 Percent of Billed Charges 79.97% $59.18 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 49.55% $36.67 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 78.94% $58.42 Percent of Billed Charges 74.00% $54.76 Percent of Billed Charges 92.50% $68.45 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 85.00% $62.90 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 75.00% $55.50 Percent of Billed Charges 66.24% $49.02 Percent of Billed Charges 165.81% $27.97 Fee Schedule 166.07% $28.02 Fee Schedule 176.26% $29.74 Fee Schedule 129.00% $21.76 Fee Schedule 191.24% $32.26 Fee Schedule 159.00% $117.66 Fee Schedule 145.00% $24.46 Fee Schedule 60.00% $44.40 Percent of Billed Charges HC CAROTENE LA 300 CPT 82380 90 Outpatient $12.92 $6.40 $20.54 $12.92 $50.28 $12.92 Fee Schedule $50.28 $12.92 Fee Schedule $80.40 $12.92 Fee Schedule 74.74% $9.66 Percent of Billed Charges 68.24% $8.82 Percent of Billed Charges 65.00% $8.40 Percent of Billed Charges 67.00% $8.66 Percent of Billed Charges 77.50% $10.01 Percent of Billed Charges 79.97% $10.33 Percent of Billed Charges 55.00% $7.11 Percent of Billed Charges 49.55% $6.40 Percent of Billed Charges 55.00% $7.11 Percent of Billed Charges 55.00% $7.11 Percent of Billed Charges 78.94% $10.20 Percent of Billed Charges 74.00% $9.56 Percent of Billed Charges 92.50% $11.95 Percent of Billed Charges 55.00% $7.11 Percent of Billed Charges 85.00% $10.98 Percent of Billed Charges 63.00% $8.14 Percent of Billed Charges 63.00% $8.14 Percent of Billed Charges 75.00% $9.69 Percent of Billed Charges 66.24% $8.56 Percent of Billed Charges 165.81% $12.92 Fee Schedule 166.07% $15.31 Fee Schedule 176.26% $16.25 Fee Schedule 129.00% $11.89 Fee Schedule 191.24% $17.63 Fee Schedule 159.00% $20.54 Fee Schedule 145.00% $13.37 Fee Schedule 60.00% $7.75 Percent of Billed Charges HC CASHEW IgE - LABCORP 300 CPT 86003 90 Outpatient $24.25 $6.73 $38.56 $24.25 $28.44 $24.25 Fee Schedule $28.44 $24.25 Fee Schedule $45.52 $24.25 Fee Schedule 74.74% $18.12 Percent of Billed Charges 68.24% $16.55 Percent of Billed Charges 65.00% $15.76 Percent of Billed Charges 67.00% $16.25 Percent of Billed Charges 77.50% $18.79 Percent of Billed Charges 79.97% $19.39 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 49.55% $12.02 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 78.94% $19.14 Percent of Billed Charges 74.00% $17.95 Percent of Billed Charges 92.50% $22.43 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 85.00% $20.61 Percent of Billed Charges 63.00% $15.28 Percent of Billed Charges 63.00% $15.28 Percent of Billed Charges 75.00% $18.19 Percent of Billed Charges 66.24% $16.06 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $38.56 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $14.55 Percent of Billed Charges HC CASHEW NUT COMPONENT QUEST 300 CPT 86008 90 Outpatient $9.83 $4.87 $34.29 $9.83 $88.56 $9.83 Fee Schedule $88.56 $9.83 Fee Schedule $156.35 $9.83 Fee Schedule 74.74% $7.35 Percent of Billed Charges 68.24% $6.71 Percent of Billed Charges 65.00% $6.39 Percent of Billed Charges 67.00% $6.59 Percent of Billed Charges 77.50% $7.62 Percent of Billed Charges 79.97% $7.86 Percent of Billed Charges 55.00% $5.41 Percent of Billed Charges 49.55% $4.87 Percent of Billed Charges 55.00% $5.41 Percent of Billed Charges 55.00% $5.41 Percent of Billed Charges 78.94% $7.76 Percent of Billed Charges 74.00% $7.27 Percent of Billed Charges 92.50% $9.09 Percent of Billed Charges 55.00% $5.41 Percent of Billed Charges 85.00% $8.36 Percent of Billed Charges 63.00% $6.19 Percent of Billed Charges 63.00% $6.19 Percent of Billed Charges 75.00% $7.37 Percent of Billed Charges 66.24% $6.51 Percent of Billed Charges 165.81% $9.83 Fee Schedule 166.07% $29.78 Fee Schedule 176.26% $31.60 Fee Schedule 129.00% $23.13 Fee Schedule 191.24% $34.29 Fee Schedule 159.00% $15.63 Fee Schedule 145.00% $26.00 Fee Schedule 60.00% $5.90 Percent of Billed Charges HC CATECHOLAIMINES/FREE URINE/ARU 300 CPT 82384 90 Outpatient $30.23 $14.98 $48.29 $30.23 $137.60 $30.23 Fee Schedule $137.60 $30.23 Fee Schedule $220.18 $30.23 Fee Schedule 74.74% $22.59 Percent of Billed Charges 68.24% $20.63 Percent of Billed Charges 65.00% $19.65 Percent of Billed Charges 67.00% $20.25 Percent of Billed Charges 77.50% $23.43 Percent of Billed Charges 79.97% $24.17 Percent of Billed Charges 55.00% $16.63 Percent of Billed Charges 49.55% $14.98 Percent of Billed Charges 55.00% $16.63 Percent of Billed Charges 55.00% $16.63 Percent of Billed Charges 78.94% $23.86 Percent of Billed Charges 74.00% $22.37 Percent of Billed Charges 92.50% $27.96 Percent of Billed Charges 55.00% $16.63 Percent of Billed Charges 85.00% $25.70 Percent of Billed Charges 63.00% $19.04 Percent of Billed Charges 63.00% $19.04 Percent of Billed Charges 75.00% $22.67 Percent of Billed Charges 66.24% $20.02 Percent of Billed Charges 165.81% $30.23 Fee Schedule 166.07% $41.93 Fee Schedule 176.26% $44.51 Fee Schedule 129.00% $32.57 Fee Schedule 191.24% $48.29 Fee Schedule 159.00% $48.07 Fee Schedule 145.00% $36.61 Fee Schedule 60.00% $18.14 Percent of Billed Charges HC CATECHOLAMINES/RAND/FRAC LABCO 300 CPT 82384 90 Outpatient $20.00 $9.91 $48.29 $20.00 $137.60 $20.00 Fee Schedule $137.60 $20.00 Fee Schedule $220.18 $20.00 Fee Schedule 74.74% $14.95 Percent of Billed Charges 68.24% $13.65 Percent of Billed Charges 65.00% $13.00 Percent of Billed Charges 67.00% $13.40 Percent of Billed Charges 77.50% $15.50 Percent of Billed Charges 79.97% $15.99 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 49.55% $9.91 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 78.94% $15.79 Percent of Billed Charges 74.00% $14.80 Percent of Billed Charges 92.50% $18.50 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 85.00% $17.00 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 75.00% $15.00 Percent of Billed Charges 66.24% $13.25 Percent of Billed Charges 165.81% $20.00 Fee Schedule 166.07% $41.93 Fee Schedule 176.26% $44.51 Fee Schedule 129.00% $32.57 Fee Schedule 191.24% $48.29 Fee Schedule 159.00% $31.80 Fee Schedule 145.00% $36.61 Fee Schedule 60.00% $12.00 Percent of Billed Charges HC CCP ABS LABCORP 300 CPT 86200 90 Outpatient $20.00 $9.91 $31.80 $20.00 $70.52 $20.00 Fee Schedule $70.52 $20.00 Fee Schedule $112.92 $20.00 Fee Schedule 74.74% $14.95 Percent of Billed Charges 68.24% $13.65 Percent of Billed Charges 65.00% $13.00 Percent of Billed Charges 67.00% $13.40 Percent of Billed Charges 77.50% $15.50 Percent of Billed Charges 79.97% $15.99 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 49.55% $9.91 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 78.94% $15.79 Percent of Billed Charges 74.00% $14.80 Percent of Billed Charges 92.50% $18.50 Percent of Billed Charges 55.00% $11.00 Percent of Billed Charges 85.00% $17.00 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 63.00% $12.60 Percent of Billed Charges 75.00% $15.00 Percent of Billed Charges 66.24% $13.25 Percent of Billed Charges 165.81% $16.45 Fee Schedule 166.07% $16.47 Fee Schedule 176.26% $17.48 Fee Schedule 129.00% $12.80 Fee Schedule 191.24% $18.97 Fee Schedule 159.00% $31.80 Fee Schedule 145.00% $14.38 Fee Schedule 60.00% $12.00 Percent of Billed Charges HC CDG MAYO 300 CPT 82373 90 Outpatient $53.33 $16.80 $84.79 $53.33 $98.40 $53.33 Fee Schedule $98.40 $53.33 Fee Schedule $157.48 $53.33 Fee Schedule 74.74% $39.86 Percent of Billed Charges 68.24% $36.39 Percent of Billed Charges 65.00% $34.66 Percent of Billed Charges 67.00% $35.73 Percent of Billed Charges 77.50% $41.33 Percent of Billed Charges 79.97% $42.65 Percent of Billed Charges 55.00% $29.33 Percent of Billed Charges 49.55% $26.43 Percent of Billed Charges 55.00% $29.33 Percent of Billed Charges 55.00% $29.33 Percent of Billed Charges 78.94% $42.10 Percent of Billed Charges 74.00% $39.46 Percent of Billed Charges 92.50% $49.33 Percent of Billed Charges 55.00% $29.33 Percent of Billed Charges 85.00% $45.33 Percent of Billed Charges 63.00% $33.60 Percent of Billed Charges 63.00% $33.60 Percent of Billed Charges 75.00% $40.00 Percent of Billed Charges 66.24% $35.33 Percent of Billed Charges 165.81% $21.59 Fee Schedule 166.07% $21.62 Fee Schedule 176.26% $22.95 Fee Schedule 129.00% $16.80 Fee Schedule 191.24% $24.90 Fee Schedule 159.00% $84.79 Fee Schedule 145.00% $18.88 Fee Schedule 60.00% $32.00 Percent of Billed Charges HC CEA LABCORP 300 CPT 82378 90 Outpatient $3.00 $1.49 $36.26 $3.00 $103.36 $3.00 Fee Schedule $103.36 $3.00 Fee Schedule $165.33 $3.00 Fee Schedule 74.74% $2.24 Percent of Billed Charges 68.24% $2.05 Percent of Billed Charges 65.00% $1.95 Percent of Billed Charges 67.00% $2.01 Percent of Billed Charges 77.50% $2.33 Percent of Billed Charges 79.97% $2.40 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 49.55% $1.49 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 78.94% $2.37 Percent of Billed Charges 74.00% $2.22 Percent of Billed Charges 92.50% $2.78 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 85.00% $2.55 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 75.00% $2.25 Percent of Billed Charges 66.24% $1.99 Percent of Billed Charges 165.81% $3.00 Fee Schedule 166.07% $31.49 Fee Schedule 176.26% $33.42 Fee Schedule 129.00% $24.46 Fee Schedule 191.24% $36.26 Fee Schedule 159.00% $4.77 Fee Schedule 145.00% $27.49 Fee Schedule 60.00% $1.80 Percent of Billed Charges HC CELIAC ABS LABCORP 300 CPT 82784 90 Outpatient $3.50 $1.73 $17.79 $3.50 $50.68 $3.50 Fee Schedule $50.68 $3.50 Fee Schedule $81.10 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $15.44 Fee Schedule 176.26% $16.39 Fee Schedule 129.00% $12.00 Fee Schedule 191.24% $17.79 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $13.49 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC CELIAC ABS LABCORP 300 CPT 83516 90 Outpatient $3.50 $1.73 $22.05 $3.50 $62.84 $3.50 Fee Schedule $62.84 $3.50 Fee Schedule $100.54 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC CELIAC ABS LABCORP 300 CPT 86255 90 Outpatient $3.50 $1.73 $23.04 $3.50 $65.64 $3.50 Fee Schedule $65.64 $3.50 Fee Schedule $105.08 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC CELIAC ASSOC HLA-DQ TYPNG MAYO 300 CPT 81376 90 Outpatient $215.00 $106.53 $341.85 $215.00 $665.96 $215.00 Fee Schedule $665.96 $215.00 Fee Schedule " $1,065.76 " $215.00 Fee Schedule 74.74% $160.69 Percent of Billed Charges 68.24% $146.72 Percent of Billed Charges 65.00% $139.75 Percent of Billed Charges 67.00% $144.05 Percent of Billed Charges 77.50% $166.63 Percent of Billed Charges 79.97% $171.94 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 49.55% $106.53 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 78.94% $169.72 Percent of Billed Charges 74.00% $159.10 Percent of Billed Charges 92.50% $198.88 Percent of Billed Charges 55.00% $118.25 Percent of Billed Charges 85.00% $182.75 Percent of Billed Charges 63.00% $135.45 Percent of Billed Charges 63.00% $135.45 Percent of Billed Charges 75.00% $161.25 Percent of Billed Charges 66.24% $142.42 Percent of Billed Charges 165.81% $202.65 Fee Schedule 166.07% $202.97 Fee Schedule 176.26% $215.42 Fee Schedule 129.00% $157.66 Fee Schedule 191.24% $233.73 Fee Schedule 159.00% $341.85 Fee Schedule 145.00% $177.22 Fee Schedule 60.00% $129.00 Percent of Billed Charges HC CELIAC PLUS PROMETHEUS LABS 300 CPT 81382 90 Outpatient $235.00 $116.44 $373.65 $235.00 $673.92 $235.00 Fee Schedule $673.92 $235.00 Fee Schedule " $1,078.49 " $235.00 Fee Schedule 74.74% $175.64 Percent of Billed Charges 68.24% $160.36 Percent of Billed Charges 65.00% $152.75 Percent of Billed Charges 67.00% $157.45 Percent of Billed Charges 77.50% $182.13 Percent of Billed Charges 79.97% $187.93 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 49.55% $116.44 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 78.94% $185.51 Percent of Billed Charges 74.00% $173.90 Percent of Billed Charges 92.50% $217.38 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 85.00% $199.75 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 75.00% $176.25 Percent of Billed Charges 66.24% $155.66 Percent of Billed Charges 165.81% $205.07 Fee Schedule 166.07% $205.40 Fee Schedule 176.26% $218.00 Fee Schedule 129.00% $159.55 Fee Schedule 191.24% $236.53 Fee Schedule 159.00% $373.65 Fee Schedule 145.00% $179.34 Fee Schedule 60.00% $141.00 Percent of Billed Charges HC CELIAC PLUS PROMETHEUS LABS 300 CPT 82784 90 Outpatient $235.00 $12.00 $373.65 $235.00 $50.68 $50.68 Fee Schedule $50.68 $50.68 Fee Schedule $81.10 $76.91 Fee Schedule 74.74% $175.64 Percent of Billed Charges 68.24% $160.36 Percent of Billed Charges 65.00% $152.75 Percent of Billed Charges 67.00% $157.45 Percent of Billed Charges 77.50% $182.13 Percent of Billed Charges 79.97% $187.93 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 49.55% $116.44 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 78.94% $185.51 Percent of Billed Charges 74.00% $173.90 Percent of Billed Charges 92.50% $217.38 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 85.00% $199.75 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 75.00% $176.25 Percent of Billed Charges 66.24% $155.66 Percent of Billed Charges 165.81% $15.42 Fee Schedule 166.07% $15.44 Fee Schedule 176.26% $16.39 Fee Schedule 129.00% $12.00 Fee Schedule 191.24% $17.79 Fee Schedule 159.00% $373.65 Fee Schedule 145.00% $13.49 Fee Schedule 60.00% $141.00 Percent of Billed Charges HC CELIAC PLUS PROMETHEUS LABS 300 CPT 83520 90 Outpatient $235.00 $22.28 $373.65 $235.00 $70.52 $70.52 Fee Schedule $70.52 $70.52 Fee Schedule $150.59 $142.82 Fee Schedule 74.74% $175.64 Percent of Billed Charges 68.24% $160.36 Percent of Billed Charges 65.00% $152.75 Percent of Billed Charges 67.00% $157.45 Percent of Billed Charges 77.50% $182.13 Percent of Billed Charges 79.97% $187.93 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 49.55% $116.44 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 78.94% $185.51 Percent of Billed Charges 74.00% $173.90 Percent of Billed Charges 92.50% $217.38 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 85.00% $199.75 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 75.00% $176.25 Percent of Billed Charges 66.24% $155.66 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $373.65 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $141.00 Percent of Billed Charges HC CELIAC PLUS PROMETHEUS LABS 300 CPT 88346 90 Outpatient $235.00 $35.59 $373.65 $235.00 $837.68 $235.00 Fee Schedule $837.68 $235.00 Fee Schedule 56.78% $133.43 Percent of Billed Charges 74.74% $175.64 Percent of Billed Charges 68.24% $160.36 Percent of Billed Charges 65.00% $152.75 Percent of Billed Charges 67.00% $157.45 Percent of Billed Charges 77.50% $182.13 Percent of Billed Charges 79.97% $187.93 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 49.55% $116.44 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 78.94% $185.51 Percent of Billed Charges 74.00% $173.90 Percent of Billed Charges 92.50% $217.38 Percent of Billed Charges 55.00% $129.25 Percent of Billed Charges 85.00% $199.75 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 63.00% $148.05 Percent of Billed Charges 75.00% $176.25 Percent of Billed Charges 66.24% $155.66 Percent of Billed Charges 165.81% $45.75 Fee Schedule 166.07% $45.82 Fee Schedule 176.26% $48.63 Fee Schedule 129.00% $35.59 Fee Schedule 191.24% $52.76 Fee Schedule 159.00% $373.65 Fee Schedule 145.00% $40.01 Fee Schedule 60.00% $141.00 Percent of Billed Charges HC CELL COUNT - BODY FLUID 300 CPT 89051 Outpatient $257.00 $7.22 $408.63 $257.00 $30.00 $30.00 Fee Schedule $30.00 $30.00 Fee Schedule $48.83 $46.31 Fee Schedule 74.74% $192.08 Percent of Billed Charges 68.24% $175.38 Percent of Billed Charges 65.00% $167.05 Percent of Billed Charges 67.00% $172.19 Percent of Billed Charges 77.50% $199.18 Percent of Billed Charges 79.97% $205.52 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 49.55% $127.34 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 78.94% $202.88 Percent of Billed Charges 74.00% $190.18 Percent of Billed Charges 92.50% $237.73 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 85.00% $218.45 Percent of Billed Charges 63.00% $161.91 Percent of Billed Charges 63.00% $161.91 Percent of Billed Charges 75.00% $192.75 Percent of Billed Charges 66.24% $170.24 Percent of Billed Charges 165.81% $9.29 Fee Schedule 166.07% $9.30 Fee Schedule 176.26% $9.87 Fee Schedule 129.00% $7.22 Fee Schedule 191.24% $10.71 Fee Schedule 159.00% $408.63 Fee Schedule 145.00% $8.12 Fee Schedule 60.00% $154.20 Percent of Billed Charges HC CELL COUNT CSF 300 CPT 89051 Outpatient $257.00 $7.22 $408.63 $257.00 $30.00 $30.00 Fee Schedule $30.00 $30.00 Fee Schedule $48.83 $46.31 Fee Schedule 74.74% $192.08 Percent of Billed Charges 68.24% $175.38 Percent of Billed Charges 65.00% $167.05 Percent of Billed Charges 67.00% $172.19 Percent of Billed Charges 77.50% $199.18 Percent of Billed Charges 79.97% $205.52 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 49.55% $127.34 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 78.94% $202.88 Percent of Billed Charges 74.00% $190.18 Percent of Billed Charges 92.50% $237.73 Percent of Billed Charges 55.00% $141.35 Percent of Billed Charges 85.00% $218.45 Percent of Billed Charges 63.00% $161.91 Percent of Billed Charges 63.00% $161.91 Percent of Billed Charges 75.00% $192.75 Percent of Billed Charges 66.24% $170.24 Percent of Billed Charges 165.81% $9.29 Fee Schedule 166.07% $9.30 Fee Schedule 176.26% $9.87 Fee Schedule 129.00% $7.22 Fee Schedule 191.24% $10.71 Fee Schedule 159.00% $408.63 Fee Schedule 145.00% $8.12 Fee Schedule 60.00% $154.20 Percent of Billed Charges "HC CENTROMERE AB, IGG LABCORP" 300 CPT 86235 90 Outpatient $6.00 $2.97 $34.29 $6.00 $97.72 $6.00 Fee Schedule $97.72 $6.00 Fee Schedule $156.35 $6.00 Fee Schedule 74.74% $4.48 Percent of Billed Charges 68.24% $4.09 Percent of Billed Charges 65.00% $3.90 Percent of Billed Charges 67.00% $4.02 Percent of Billed Charges 77.50% $4.65 Percent of Billed Charges 79.97% $4.80 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 49.55% $2.97 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 78.94% $4.74 Percent of Billed Charges 74.00% $4.44 Percent of Billed Charges 92.50% $5.55 Percent of Billed Charges 55.00% $3.30 Percent of Billed Charges 85.00% $5.10 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 63.00% $3.78 Percent of Billed Charges 75.00% $4.50 Percent of Billed Charges 66.24% $3.97 Percent of Billed Charges 165.81% $6.00 Fee Schedule 166.07% $29.78 Fee Schedule 176.26% $31.60 Fee Schedule 129.00% $23.13 Fee Schedule 191.24% $34.29 Fee Schedule 159.00% $9.54 Fee Schedule 145.00% $26.00 Fee Schedule 60.00% $3.60 Percent of Billed Charges HC CEROID LIPOFUCINOSIS 300 CPT 88348 90 Outpatient " $1,722.00 " $122.89 " $2,737.98 " " $1,722.00 " " $1,762.12 " " $1,722.00 " Fee Schedule " $1,762.12 " " $1,722.00 " Fee Schedule 56.78% $977.75 Percent of Billed Charges 74.74% " $1,287.02 " Percent of Billed Charges 68.24% " $1,175.09 " Percent of Billed Charges 65.00% " $1,119.30 " Percent of Billed Charges 67.00% " $1,153.74 " Percent of Billed Charges 77.50% " $1,334.55 " Percent of Billed Charges 79.97% " $1,377.08 " Percent of Billed Charges 55.00% $947.10 Percent of Billed Charges 49.55% $853.25 Percent of Billed Charges 55.00% $947.10 Percent of Billed Charges 55.00% $947.10 Percent of Billed Charges 78.94% " $1,359.35 " Percent of Billed Charges 74.00% " $1,274.28 " Percent of Billed Charges 92.50% " $1,592.85 " Percent of Billed Charges 55.00% $947.10 Percent of Billed Charges 85.00% " $1,463.70 " Percent of Billed Charges 63.00% " $1,084.86 " Percent of Billed Charges 63.00% " $1,084.86 " Percent of Billed Charges 75.00% " $1,291.50 " Percent of Billed Charges 66.24% " $1,140.65 " Percent of Billed Charges 165.81% $157.95 Fee Schedule 166.07% $158.20 Fee Schedule 176.26% $167.91 Fee Schedule 129.00% $122.89 Fee Schedule 191.24% $182.18 Fee Schedule 159.00% " $2,737.98 " Fee Schedule 145.00% $138.13 Fee Schedule 60.00% " $1,033.20 " Percent of Billed Charges HC CERULOPLASMIN LABCORP 300 CPT 82390 90 Outpatient $3.75 $1.86 $20.54 $3.75 $58.52 $3.75 Fee Schedule $58.52 $3.75 Fee Schedule $93.65 $3.75 Fee Schedule 74.74% $2.80 Percent of Billed Charges 68.24% $2.56 Percent of Billed Charges 65.00% $2.44 Percent of Billed Charges 67.00% $2.51 Percent of Billed Charges 77.50% $2.91 Percent of Billed Charges 79.97% $3.00 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 49.55% $1.86 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 78.94% $2.96 Percent of Billed Charges 74.00% $2.78 Percent of Billed Charges 92.50% $3.47 Percent of Billed Charges 55.00% $2.06 Percent of Billed Charges 85.00% $3.19 Percent of Billed Charges 63.00% $2.36 Percent of Billed Charges 63.00% $2.36 Percent of Billed Charges 75.00% $2.81 Percent of Billed Charges 66.24% $2.48 Percent of Billed Charges 165.81% $3.75 Fee Schedule 166.07% $17.84 Fee Schedule 176.26% $18.93 Fee Schedule 129.00% $13.85 Fee Schedule 191.24% $20.54 Fee Schedule 159.00% $5.96 Fee Schedule 145.00% $15.57 Fee Schedule 60.00% $2.25 Percent of Billed Charges HC CF MUTATION INTEGRATED GENETIC 300 CPT 81220 90 Outpatient $800.00 $324.38 " $1,272.00 " $800.00 " $2,226.40 " $800.00 Fee Schedule " $2,226.40 " $800.00 Fee Schedule " $4,853.55 " $800.00 Fee Schedule 74.74% $597.92 Percent of Billed Charges 68.24% $545.92 Percent of Billed Charges 65.00% $520.00 Percent of Billed Charges 67.00% $536.00 Percent of Billed Charges 77.50% $620.00 Percent of Billed Charges 79.97% $639.76 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 49.55% $396.40 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 78.94% $631.52 Percent of Billed Charges 74.00% $592.00 Percent of Billed Charges 92.50% $740.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 85.00% $680.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 75.00% $600.00 Percent of Billed Charges 66.24% $529.92 Percent of Billed Charges 165.81% $416.95 Fee Schedule 166.07% $417.60 Fee Schedule 176.26% $443.22 Fee Schedule 129.00% $324.38 Fee Schedule 191.24% $480.89 Fee Schedule 159.00% " $1,272.00 " Fee Schedule 145.00% $364.62 Fee Schedule 60.00% $480.00 Percent of Billed Charges HC CH50 LABCORP 300 CPT 86162 90 Outpatient $4.75 $2.35 $38.86 $4.75 $110.72 $4.75 Fee Schedule $110.72 $4.75 Fee Schedule $177.19 $4.75 Fee Schedule 74.74% $3.55 Percent of Billed Charges 68.24% $3.24 Percent of Billed Charges 65.00% $3.09 Percent of Billed Charges 67.00% $3.18 Percent of Billed Charges 77.50% $3.68 Percent of Billed Charges 79.97% $3.80 Percent of Billed Charges 55.00% $2.61 Percent of Billed Charges 49.55% $2.35 Percent of Billed Charges 55.00% $2.61 Percent of Billed Charges 55.00% $2.61 Percent of Billed Charges 78.94% $3.75 Percent of Billed Charges 74.00% $3.52 Percent of Billed Charges 92.50% $4.39 Percent of Billed Charges 55.00% $2.61 Percent of Billed Charges 85.00% $4.04 Percent of Billed Charges 63.00% $2.99 Percent of Billed Charges 63.00% $2.99 Percent of Billed Charges 75.00% $3.56 Percent of Billed Charges 66.24% $3.15 Percent of Billed Charges 165.81% $4.75 Fee Schedule 166.07% $33.75 Fee Schedule 176.26% $35.82 Fee Schedule 129.00% $26.21 Fee Schedule 191.24% $38.86 Fee Schedule 159.00% $7.55 Fee Schedule 145.00% $29.46 Fee Schedule 60.00% $2.85 Percent of Billed Charges HC CH50/CLASSIC PATHWAY (JEW1) 300 CPT 86162 90 Outpatient $191.00 $26.21 $303.69 $191.00 $110.72 $110.72 Fee Schedule $110.72 $110.72 Fee Schedule $177.19 $168.05 Fee Schedule 74.74% $142.75 Percent of Billed Charges 68.24% $130.34 Percent of Billed Charges 65.00% $124.15 Percent of Billed Charges 67.00% $127.97 Percent of Billed Charges 77.50% $148.03 Percent of Billed Charges 79.97% $152.74 Percent of Billed Charges 55.00% $105.05 Percent of Billed Charges 49.55% $94.64 Percent of Billed Charges 55.00% $105.05 Percent of Billed Charges 55.00% $105.05 Percent of Billed Charges 78.94% $150.78 Percent of Billed Charges 74.00% $141.34 Percent of Billed Charges 92.50% $176.68 Percent of Billed Charges 55.00% $105.05 Percent of Billed Charges 85.00% $162.35 Percent of Billed Charges 63.00% $120.33 Percent of Billed Charges 63.00% $120.33 Percent of Billed Charges 75.00% $143.25 Percent of Billed Charges 66.24% $126.52 Percent of Billed Charges 165.81% $33.69 Fee Schedule 166.07% $33.75 Fee Schedule 176.26% $35.82 Fee Schedule 129.00% $26.21 Fee Schedule 191.24% $38.86 Fee Schedule 159.00% $303.69 Fee Schedule 145.00% $29.46 Fee Schedule 60.00% $114.60 Percent of Billed Charges HC CHILDHOOD ALLERGY LABCORP 300 CPT 86003 90 Outpatient $74.00 $6.73 $117.66 $74.00 $28.44 $28.44 Fee Schedule $28.44 $28.44 Fee Schedule $45.52 $43.17 Fee Schedule 74.74% $55.31 Percent of Billed Charges 68.24% $50.50 Percent of Billed Charges 65.00% $48.10 Percent of Billed Charges 67.00% $49.58 Percent of Billed Charges 77.50% $57.35 Percent of Billed Charges 79.97% $59.18 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 49.55% $36.67 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 78.94% $58.42 Percent of Billed Charges 74.00% $54.76 Percent of Billed Charges 92.50% $68.45 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 85.00% $62.90 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 75.00% $55.50 Percent of Billed Charges 66.24% $49.02 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $117.66 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $44.40 Percent of Billed Charges HC CHIMERISM CITY OF HOPE 300 CPT 81267 90 Outpatient $565.00 $215.86 $898.35 $565.00 " $1,130.40 " $565.00 Fee Schedule " $1,130.40 " $565.00 Fee Schedule " $1,809.05 " $565.00 Fee Schedule 74.74% $422.28 Percent of Billed Charges 68.24% $385.56 Percent of Billed Charges 65.00% $367.25 Percent of Billed Charges 67.00% $378.55 Percent of Billed Charges 77.50% $437.88 Percent of Billed Charges 79.97% $451.83 Percent of Billed Charges 55.00% $310.75 Percent of Billed Charges 49.55% $279.96 Percent of Billed Charges 55.00% $310.75 Percent of Billed Charges 55.00% $310.75 Percent of Billed Charges 78.94% $446.01 Percent of Billed Charges 74.00% $418.10 Percent of Billed Charges 92.50% $522.63 Percent of Billed Charges 55.00% $310.75 Percent of Billed Charges 85.00% $480.25 Percent of Billed Charges 63.00% $355.95 Percent of Billed Charges 63.00% $355.95 Percent of Billed Charges 75.00% $423.75 Percent of Billed Charges 66.24% $374.26 Percent of Billed Charges 165.81% $277.45 Fee Schedule 166.07% $277.88 Fee Schedule 176.26% $294.94 Fee Schedule 129.00% $215.86 Fee Schedule 191.24% $320.00 Fee Schedule 159.00% $898.35 Fee Schedule 145.00% $242.63 Fee Schedule 60.00% $339.00 Percent of Billed Charges HC CHIMERISM CITY OF HOPE 300 CPT 81268 90 Outpatient $355.00 $175.90 $564.45 $355.00 " $1,420.96 " $355.00 Fee Schedule " $1,420.96 " $355.00 Fee Schedule " $2,274.09 " $355.00 Fee Schedule 74.74% $265.33 Percent of Billed Charges 68.24% $242.25 Percent of Billed Charges 65.00% $230.75 Percent of Billed Charges 67.00% $237.85 Percent of Billed Charges 77.50% $275.13 Percent of Billed Charges 79.97% $283.89 Percent of Billed Charges 55.00% $195.25 Percent of Billed Charges 49.55% $175.90 Percent of Billed Charges 55.00% $195.25 Percent of Billed Charges 55.00% $195.25 Percent of Billed Charges 78.94% $280.24 Percent of Billed Charges 74.00% $262.70 Percent of Billed Charges 92.50% $328.38 Percent of Billed Charges 55.00% $195.25 Percent of Billed Charges 85.00% $301.75 Percent of Billed Charges 63.00% $223.65 Percent of Billed Charges 63.00% $223.65 Percent of Billed Charges 75.00% $266.25 Percent of Billed Charges 66.24% $235.15 Percent of Billed Charges 165.81% $277.45 Fee Schedule 166.07% $277.88 Fee Schedule 176.26% $294.94 Fee Schedule 129.00% $215.86 Fee Schedule 191.24% $320.00 Fee Schedule 159.00% $564.45 Fee Schedule 145.00% $242.63 Fee Schedule 60.00% $213.00 Percent of Billed Charges HC CHIMERISM STANFORD 81265 300 CPT 81265 90 Outpatient $196.00 $97.12 $445.72 $196.00 " $1,171.76 " $196.00 Fee Schedule " $1,171.76 " $196.00 Fee Schedule " $2,032.37 " $196.00 Fee Schedule 74.74% $146.49 Percent of Billed Charges 68.24% $133.75 Percent of Billed Charges 65.00% $127.40 Percent of Billed Charges 67.00% $131.32 Percent of Billed Charges 77.50% $151.90 Percent of Billed Charges 79.97% $156.74 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 49.55% $97.12 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 78.94% $154.72 Percent of Billed Charges 74.00% $145.04 Percent of Billed Charges 92.50% $181.30 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 85.00% $166.60 Percent of Billed Charges 63.00% $123.48 Percent of Billed Charges 63.00% $123.48 Percent of Billed Charges 75.00% $147.00 Percent of Billed Charges 66.24% $129.83 Percent of Billed Charges 165.81% $196.00 Fee Schedule 166.07% $387.06 Fee Schedule 176.26% $410.81 Fee Schedule 129.00% $300.66 Fee Schedule 191.24% $445.72 Fee Schedule 159.00% $311.64 Fee Schedule 145.00% $337.95 Fee Schedule 60.00% $117.60 Percent of Billed Charges HC CHIMERISM STANFORD 81268 300 CPT 81268 90 Outpatient $196.00 $97.12 $320.00 $196.00 " $1,420.96 " $196.00 Fee Schedule " $1,420.96 " $196.00 Fee Schedule " $2,274.09 " $196.00 Fee Schedule 74.74% $146.49 Percent of Billed Charges 68.24% $133.75 Percent of Billed Charges 65.00% $127.40 Percent of Billed Charges 67.00% $131.32 Percent of Billed Charges 77.50% $151.90 Percent of Billed Charges 79.97% $156.74 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 49.55% $97.12 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 78.94% $154.72 Percent of Billed Charges 74.00% $145.04 Percent of Billed Charges 92.50% $181.30 Percent of Billed Charges 55.00% $107.80 Percent of Billed Charges 85.00% $166.60 Percent of Billed Charges 63.00% $123.48 Percent of Billed Charges 63.00% $123.48 Percent of Billed Charges 75.00% $147.00 Percent of Billed Charges 66.24% $129.83 Percent of Billed Charges 165.81% $196.00 Fee Schedule 166.07% $277.88 Fee Schedule 176.26% $294.94 Fee Schedule 129.00% $215.86 Fee Schedule 191.24% $320.00 Fee Schedule 159.00% $311.64 Fee Schedule 145.00% $242.63 Fee Schedule 60.00% $117.60 Percent of Billed Charges HC CHIMERISM STANFORD 81479 300 CPT 81479 90 Outpatient $157.00 $- $249.63 $157.00 50.00% $78.50 Percent of Billed Charges 50.00% $78.50 Percent of Billed Charges 56.78% $89.14 Percent of Billed Charges 74.74% $117.34 Percent of Billed Charges 68.24% $107.14 Percent of Billed Charges 65.00% $102.05 Percent of Billed Charges 67.00% $105.19 Percent of Billed Charges 77.50% $121.68 Percent of Billed Charges 79.97% $125.55 Percent of Billed Charges 55.00% $86.35 Percent of Billed Charges 49.55% $77.79 Percent of Billed Charges 55.00% $86.35 Percent of Billed Charges 55.00% $86.35 Percent of Billed Charges 78.94% $123.94 Percent of Billed Charges 74.00% $116.18 Percent of Billed Charges 92.50% $145.23 Percent of Billed Charges 55.00% $86.35 Percent of Billed Charges 85.00% $133.45 Percent of Billed Charges 63.00% $98.91 Percent of Billed Charges 63.00% $98.91 Percent of Billed Charges 75.00% $117.75 Percent of Billed Charges 66.24% $104.00 Percent of Billed Charges 35.00% $54.95 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $249.63 Fee Schedule 145.00% $- Fee Schedule 60.00% $94.20 Percent of Billed Charges HC CHLAMYDIA ANTIBODY ARUP 300 CPT 86631 90 Outpatient $50.70 $15.25 $80.61 $50.70 $64.44 $50.70 Fee Schedule $64.44 $50.70 Fee Schedule $103.07 $50.70 Fee Schedule 74.74% $37.89 Percent of Billed Charges 68.24% $34.60 Percent of Billed Charges 65.00% $32.96 Percent of Billed Charges 67.00% $33.97 Percent of Billed Charges 77.50% $39.29 Percent of Billed Charges 79.97% $40.54 Percent of Billed Charges 55.00% $27.89 Percent of Billed Charges 49.55% $25.12 Percent of Billed Charges 55.00% $27.89 Percent of Billed Charges 55.00% $27.89 Percent of Billed Charges 78.94% $40.02 Percent of Billed Charges 74.00% $37.52 Percent of Billed Charges 92.50% $46.90 Percent of Billed Charges 55.00% $27.89 Percent of Billed Charges 85.00% $43.10 Percent of Billed Charges 63.00% $31.94 Percent of Billed Charges 63.00% $31.94 Percent of Billed Charges 75.00% $38.03 Percent of Billed Charges 66.24% $33.58 Percent of Billed Charges 165.81% $19.60 Fee Schedule 166.07% $19.63 Fee Schedule 176.26% $20.83 Fee Schedule 129.00% $15.25 Fee Schedule 191.24% $22.60 Fee Schedule 159.00% $80.61 Fee Schedule 145.00% $17.14 Fee Schedule 60.00% $30.42 Percent of Billed Charges HC CHLAMYDIA T AMPLIF NA PROBE LABCORP 300 CPT 87491 90 Outpatient $32.40 $16.05 $67.11 $32.40 $191.20 $32.40 Fee Schedule $191.20 $32.40 Fee Schedule $305.98 $32.40 Fee Schedule 74.74% $24.22 Percent of Billed Charges 68.24% $22.11 Percent of Billed Charges 65.00% $21.06 Percent of Billed Charges 67.00% $21.71 Percent of Billed Charges 77.50% $25.11 Percent of Billed Charges 79.97% $25.91 Percent of Billed Charges 55.00% $17.82 Percent of Billed Charges 49.55% $16.05 Percent of Billed Charges 55.00% $17.82 Percent of Billed Charges 55.00% $17.82 Percent of Billed Charges 78.94% $25.58 Percent of Billed Charges 74.00% $23.98 Percent of Billed Charges 92.50% $29.97 Percent of Billed Charges 55.00% $17.82 Percent of Billed Charges 85.00% $27.54 Percent of Billed Charges 63.00% $20.41 Percent of Billed Charges 63.00% $20.41 Percent of Billed Charges 75.00% $24.30 Percent of Billed Charges 66.24% $21.46 Percent of Billed Charges 165.81% $32.40 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $51.52 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $19.44 Percent of Billed Charges HC CHLAMYDIA TRACH CULT LABCORP 300 CPT 87110 90 Outpatient $14.30 $7.09 $37.48 $14.30 $106.76 $14.30 Fee Schedule $106.76 $14.30 Fee Schedule $170.91 $14.30 Fee Schedule 74.74% $10.69 Percent of Billed Charges 68.24% $9.76 Percent of Billed Charges 65.00% $9.30 Percent of Billed Charges 67.00% $9.58 Percent of Billed Charges 77.50% $11.08 Percent of Billed Charges 79.97% $11.44 Percent of Billed Charges 55.00% $7.87 Percent of Billed Charges 49.55% $7.09 Percent of Billed Charges 55.00% $7.87 Percent of Billed Charges 55.00% $7.87 Percent of Billed Charges 78.94% $11.29 Percent of Billed Charges 74.00% $10.58 Percent of Billed Charges 92.50% $13.23 Percent of Billed Charges 55.00% $7.87 Percent of Billed Charges 85.00% $12.16 Percent of Billed Charges 63.00% $9.01 Percent of Billed Charges 63.00% $9.01 Percent of Billed Charges 75.00% $10.73 Percent of Billed Charges 66.24% $9.47 Percent of Billed Charges 165.81% $14.30 Fee Schedule 166.07% $32.55 Fee Schedule 176.26% $34.55 Fee Schedule 129.00% $25.28 Fee Schedule 191.24% $37.48 Fee Schedule 159.00% $22.74 Fee Schedule 145.00% $28.42 Fee Schedule 60.00% $8.58 Percent of Billed Charges "HC CHLAMYDIA/GONOOCCUS, PHARYNGEAL - 87491" 300 CPT 87491 90 Outpatient $10.75 $5.33 $67.11 $10.75 $191.20 $10.75 Fee Schedule $191.20 $10.75 Fee Schedule $305.98 $10.75 Fee Schedule 74.74% $8.03 Percent of Billed Charges 68.24% $7.34 Percent of Billed Charges 65.00% $6.99 Percent of Billed Charges 67.00% $7.20 Percent of Billed Charges 77.50% $8.33 Percent of Billed Charges 79.97% $8.60 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 49.55% $5.33 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 78.94% $8.49 Percent of Billed Charges 74.00% $7.96 Percent of Billed Charges 92.50% $9.94 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 85.00% $9.14 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 75.00% $8.06 Percent of Billed Charges 66.24% $7.12 Percent of Billed Charges 165.81% $10.75 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $17.09 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $6.45 Percent of Billed Charges "HC CHLAMYDIA/GONOOCCUS, PHARYNGEAL - 87591" 300 CPT 87591 90 Outpatient $10.75 $5.33 $67.11 $10.75 $191.20 $10.75 Fee Schedule $191.20 $10.75 Fee Schedule $305.98 $10.75 Fee Schedule 74.74% $8.03 Percent of Billed Charges 68.24% $7.34 Percent of Billed Charges 65.00% $6.99 Percent of Billed Charges 67.00% $7.20 Percent of Billed Charges 77.50% $8.33 Percent of Billed Charges 79.97% $8.60 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 49.55% $5.33 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 78.94% $8.49 Percent of Billed Charges 74.00% $7.96 Percent of Billed Charges 92.50% $9.94 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 85.00% $9.14 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 75.00% $8.06 Percent of Billed Charges 66.24% $7.12 Percent of Billed Charges 165.81% $10.75 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $17.09 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $6.45 Percent of Billed Charges "HC CHLAMYDIA/GONOOCCUS, RECTAL - 87491" 300 CPT 87491 90 Outpatient $10.75 $5.33 $67.11 $10.75 $191.20 $10.75 Fee Schedule $191.20 $10.75 Fee Schedule $305.98 $10.75 Fee Schedule 74.74% $8.03 Percent of Billed Charges 68.24% $7.34 Percent of Billed Charges 65.00% $6.99 Percent of Billed Charges 67.00% $7.20 Percent of Billed Charges 77.50% $8.33 Percent of Billed Charges 79.97% $8.60 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 49.55% $5.33 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 78.94% $8.49 Percent of Billed Charges 74.00% $7.96 Percent of Billed Charges 92.50% $9.94 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 85.00% $9.14 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 75.00% $8.06 Percent of Billed Charges 66.24% $7.12 Percent of Billed Charges 165.81% $10.75 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $17.09 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $6.45 Percent of Billed Charges "HC CHLAMYDIA/GONOOCCUS, RECTAL - 87591" 300 CPT 87591 90 Outpatient $10.75 $5.33 $67.11 $10.75 $191.20 $10.75 Fee Schedule $191.20 $10.75 Fee Schedule $305.98 $10.75 Fee Schedule 74.74% $8.03 Percent of Billed Charges 68.24% $7.34 Percent of Billed Charges 65.00% $6.99 Percent of Billed Charges 67.00% $7.20 Percent of Billed Charges 77.50% $8.33 Percent of Billed Charges 79.97% $8.60 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 49.55% $5.33 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 78.94% $8.49 Percent of Billed Charges 74.00% $7.96 Percent of Billed Charges 92.50% $9.94 Percent of Billed Charges 55.00% $5.91 Percent of Billed Charges 85.00% $9.14 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 63.00% $6.77 Percent of Billed Charges 75.00% $8.06 Percent of Billed Charges 66.24% $7.12 Percent of Billed Charges 165.81% $10.75 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $17.09 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $6.45 Percent of Billed Charges "HC CHLORIDE,BODY FLUID" 300 CPT 82438 90 Outpatient $8.73 $4.33 $13.88 $8.73 $26.64 $8.73 Fee Schedule $26.64 $8.73 Fee Schedule $43.60 $8.73 Fee Schedule 74.74% $6.52 Percent of Billed Charges 68.24% $5.96 Percent of Billed Charges 65.00% $5.67 Percent of Billed Charges 67.00% $5.85 Percent of Billed Charges 77.50% $6.77 Percent of Billed Charges 79.97% $6.98 Percent of Billed Charges 55.00% $4.80 Percent of Billed Charges 49.55% $4.33 Percent of Billed Charges 55.00% $4.80 Percent of Billed Charges 55.00% $4.80 Percent of Billed Charges 78.94% $6.89 Percent of Billed Charges 74.00% $6.46 Percent of Billed Charges 92.50% $8.08 Percent of Billed Charges 55.00% $4.80 Percent of Billed Charges 85.00% $7.42 Percent of Billed Charges 63.00% $5.50 Percent of Billed Charges 63.00% $5.50 Percent of Billed Charges 75.00% $6.55 Percent of Billed Charges 66.24% $5.78 Percent of Billed Charges 165.81% $8.29 Fee Schedule 166.07% $8.30 Fee Schedule 176.26% $8.81 Fee Schedule 129.00% $6.45 Fee Schedule 191.24% $9.56 Fee Schedule 159.00% $13.88 Fee Schedule 145.00% $7.25 Fee Schedule 60.00% $5.24 Percent of Billed Charges "HC CHLORIDE,FECAL ARUP" 300 CPT 82438 90 Outpatient $15.00 $6.45 $23.85 $15.00 $26.64 $15.00 Fee Schedule $26.64 $15.00 Fee Schedule $43.60 $15.00 Fee Schedule 74.74% $11.21 Percent of Billed Charges 68.24% $10.24 Percent of Billed Charges 65.00% $9.75 Percent of Billed Charges 67.00% $10.05 Percent of Billed Charges 77.50% $11.63 Percent of Billed Charges 79.97% $12.00 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 49.55% $7.43 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 78.94% $11.84 Percent of Billed Charges 74.00% $11.10 Percent of Billed Charges 92.50% $13.88 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 85.00% $12.75 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 75.00% $11.25 Percent of Billed Charges 66.24% $9.94 Percent of Billed Charges 165.81% $8.29 Fee Schedule 166.07% $8.30 Fee Schedule 176.26% $8.81 Fee Schedule 129.00% $6.45 Fee Schedule 191.24% $9.56 Fee Schedule 159.00% $23.85 Fee Schedule 145.00% $7.25 Fee Schedule 60.00% $9.00 Percent of Billed Charges "HC CHLORIDE,URINE ARUP" 300 CPT 82436 90 Outpatient $9.35 $4.63 $14.87 $9.35 $27.40 $9.35 Fee Schedule $27.40 $9.35 Fee Schedule $50.14 $9.35 Fee Schedule 74.74% $6.99 Percent of Billed Charges 68.24% $6.38 Percent of Billed Charges 65.00% $6.08 Percent of Billed Charges 67.00% $6.26 Percent of Billed Charges 77.50% $7.25 Percent of Billed Charges 79.97% $7.48 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 49.55% $4.63 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 78.94% $7.38 Percent of Billed Charges 74.00% $6.92 Percent of Billed Charges 92.50% $8.65 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 85.00% $7.95 Percent of Billed Charges 63.00% $5.89 Percent of Billed Charges 63.00% $5.89 Percent of Billed Charges 75.00% $7.01 Percent of Billed Charges 66.24% $6.19 Percent of Billed Charges 165.81% $9.35 Fee Schedule 166.07% $9.55 Fee Schedule 176.26% $10.13 Fee Schedule 129.00% $7.42 Fee Schedule 191.24% $11.00 Fee Schedule 159.00% $14.87 Fee Schedule 145.00% $8.34 Fee Schedule 60.00% $5.61 Percent of Billed Charges HC CHOLESTASIS PNL -81223 300 CPT 81223 90 Outpatient $200.00 $99.10 $954.29 $200.00 " $1,996.00 " $200.00 Fee Schedule " $1,996.00 " $200.00 Fee Schedule " $4,351.28 " $200.00 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 165.81% $200.00 Fee Schedule 166.07% $828.69 Fee Schedule 176.26% $879.54 Fee Schedule 129.00% $643.71 Fee Schedule 191.24% $954.29 Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $723.55 Fee Schedule 60.00% $120.00 Percent of Billed Charges HC CHOLESTASIS PNL -81330 300 CPT 81330 90 Outpatient $200.00 $- $318.00 $200.00 $188.00 $188.00 Fee Schedule $188.00 $188.00 Fee Schedule $409.84 $200.00 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 35.00% $70.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $- Fee Schedule 60.00% $120.00 Percent of Billed Charges HC CHOLESTASIS PNL -81332 300 CPT 81332 90 Outpatient $200.00 $- $318.00 $200.00 $237.84 $200.00 Fee Schedule $237.84 $200.00 Fee Schedule $380.63 $200.00 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 35.00% $70.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $- Fee Schedule 60.00% $120.00 Percent of Billed Charges HC CHOLESTASIS PNL -81404 300 CPT 81404 90 Outpatient " $1,000.00 " $- " $1,590.00 " " $1,000.00 " " $1,099.32 " " $1,000.00 " Fee Schedule " $1,099.32 " " $1,000.00 " Fee Schedule " $2,396.52 " " $1,000.00 " Fee Schedule 74.74% $747.40 Percent of Billed Charges 68.24% $682.40 Percent of Billed Charges 65.00% $650.00 Percent of Billed Charges 67.00% $670.00 Percent of Billed Charges 77.50% $775.00 Percent of Billed Charges 79.97% $799.70 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 49.55% $495.50 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 78.94% $789.40 Percent of Billed Charges 74.00% $740.00 Percent of Billed Charges 92.50% $925.00 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 85.00% $850.00 Percent of Billed Charges 63.00% $630.00 Percent of Billed Charges 63.00% $630.00 Percent of Billed Charges 75.00% $750.00 Percent of Billed Charges 66.24% $662.40 Percent of Billed Charges 35.00% $350.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,590.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $600.00 Percent of Billed Charges HC CHOLESTASIS PNL -81405 300 CPT 81405 90 Outpatient " $1,000.00 " $- " $1,590.00 " " $1,000.00 " " $1,205.40 " " $1,000.00 " Fee Schedule " $1,205.40 " " $1,000.00 " Fee Schedule " $2,627.77 " " $1,000.00 " Fee Schedule 74.74% $747.40 Percent of Billed Charges 68.24% $682.40 Percent of Billed Charges 65.00% $650.00 Percent of Billed Charges 67.00% $670.00 Percent of Billed Charges 77.50% $775.00 Percent of Billed Charges 79.97% $799.70 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 49.55% $495.50 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 78.94% $789.40 Percent of Billed Charges 74.00% $740.00 Percent of Billed Charges 92.50% $925.00 Percent of Billed Charges 55.00% $550.00 Percent of Billed Charges 85.00% $850.00 Percent of Billed Charges 63.00% $630.00 Percent of Billed Charges 63.00% $630.00 Percent of Billed Charges 75.00% $750.00 Percent of Billed Charges 66.24% $662.40 Percent of Billed Charges 35.00% $350.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,590.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $600.00 Percent of Billed Charges HC CHOLESTASIS PNL -81406 300 CPT 81406 90 Outpatient $600.00 $- $954.00 $600.00 " $1,131.52 " $600.00 Fee Schedule " $1,131.52 " $600.00 Fee Schedule " $2,466.71 " $600.00 Fee Schedule 74.74% $448.44 Percent of Billed Charges 68.24% $409.44 Percent of Billed Charges 65.00% $390.00 Percent of Billed Charges 67.00% $402.00 Percent of Billed Charges 77.50% $465.00 Percent of Billed Charges 79.97% $479.82 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 49.55% $297.30 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 78.94% $473.64 Percent of Billed Charges 74.00% $444.00 Percent of Billed Charges 92.50% $555.00 Percent of Billed Charges 55.00% $330.00 Percent of Billed Charges 85.00% $510.00 Percent of Billed Charges 63.00% $378.00 Percent of Billed Charges 63.00% $378.00 Percent of Billed Charges 75.00% $450.00 Percent of Billed Charges 66.24% $397.44 Percent of Billed Charges 35.00% $210.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $954.00 Fee Schedule 145.00% $- Fee Schedule 60.00% $360.00 Percent of Billed Charges HC CHOLESTEROL 300 CPT 82465 90 Outpatient $5.00 $2.48 $8.32 $5.00 $23.68 $5.00 Fee Schedule $23.68 $5.00 Fee Schedule $37.93 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $7.22 Fee Schedule 176.26% $7.67 Fee Schedule 129.00% $5.61 Fee Schedule 191.24% $8.32 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $6.31 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC CHOLESTEROL PERITONEAL QU 300 CPT 84311 90 Outpatient $4.48 $2.22 $15.49 $4.48 $38.08 $4.48 Fee Schedule $38.08 $4.48 Fee Schedule $70.63 $4.48 Fee Schedule 74.74% $3.35 Percent of Billed Charges 68.24% $3.06 Percent of Billed Charges 65.00% $2.91 Percent of Billed Charges 67.00% $3.00 Percent of Billed Charges 77.50% $3.47 Percent of Billed Charges 79.97% $3.58 Percent of Billed Charges 55.00% $2.46 Percent of Billed Charges 49.55% $2.22 Percent of Billed Charges 55.00% $2.46 Percent of Billed Charges 55.00% $2.46 Percent of Billed Charges 78.94% $3.54 Percent of Billed Charges 74.00% $3.32 Percent of Billed Charges 92.50% $4.14 Percent of Billed Charges 55.00% $2.46 Percent of Billed Charges 85.00% $3.81 Percent of Billed Charges 63.00% $2.82 Percent of Billed Charges 63.00% $2.82 Percent of Billed Charges 75.00% $3.36 Percent of Billed Charges 66.24% $2.97 Percent of Billed Charges 165.81% $4.48 Fee Schedule 166.07% $13.45 Fee Schedule 176.26% $14.28 Fee Schedule 129.00% $10.45 Fee Schedule 191.24% $15.49 Fee Schedule 159.00% $7.12 Fee Schedule 145.00% $11.75 Fee Schedule 60.00% $2.69 Percent of Billed Charges "HC CHROMATIN ANTIBODY, IGG ARUP" 300 CPT 83516 90 Outpatient $59.40 $14.87 $94.45 $59.40 $62.84 $59.40 Fee Schedule $62.84 $59.40 Fee Schedule $100.54 $59.40 Fee Schedule 74.74% $44.40 Percent of Billed Charges 68.24% $40.53 Percent of Billed Charges 65.00% $38.61 Percent of Billed Charges 67.00% $39.80 Percent of Billed Charges 77.50% $46.04 Percent of Billed Charges 79.97% $47.50 Percent of Billed Charges 55.00% $32.67 Percent of Billed Charges 49.55% $29.43 Percent of Billed Charges 55.00% $32.67 Percent of Billed Charges 55.00% $32.67 Percent of Billed Charges 78.94% $46.89 Percent of Billed Charges 74.00% $43.96 Percent of Billed Charges 92.50% $54.95 Percent of Billed Charges 55.00% $32.67 Percent of Billed Charges 85.00% $50.49 Percent of Billed Charges 63.00% $37.42 Percent of Billed Charges 63.00% $37.42 Percent of Billed Charges 75.00% $44.55 Percent of Billed Charges 66.24% $39.35 Percent of Billed Charges 165.81% $19.12 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $94.45 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $35.64 Percent of Billed Charges HC CHROMATOGRAPHY SINGLE MEDNEURO 300 CPT 82542 90 Outpatient $182.00 $31.08 $289.38 $182.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $182.00 Fee Schedule 74.74% $136.03 Percent of Billed Charges 68.24% $124.20 Percent of Billed Charges 65.00% $118.30 Percent of Billed Charges 67.00% $121.94 Percent of Billed Charges 77.50% $141.05 Percent of Billed Charges 79.97% $145.55 Percent of Billed Charges 55.00% $100.10 Percent of Billed Charges 49.55% $90.18 Percent of Billed Charges 55.00% $100.10 Percent of Billed Charges 55.00% $100.10 Percent of Billed Charges 78.94% $143.67 Percent of Billed Charges 74.00% $134.68 Percent of Billed Charges 92.50% $168.35 Percent of Billed Charges 55.00% $100.10 Percent of Billed Charges 85.00% $154.70 Percent of Billed Charges 63.00% $114.66 Percent of Billed Charges 63.00% $114.66 Percent of Billed Charges 75.00% $136.50 Percent of Billed Charges 66.24% $120.56 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $289.38 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $109.20 Percent of Billed Charges "HC CHROMIUM,BLOOD LABCORP" 300 CPT 82495 90 Outpatient $31.28 $15.50 $49.74 $31.28 $110.52 $31.28 Fee Schedule $110.52 $31.28 Fee Schedule $176.84 $31.28 Fee Schedule 74.74% $23.38 Percent of Billed Charges 68.24% $21.35 Percent of Billed Charges 65.00% $20.33 Percent of Billed Charges 67.00% $20.96 Percent of Billed Charges 77.50% $24.24 Percent of Billed Charges 79.97% $25.01 Percent of Billed Charges 55.00% $17.20 Percent of Billed Charges 49.55% $15.50 Percent of Billed Charges 55.00% $17.20 Percent of Billed Charges 55.00% $17.20 Percent of Billed Charges 78.94% $24.69 Percent of Billed Charges 74.00% $23.15 Percent of Billed Charges 92.50% $28.93 Percent of Billed Charges 55.00% $17.20 Percent of Billed Charges 85.00% $26.59 Percent of Billed Charges 63.00% $19.71 Percent of Billed Charges 63.00% $19.71 Percent of Billed Charges 75.00% $23.46 Percent of Billed Charges 66.24% $20.72 Percent of Billed Charges 165.81% $31.28 Fee Schedule 166.07% $33.68 Fee Schedule 176.26% $35.75 Fee Schedule 129.00% $26.16 Fee Schedule 191.24% $38.78 Fee Schedule 159.00% $49.74 Fee Schedule 145.00% $29.41 Fee Schedule 60.00% $18.77 Percent of Billed Charges HC CHROMOGENIC FACTOR MAYO 300 CPT 85130 90 Outpatient $225.00 $15.34 $357.75 $225.00 $64.80 $64.80 Fee Schedule $64.80 $64.80 Fee Schedule $103.68 $98.33 Fee Schedule 74.74% $168.17 Percent of Billed Charges 68.24% $153.54 Percent of Billed Charges 65.00% $146.25 Percent of Billed Charges 67.00% $150.75 Percent of Billed Charges 77.50% $174.38 Percent of Billed Charges 79.97% $179.93 Percent of Billed Charges 55.00% $123.75 Percent of Billed Charges 49.55% $111.49 Percent of Billed Charges 55.00% $123.75 Percent of Billed Charges 55.00% $123.75 Percent of Billed Charges 78.94% $177.62 Percent of Billed Charges 74.00% $166.50 Percent of Billed Charges 92.50% $208.13 Percent of Billed Charges 55.00% $123.75 Percent of Billed Charges 85.00% $191.25 Percent of Billed Charges 63.00% $141.75 Percent of Billed Charges 63.00% $141.75 Percent of Billed Charges 75.00% $168.75 Percent of Billed Charges 66.24% $149.04 Percent of Billed Charges 165.81% $19.71 Fee Schedule 166.07% $19.75 Fee Schedule 176.26% $20.96 Fee Schedule 129.00% $15.34 Fee Schedule 191.24% $22.74 Fee Schedule 159.00% $357.75 Fee Schedule 145.00% $17.24 Fee Schedule 60.00% $135.00 Percent of Billed Charges HC CHROMOGRANIN A ARUP 300 CPT 86316 90 Outpatient $38.00 $18.83 $60.42 $38.00 $113.40 $38.00 Fee Schedule $113.40 $38.00 Fee Schedule $181.46 $38.00 Fee Schedule 74.74% $28.40 Percent of Billed Charges 68.24% $25.93 Percent of Billed Charges 65.00% $24.70 Percent of Billed Charges 67.00% $25.46 Percent of Billed Charges 77.50% $29.45 Percent of Billed Charges 79.97% $30.39 Percent of Billed Charges 55.00% $20.90 Percent of Billed Charges 49.55% $18.83 Percent of Billed Charges 55.00% $20.90 Percent of Billed Charges 55.00% $20.90 Percent of Billed Charges 78.94% $30.00 Percent of Billed Charges 74.00% $28.12 Percent of Billed Charges 92.50% $35.15 Percent of Billed Charges 55.00% $20.90 Percent of Billed Charges 85.00% $32.30 Percent of Billed Charges 63.00% $23.94 Percent of Billed Charges 63.00% $23.94 Percent of Billed Charges 75.00% $28.50 Percent of Billed Charges 66.24% $25.17 Percent of Billed Charges 165.81% $34.51 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $60.42 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $22.80 Percent of Billed Charges HC CHROMOSOME AMNIOTIC INTEGRATED 300 CPT 88235 90 Outpatient $165.00 $81.76 $287.43 $165.00 $802.40 $165.00 Fee Schedule $802.40 $165.00 Fee Schedule " $1,310.62 " $165.00 Fee Schedule 74.74% $123.32 Percent of Billed Charges 68.24% $112.60 Percent of Billed Charges 65.00% $107.25 Percent of Billed Charges 67.00% $110.55 Percent of Billed Charges 77.50% $127.88 Percent of Billed Charges 79.97% $131.95 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 49.55% $81.76 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 78.94% $130.25 Percent of Billed Charges 74.00% $122.10 Percent of Billed Charges 92.50% $152.63 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 85.00% $140.25 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 75.00% $123.75 Percent of Billed Charges 66.24% $109.30 Percent of Billed Charges 165.81% $165.00 Fee Schedule 166.07% $249.60 Fee Schedule 176.26% $264.92 Fee Schedule 129.00% $193.89 Fee Schedule 191.24% $287.43 Fee Schedule 159.00% $262.35 Fee Schedule 145.00% $217.94 Fee Schedule 60.00% $99.00 Percent of Billed Charges HC CHROMOSOME AMNIOTIC INTEGRATED 300 CPT 88267 90 Outpatient $165.00 $81.76 $360.62 $165.00 $979.56 $165.00 Fee Schedule $979.56 $165.00 Fee Schedule " $1,644.33 " $165.00 Fee Schedule 74.74% $123.32 Percent of Billed Charges 68.24% $112.60 Percent of Billed Charges 65.00% $107.25 Percent of Billed Charges 67.00% $110.55 Percent of Billed Charges 77.50% $127.88 Percent of Billed Charges 79.97% $131.95 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 49.55% $81.76 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 78.94% $130.25 Percent of Billed Charges 74.00% $122.10 Percent of Billed Charges 92.50% $152.63 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 85.00% $140.25 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 75.00% $123.75 Percent of Billed Charges 66.24% $109.30 Percent of Billed Charges 165.81% $165.00 Fee Schedule 166.07% $313.16 Fee Schedule 176.26% $332.37 Fee Schedule 129.00% $243.26 Fee Schedule 191.24% $360.62 Fee Schedule 159.00% $262.35 Fee Schedule 145.00% $273.43 Fee Schedule 60.00% $99.00 Percent of Billed Charges HC CHROMOSOME AMNIOTIC INTEGRATED 300 CPT 88280 90 Outpatient $165.00 $43.18 $262.35 $165.00 $136.76 $136.76 Fee Schedule $136.76 $136.76 Fee Schedule $291.86 $165.00 Fee Schedule 74.74% $123.32 Percent of Billed Charges 68.24% $112.60 Percent of Billed Charges 65.00% $107.25 Percent of Billed Charges 67.00% $110.55 Percent of Billed Charges 77.50% $127.88 Percent of Billed Charges 79.97% $131.95 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 49.55% $81.76 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 78.94% $130.25 Percent of Billed Charges 74.00% $122.10 Percent of Billed Charges 92.50% $152.63 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 85.00% $140.25 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 75.00% $123.75 Percent of Billed Charges 66.24% $109.30 Percent of Billed Charges 165.81% $55.50 Fee Schedule 166.07% $55.58 Fee Schedule 176.26% $58.99 Fee Schedule 129.00% $43.18 Fee Schedule 191.24% $64.01 Fee Schedule 159.00% $262.35 Fee Schedule 145.00% $48.53 Fee Schedule 60.00% $99.00 Percent of Billed Charges HC CHROMOSOME AMNIOTIC INTEGRATED 300 CPT 88285 90 Outpatient $165.00 $19.65 $262.35 $165.00 $103.52 $103.52 Fee Schedule $103.52 $103.52 Fee Schedule $234.66 $165.00 Fee Schedule 74.74% $123.32 Percent of Billed Charges 68.24% $112.60 Percent of Billed Charges 65.00% $107.25 Percent of Billed Charges 67.00% $110.55 Percent of Billed Charges 77.50% $127.88 Percent of Billed Charges 79.97% $131.95 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 49.55% $81.76 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 78.94% $130.25 Percent of Billed Charges 74.00% $122.10 Percent of Billed Charges 92.50% $152.63 Percent of Billed Charges 55.00% $90.75 Percent of Billed Charges 85.00% $140.25 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 63.00% $103.95 Percent of Billed Charges 75.00% $123.75 Percent of Billed Charges 66.24% $109.30 Percent of Billed Charges 165.81% $25.25 Fee Schedule 166.07% $25.29 Fee Schedule 176.26% $26.84 Fee Schedule 129.00% $19.65 Fee Schedule 191.24% $29.13 Fee Schedule 159.00% $262.35 Fee Schedule 145.00% $22.08 Fee Schedule 60.00% $99.00 Percent of Billed Charges "HC CHROMOSOME ANAL, BONE MAR ARUP" 300 CPT 88237 90 Outpatient $124.58 $61.73 $274.91 $124.58 $688.24 $124.58 Fee Schedule $688.24 $124.58 Fee Schedule " $1,253.50 " $124.58 Fee Schedule 74.74% $93.11 Percent of Billed Charges 68.24% $85.01 Percent of Billed Charges 65.00% $80.98 Percent of Billed Charges 67.00% $83.47 Percent of Billed Charges 77.50% $96.55 Percent of Billed Charges 79.97% $99.63 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 49.55% $61.73 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 78.94% $98.34 Percent of Billed Charges 74.00% $92.19 Percent of Billed Charges 92.50% $115.24 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 85.00% $105.89 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 75.00% $93.44 Percent of Billed Charges 66.24% $82.52 Percent of Billed Charges 165.81% $124.58 Fee Schedule 166.07% $238.73 Fee Schedule 176.26% $253.37 Fee Schedule 129.00% $185.44 Fee Schedule 191.24% $274.91 Fee Schedule 159.00% $198.08 Fee Schedule 145.00% $208.44 Fee Schedule 60.00% $74.75 Percent of Billed Charges "HC CHROMOSOME ANAL, BONE MAR ARUP" 300 CPT 88264 90 Outpatient $124.58 $61.73 $276.55 $124.58 $679.16 $124.58 Fee Schedule $679.16 $124.58 Fee Schedule " $1,261.00 " $124.58 Fee Schedule 74.74% $93.11 Percent of Billed Charges 68.24% $85.01 Percent of Billed Charges 65.00% $80.98 Percent of Billed Charges 67.00% $83.47 Percent of Billed Charges 77.50% $96.55 Percent of Billed Charges 79.97% $99.63 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 49.55% $61.73 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 78.94% $98.34 Percent of Billed Charges 74.00% $92.19 Percent of Billed Charges 92.50% $115.24 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 85.00% $105.89 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 75.00% $93.44 Percent of Billed Charges 66.24% $82.52 Percent of Billed Charges 165.81% $124.58 Fee Schedule 166.07% $240.15 Fee Schedule 176.26% $254.89 Fee Schedule 129.00% $186.55 Fee Schedule 191.24% $276.55 Fee Schedule 159.00% $198.08 Fee Schedule 145.00% $209.68 Fee Schedule 60.00% $74.75 Percent of Billed Charges "HC CHROMOSOME ANAL, BONE MAR ARUP" 300 CPT 88291 90 Outpatient $124.58 $61.06 $198.08 $124.58 $128.88 $124.58 Fee Schedule $128.88 $124.58 Fee Schedule 56.78% $70.74 Percent of Billed Charges 74.74% $93.11 Percent of Billed Charges 68.24% $85.01 Percent of Billed Charges 65.00% $80.98 Percent of Billed Charges 67.00% $83.47 Percent of Billed Charges 77.50% $96.55 Percent of Billed Charges 79.97% $99.63 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 49.55% $61.73 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 78.94% $98.34 Percent of Billed Charges 74.00% $92.19 Percent of Billed Charges 92.50% $115.24 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 85.00% $105.89 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 75.00% $93.44 Percent of Billed Charges 66.24% $82.52 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $198.08 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $74.75 Percent of Billed Charges "HC CHROMOSOME ANAL, LEUK BLD ARUP" 300 CPT 88237 90 Outpatient $124.58 $61.73 $274.91 $124.58 $688.24 $124.58 Fee Schedule $688.24 $124.58 Fee Schedule " $1,253.50 " $124.58 Fee Schedule 74.74% $93.11 Percent of Billed Charges 68.24% $85.01 Percent of Billed Charges 65.00% $80.98 Percent of Billed Charges 67.00% $83.47 Percent of Billed Charges 77.50% $96.55 Percent of Billed Charges 79.97% $99.63 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 49.55% $61.73 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 78.94% $98.34 Percent of Billed Charges 74.00% $92.19 Percent of Billed Charges 92.50% $115.24 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 85.00% $105.89 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 75.00% $93.44 Percent of Billed Charges 66.24% $82.52 Percent of Billed Charges 165.81% $124.58 Fee Schedule 166.07% $238.73 Fee Schedule 176.26% $253.37 Fee Schedule 129.00% $185.44 Fee Schedule 191.24% $274.91 Fee Schedule 159.00% $198.08 Fee Schedule 145.00% $208.44 Fee Schedule 60.00% $74.75 Percent of Billed Charges "HC CHROMOSOME ANAL, LEUK BLD ARUP" 300 CPT 88264 90 Outpatient $124.58 $61.73 $276.55 $124.58 $679.16 $124.58 Fee Schedule $679.16 $124.58 Fee Schedule " $1,261.00 " $124.58 Fee Schedule 74.74% $93.11 Percent of Billed Charges 68.24% $85.01 Percent of Billed Charges 65.00% $80.98 Percent of Billed Charges 67.00% $83.47 Percent of Billed Charges 77.50% $96.55 Percent of Billed Charges 79.97% $99.63 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 49.55% $61.73 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 78.94% $98.34 Percent of Billed Charges 74.00% $92.19 Percent of Billed Charges 92.50% $115.24 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 85.00% $105.89 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 75.00% $93.44 Percent of Billed Charges 66.24% $82.52 Percent of Billed Charges 165.81% $124.58 Fee Schedule 166.07% $240.15 Fee Schedule 176.26% $254.89 Fee Schedule 129.00% $186.55 Fee Schedule 191.24% $276.55 Fee Schedule 159.00% $198.08 Fee Schedule 145.00% $209.68 Fee Schedule 60.00% $74.75 Percent of Billed Charges "HC CHROMOSOME ANAL, LEUK BLD ARUP" 300 CPT 88291 90 Outpatient $124.58 $61.06 $198.08 $124.58 $128.88 $124.58 Fee Schedule $128.88 $124.58 Fee Schedule 56.78% $70.74 Percent of Billed Charges 74.74% $93.11 Percent of Billed Charges 68.24% $85.01 Percent of Billed Charges 65.00% $80.98 Percent of Billed Charges 67.00% $83.47 Percent of Billed Charges 77.50% $96.55 Percent of Billed Charges 79.97% $99.63 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 49.55% $61.73 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 78.94% $98.34 Percent of Billed Charges 74.00% $92.19 Percent of Billed Charges 92.50% $115.24 Percent of Billed Charges 55.00% $68.52 Percent of Billed Charges 85.00% $105.89 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 63.00% $78.49 Percent of Billed Charges 75.00% $93.44 Percent of Billed Charges 66.24% $82.52 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $198.08 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $74.75 Percent of Billed Charges HC CHROMOSOME ANALYSIS LABCORP 300 CPT 88262 90 Outpatient $28.65 $14.20 $239.99 $28.65 $679.16 $28.65 Fee Schedule $679.16 $28.65 Fee Schedule " $1,094.27 " $28.65 Fee Schedule 74.74% $21.41 Percent of Billed Charges 68.24% $19.55 Percent of Billed Charges 65.00% $18.62 Percent of Billed Charges 67.00% $19.20 Percent of Billed Charges 77.50% $22.20 Percent of Billed Charges 79.97% $22.91 Percent of Billed Charges 55.00% $15.76 Percent of Billed Charges 49.55% $14.20 Percent of Billed Charges 55.00% $15.76 Percent of Billed Charges 55.00% $15.76 Percent of Billed Charges 78.94% $22.62 Percent of Billed Charges 74.00% $21.20 Percent of Billed Charges 92.50% $26.50 Percent of Billed Charges 55.00% $15.76 Percent of Billed Charges 85.00% $24.35 Percent of Billed Charges 63.00% $18.05 Percent of Billed Charges 63.00% $18.05 Percent of Billed Charges 75.00% $21.49 Percent of Billed Charges 66.24% $18.98 Percent of Billed Charges 165.81% $28.65 Fee Schedule 166.07% $208.40 Fee Schedule 176.26% $221.19 Fee Schedule 129.00% $161.88 Fee Schedule 191.24% $239.99 Fee Schedule 159.00% $45.55 Fee Schedule 145.00% $181.96 Fee Schedule 60.00% $17.19 Percent of Billed Charges HC CHROMOSOME ANALYSIS LABCORP 300 CPT 88230 90 Outpatient $117.86 $58.40 $222.78 $117.86 $634.76 $117.86 Fee Schedule $634.76 $117.86 Fee Schedule " $1,015.79 " $117.86 Fee Schedule 74.74% $88.09 Percent of Billed Charges 68.24% $80.43 Percent of Billed Charges 65.00% $76.61 Percent of Billed Charges 67.00% $78.97 Percent of Billed Charges 77.50% $91.34 Percent of Billed Charges 79.97% $94.25 Percent of Billed Charges 55.00% $64.82 Percent of Billed Charges 49.55% $58.40 Percent of Billed Charges 55.00% $64.82 Percent of Billed Charges 55.00% $64.82 Percent of Billed Charges 78.94% $93.04 Percent of Billed Charges 74.00% $87.22 Percent of Billed Charges 92.50% $109.02 Percent of Billed Charges 55.00% $64.82 Percent of Billed Charges 85.00% $100.18 Percent of Billed Charges 63.00% $74.25 Percent of Billed Charges 63.00% $74.25 Percent of Billed Charges 75.00% $88.40 Percent of Billed Charges 66.24% $78.07 Percent of Billed Charges 165.81% $117.86 Fee Schedule 166.07% $193.45 Fee Schedule 176.26% $205.33 Fee Schedule 129.00% $150.27 Fee Schedule 191.24% $222.78 Fee Schedule 159.00% $187.40 Fee Schedule 145.00% $168.91 Fee Schedule 60.00% $70.72 Percent of Billed Charges HC CHROMOSOME FISH ARUP 300 CPT 88271 90 Outpatient $88.96 $27.63 $141.45 $88.96 $116.68 $88.96 Fee Schedule $116.68 $88.96 Fee Schedule $186.78 $88.96 Fee Schedule 74.74% $66.49 Percent of Billed Charges 68.24% $60.71 Percent of Billed Charges 65.00% $57.82 Percent of Billed Charges 67.00% $59.60 Percent of Billed Charges 77.50% $68.94 Percent of Billed Charges 79.97% $71.14 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 49.55% $44.08 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 78.94% $70.23 Percent of Billed Charges 74.00% $65.83 Percent of Billed Charges 92.50% $82.29 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 85.00% $75.62 Percent of Billed Charges 63.00% $56.04 Percent of Billed Charges 63.00% $56.04 Percent of Billed Charges 75.00% $66.72 Percent of Billed Charges 66.24% $58.93 Percent of Billed Charges 165.81% $35.52 Fee Schedule 166.07% $35.57 Fee Schedule 176.26% $37.75 Fee Schedule 129.00% $27.63 Fee Schedule 191.24% $40.96 Fee Schedule 159.00% $141.45 Fee Schedule 145.00% $31.06 Fee Schedule 60.00% $53.38 Percent of Billed Charges HC CHROMOSOME FISH ARUP 300 CPT 88275 90 Outpatient $88.96 $44.08 $141.45 $88.96 $218.80 $88.96 Fee Schedule $218.80 $88.96 Fee Schedule $446.38 $88.96 Fee Schedule 74.74% $66.49 Percent of Billed Charges 68.24% $60.71 Percent of Billed Charges 65.00% $57.82 Percent of Billed Charges 67.00% $59.60 Percent of Billed Charges 77.50% $68.94 Percent of Billed Charges 79.97% $71.14 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 49.55% $44.08 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 78.94% $70.23 Percent of Billed Charges 74.00% $65.83 Percent of Billed Charges 92.50% $82.29 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 85.00% $75.62 Percent of Billed Charges 63.00% $56.04 Percent of Billed Charges 63.00% $56.04 Percent of Billed Charges 75.00% $66.72 Percent of Billed Charges 66.24% $58.93 Percent of Billed Charges 165.81% $84.88 Fee Schedule 166.07% $85.01 Fee Schedule 176.26% $90.23 Fee Schedule 129.00% $66.04 Fee Schedule 191.24% $97.90 Fee Schedule 159.00% $141.45 Fee Schedule 145.00% $74.23 Fee Schedule 60.00% $53.38 Percent of Billed Charges HC CHROMOSOME FISH ARUP 300 CPT 88291 90 Outpatient $88.96 $44.08 $141.45 $88.96 $128.88 $88.96 Fee Schedule $128.88 $88.96 Fee Schedule 56.78% $50.51 Percent of Billed Charges 74.74% $66.49 Percent of Billed Charges 68.24% $60.71 Percent of Billed Charges 65.00% $57.82 Percent of Billed Charges 67.00% $59.60 Percent of Billed Charges 77.50% $68.94 Percent of Billed Charges 79.97% $71.14 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 49.55% $44.08 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 78.94% $70.23 Percent of Billed Charges 74.00% $65.83 Percent of Billed Charges 92.50% $82.29 Percent of Billed Charges 55.00% $48.93 Percent of Billed Charges 85.00% $75.62 Percent of Billed Charges 63.00% $56.04 Percent of Billed Charges 63.00% $56.04 Percent of Billed Charges 75.00% $66.72 Percent of Billed Charges 66.24% $58.93 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $141.45 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $53.38 Percent of Billed Charges HC CHROMOSOME LYMPH NODE ARUP 300 CPT 88237 90 Outpatient $122.50 $60.70 $274.91 $122.50 $688.24 $122.50 Fee Schedule $688.24 $122.50 Fee Schedule " $1,253.50 " $122.50 Fee Schedule 74.74% $91.56 Percent of Billed Charges 68.24% $83.59 Percent of Billed Charges 65.00% $79.63 Percent of Billed Charges 67.00% $82.08 Percent of Billed Charges 77.50% $94.94 Percent of Billed Charges 79.97% $97.96 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 49.55% $60.70 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 78.94% $96.70 Percent of Billed Charges 74.00% $90.65 Percent of Billed Charges 92.50% $113.31 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 85.00% $104.13 Percent of Billed Charges 63.00% $77.18 Percent of Billed Charges 63.00% $77.18 Percent of Billed Charges 75.00% $91.88 Percent of Billed Charges 66.24% $81.14 Percent of Billed Charges 165.81% $122.50 Fee Schedule 166.07% $238.73 Fee Schedule 176.26% $253.37 Fee Schedule 129.00% $185.44 Fee Schedule 191.24% $274.91 Fee Schedule 159.00% $194.78 Fee Schedule 145.00% $208.44 Fee Schedule 60.00% $73.50 Percent of Billed Charges HC CHROMOSOME LYMPH NODE ARUP 300 CPT 88264 90 Outpatient $122.50 $60.70 $276.55 $122.50 $679.16 $122.50 Fee Schedule $679.16 $122.50 Fee Schedule " $1,261.00 " $122.50 Fee Schedule 74.74% $91.56 Percent of Billed Charges 68.24% $83.59 Percent of Billed Charges 65.00% $79.63 Percent of Billed Charges 67.00% $82.08 Percent of Billed Charges 77.50% $94.94 Percent of Billed Charges 79.97% $97.96 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 49.55% $60.70 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 78.94% $96.70 Percent of Billed Charges 74.00% $90.65 Percent of Billed Charges 92.50% $113.31 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 85.00% $104.13 Percent of Billed Charges 63.00% $77.18 Percent of Billed Charges 63.00% $77.18 Percent of Billed Charges 75.00% $91.88 Percent of Billed Charges 66.24% $81.14 Percent of Billed Charges 165.81% $122.50 Fee Schedule 166.07% $240.15 Fee Schedule 176.26% $254.89 Fee Schedule 129.00% $186.55 Fee Schedule 191.24% $276.55 Fee Schedule 159.00% $194.78 Fee Schedule 145.00% $209.68 Fee Schedule 60.00% $73.50 Percent of Billed Charges HC CHROMOSOME LYMPH NODE ARUP 300 CPT 88291 90 Outpatient $122.50 $60.70 $194.78 $122.50 $128.88 $122.50 Fee Schedule $128.88 $122.50 Fee Schedule 56.78% $69.56 Percent of Billed Charges 74.74% $91.56 Percent of Billed Charges 68.24% $83.59 Percent of Billed Charges 65.00% $79.63 Percent of Billed Charges 67.00% $82.08 Percent of Billed Charges 77.50% $94.94 Percent of Billed Charges 79.97% $97.96 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 49.55% $60.70 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 78.94% $96.70 Percent of Billed Charges 74.00% $90.65 Percent of Billed Charges 92.50% $113.31 Percent of Billed Charges 55.00% $67.38 Percent of Billed Charges 85.00% $104.13 Percent of Billed Charges 63.00% $77.18 Percent of Billed Charges 63.00% $77.18 Percent of Billed Charges 75.00% $91.88 Percent of Billed Charges 66.24% $81.14 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $194.78 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $73.50 Percent of Billed Charges HC CHROMOSOME SOLID TUMOR ARUP 300 CPT 88239 90 Outpatient $171.66 $85.06 $282.12 $171.66 $803.80 $171.66 Fee Schedule $803.80 $171.66 Fee Schedule " $1,286.37 " $171.66 Fee Schedule 74.74% $128.30 Percent of Billed Charges 68.24% $117.14 Percent of Billed Charges 65.00% $111.58 Percent of Billed Charges 67.00% $115.01 Percent of Billed Charges 77.50% $133.04 Percent of Billed Charges 79.97% $137.28 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 49.55% $85.06 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 78.94% $135.51 Percent of Billed Charges 74.00% $127.03 Percent of Billed Charges 92.50% $158.79 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 85.00% $145.91 Percent of Billed Charges 63.00% $108.15 Percent of Billed Charges 63.00% $108.15 Percent of Billed Charges 75.00% $128.75 Percent of Billed Charges 66.24% $113.71 Percent of Billed Charges 165.81% $171.66 Fee Schedule 166.07% $244.99 Fee Schedule 176.26% $260.02 Fee Schedule 129.00% $190.30 Fee Schedule 191.24% $282.12 Fee Schedule 159.00% $272.94 Fee Schedule 145.00% $213.90 Fee Schedule 60.00% $103.00 Percent of Billed Charges HC CHROMOSOME SOLID TUMOR ARUP 300 CPT 88264 90 Outpatient $171.66 $85.06 $276.55 $171.66 $679.16 $171.66 Fee Schedule $679.16 $171.66 Fee Schedule " $1,261.00 " $171.66 Fee Schedule 74.74% $128.30 Percent of Billed Charges 68.24% $117.14 Percent of Billed Charges 65.00% $111.58 Percent of Billed Charges 67.00% $115.01 Percent of Billed Charges 77.50% $133.04 Percent of Billed Charges 79.97% $137.28 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 49.55% $85.06 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 78.94% $135.51 Percent of Billed Charges 74.00% $127.03 Percent of Billed Charges 92.50% $158.79 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 85.00% $145.91 Percent of Billed Charges 63.00% $108.15 Percent of Billed Charges 63.00% $108.15 Percent of Billed Charges 75.00% $128.75 Percent of Billed Charges 66.24% $113.71 Percent of Billed Charges 165.81% $171.66 Fee Schedule 166.07% $240.15 Fee Schedule 176.26% $254.89 Fee Schedule 129.00% $186.55 Fee Schedule 191.24% $276.55 Fee Schedule 159.00% $272.94 Fee Schedule 145.00% $209.68 Fee Schedule 60.00% $103.00 Percent of Billed Charges HC CHROMOSOME SOLID TUMOR ARUP 300 CPT 88291 90 Outpatient $171.66 $61.06 $272.94 $171.66 $128.88 $128.88 Fee Schedule $128.88 $128.88 Fee Schedule 56.78% $97.47 Percent of Billed Charges 74.74% $128.30 Percent of Billed Charges 68.24% $117.14 Percent of Billed Charges 65.00% $111.58 Percent of Billed Charges 67.00% $115.01 Percent of Billed Charges 77.50% $133.04 Percent of Billed Charges 79.97% $137.28 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 49.55% $85.06 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 78.94% $135.51 Percent of Billed Charges 74.00% $127.03 Percent of Billed Charges 92.50% $158.79 Percent of Billed Charges 55.00% $94.41 Percent of Billed Charges 85.00% $145.91 Percent of Billed Charges 63.00% $108.15 Percent of Billed Charges 63.00% $108.15 Percent of Billed Charges 75.00% $128.75 Percent of Billed Charges 66.24% $113.71 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $272.94 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $103.00 Percent of Billed Charges "HC CHROMOSOME,MOSAICISM QUEST 88230" 300 CPT 88230 90 Outpatient $124.31 $61.60 $222.78 $124.31 $634.76 $124.31 Fee Schedule $634.76 $124.31 Fee Schedule " $1,015.79 " $124.31 Fee Schedule 74.74% $92.91 Percent of Billed Charges 68.24% $84.83 Percent of Billed Charges 65.00% $80.80 Percent of Billed Charges 67.00% $83.29 Percent of Billed Charges 77.50% $96.34 Percent of Billed Charges 79.97% $99.41 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 49.55% $61.60 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 78.94% $98.13 Percent of Billed Charges 74.00% $91.99 Percent of Billed Charges 92.50% $114.99 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 85.00% $105.66 Percent of Billed Charges 63.00% $78.32 Percent of Billed Charges 63.00% $78.32 Percent of Billed Charges 75.00% $93.23 Percent of Billed Charges 66.24% $82.34 Percent of Billed Charges 165.81% $124.31 Fee Schedule 166.07% $193.45 Fee Schedule 176.26% $205.33 Fee Schedule 129.00% $150.27 Fee Schedule 191.24% $222.78 Fee Schedule 159.00% $197.65 Fee Schedule 145.00% $168.91 Fee Schedule 60.00% $74.59 Percent of Billed Charges "HC CHROMOSOME,MOSAICISM QUEST 88263" 300 CPT 88263 90 Outpatient $124.31 $61.60 $287.41 $124.31 $818.92 $124.31 Fee Schedule $818.92 $124.31 Fee Schedule " $1,310.53 " $124.31 Fee Schedule 74.74% $92.91 Percent of Billed Charges 68.24% $84.83 Percent of Billed Charges 65.00% $80.80 Percent of Billed Charges 67.00% $83.29 Percent of Billed Charges 77.50% $96.34 Percent of Billed Charges 79.97% $99.41 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 49.55% $61.60 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 78.94% $98.13 Percent of Billed Charges 74.00% $91.99 Percent of Billed Charges 92.50% $114.99 Percent of Billed Charges 55.00% $68.37 Percent of Billed Charges 85.00% $105.66 Percent of Billed Charges 63.00% $78.32 Percent of Billed Charges 63.00% $78.32 Percent of Billed Charges 75.00% $93.23 Percent of Billed Charges 66.24% $82.34 Percent of Billed Charges 165.81% $124.31 Fee Schedule 166.07% $249.59 Fee Schedule 176.26% $264.90 Fee Schedule 129.00% $193.87 Fee Schedule 191.24% $287.41 Fee Schedule 159.00% $197.65 Fee Schedule 145.00% $217.92 Fee Schedule 60.00% $74.59 Percent of Billed Charges "HC CHROMOSOME,MOSAICISM QUEST 88291" 300 CPT 88291 90 Outpatient $124.32 $61.06 $197.67 $124.32 $128.88 $124.32 Fee Schedule $128.88 $124.32 Fee Schedule 56.78% $70.59 Percent of Billed Charges 74.74% $92.92 Percent of Billed Charges 68.24% $84.84 Percent of Billed Charges 65.00% $80.81 Percent of Billed Charges 67.00% $83.29 Percent of Billed Charges 77.50% $96.35 Percent of Billed Charges 79.97% $99.42 Percent of Billed Charges 55.00% $68.38 Percent of Billed Charges 49.55% $61.60 Percent of Billed Charges 55.00% $68.38 Percent of Billed Charges 55.00% $68.38 Percent of Billed Charges 78.94% $98.14 Percent of Billed Charges 74.00% $92.00 Percent of Billed Charges 92.50% $115.00 Percent of Billed Charges 55.00% $68.38 Percent of Billed Charges 85.00% $105.67 Percent of Billed Charges 63.00% $78.32 Percent of Billed Charges 63.00% $78.32 Percent of Billed Charges 75.00% $93.24 Percent of Billed Charges 66.24% $82.35 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $197.67 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $74.59 Percent of Billed Charges HC CITRIC ACID QUEST 300 CPT 82507 90 Outpatient $122.87 $35.86 $195.36 $122.87 $151.48 $122.87 Fee Schedule $151.48 $122.87 Fee Schedule $242.42 $122.87 Fee Schedule 74.74% $91.83 Percent of Billed Charges 68.24% $83.85 Percent of Billed Charges 65.00% $79.87 Percent of Billed Charges 67.00% $82.32 Percent of Billed Charges 77.50% $95.22 Percent of Billed Charges 79.97% $98.26 Percent of Billed Charges 55.00% $67.58 Percent of Billed Charges 49.55% $60.88 Percent of Billed Charges 55.00% $67.58 Percent of Billed Charges 55.00% $67.58 Percent of Billed Charges 78.94% $96.99 Percent of Billed Charges 74.00% $90.92 Percent of Billed Charges 92.50% $113.65 Percent of Billed Charges 55.00% $67.58 Percent of Billed Charges 85.00% $104.44 Percent of Billed Charges 63.00% $77.41 Percent of Billed Charges 63.00% $77.41 Percent of Billed Charges 75.00% $92.15 Percent of Billed Charges 66.24% $81.39 Percent of Billed Charges 165.81% $46.10 Fee Schedule 166.07% $46.17 Fee Schedule 176.26% $49.00 Fee Schedule 129.00% $35.86 Fee Schedule 191.24% $53.16 Fee Schedule 159.00% $195.36 Fee Schedule 145.00% $40.31 Fee Schedule 60.00% $73.72 Percent of Billed Charges HC CITRIC ACID URINE ARUP 300 CPT 82507 90 Outpatient $13.03 $6.46 $53.16 $13.03 $151.48 $13.03 Fee Schedule $151.48 $13.03 Fee Schedule $242.42 $13.03 Fee Schedule 74.74% $9.74 Percent of Billed Charges 68.24% $8.89 Percent of Billed Charges 65.00% $8.47 Percent of Billed Charges 67.00% $8.73 Percent of Billed Charges 77.50% $10.10 Percent of Billed Charges 79.97% $10.42 Percent of Billed Charges 55.00% $7.17 Percent of Billed Charges 49.55% $6.46 Percent of Billed Charges 55.00% $7.17 Percent of Billed Charges 55.00% $7.17 Percent of Billed Charges 78.94% $10.29 Percent of Billed Charges 74.00% $9.64 Percent of Billed Charges 92.50% $12.05 Percent of Billed Charges 55.00% $7.17 Percent of Billed Charges 85.00% $11.08 Percent of Billed Charges 63.00% $8.21 Percent of Billed Charges 63.00% $8.21 Percent of Billed Charges 75.00% $9.77 Percent of Billed Charges 66.24% $8.63 Percent of Billed Charges 165.81% $13.03 Fee Schedule 166.07% $46.17 Fee Schedule 176.26% $49.00 Fee Schedule 129.00% $35.86 Fee Schedule 191.24% $53.16 Fee Schedule 159.00% $20.72 Fee Schedule 145.00% $40.31 Fee Schedule 60.00% $7.82 Percent of Billed Charges HC CK ISOENZYMES LABCORP 300 CPT 82552 90 Outpatient $12.00 $5.95 $25.61 $12.00 $73.00 $12.00 Fee Schedule $73.00 $12.00 Fee Schedule $116.76 $12.00 Fee Schedule 74.74% $8.97 Percent of Billed Charges 68.24% $8.19 Percent of Billed Charges 65.00% $7.80 Percent of Billed Charges 67.00% $8.04 Percent of Billed Charges 77.50% $9.30 Percent of Billed Charges 79.97% $9.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 49.55% $5.95 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 78.94% $9.47 Percent of Billed Charges 74.00% $8.88 Percent of Billed Charges 92.50% $11.10 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 85.00% $10.20 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 75.00% $9.00 Percent of Billed Charges 66.24% $7.95 Percent of Billed Charges 165.81% $12.00 Fee Schedule 166.07% $22.24 Fee Schedule 176.26% $23.60 Fee Schedule 129.00% $17.27 Fee Schedule 191.24% $25.61 Fee Schedule 159.00% $19.08 Fee Schedule 145.00% $19.42 Fee Schedule 60.00% $7.20 Percent of Billed Charges HC CK MB LABCORP 300 CPT 82553 90 Outpatient $30.00 $14.87 $47.70 $30.00 $62.92 $30.00 Fee Schedule $62.92 $30.00 Fee Schedule $100.72 $30.00 Fee Schedule 74.74% $22.42 Percent of Billed Charges 68.24% $20.47 Percent of Billed Charges 65.00% $19.50 Percent of Billed Charges 67.00% $20.10 Percent of Billed Charges 77.50% $23.25 Percent of Billed Charges 79.97% $23.99 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 49.55% $14.87 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 78.94% $23.68 Percent of Billed Charges 74.00% $22.20 Percent of Billed Charges 92.50% $27.75 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 85.00% $25.50 Percent of Billed Charges 63.00% $18.90 Percent of Billed Charges 63.00% $18.90 Percent of Billed Charges 75.00% $22.50 Percent of Billed Charges 66.24% $19.87 Percent of Billed Charges 165.81% $19.15 Fee Schedule 166.07% $19.18 Fee Schedule 176.26% $20.36 Fee Schedule 129.00% $14.90 Fee Schedule 191.24% $22.09 Fee Schedule 159.00% $47.70 Fee Schedule 145.00% $16.75 Fee Schedule 60.00% $18.00 Percent of Billed Charges HC CLOBAZAM LABCORP 300 CPT G0480 90 Outpatient $65.25 $32.33 $170.85 $65.25 $319.76 $65.25 Fee Schedule $319.76 $65.25 Fee Schedule $997.83 $65.25 Fee Schedule 74.74% $48.77 Percent of Billed Charges 68.24% $44.53 Percent of Billed Charges 65.00% $42.41 Percent of Billed Charges 67.00% $43.72 Percent of Billed Charges 77.50% $50.57 Percent of Billed Charges 79.97% $52.18 Percent of Billed Charges 55.00% $35.89 Percent of Billed Charges 49.55% $32.33 Percent of Billed Charges 55.00% $35.89 Percent of Billed Charges 55.00% $35.89 Percent of Billed Charges 78.94% $51.51 Percent of Billed Charges 74.00% $48.29 Percent of Billed Charges 92.50% $60.36 Percent of Billed Charges 55.00% $35.89 Percent of Billed Charges 85.00% $55.46 Percent of Billed Charges 63.00% $41.11 Percent of Billed Charges 63.00% $41.11 Percent of Billed Charges 75.00% $48.94 Percent of Billed Charges 66.24% $43.22 Percent of Billed Charges 165.81% $65.25 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $103.75 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $39.15 Percent of Billed Charges HC CLONAZEPAM LABCORP 300 CPT G0480 90 Outpatient $18.52 $9.18 $170.85 $18.52 $319.76 $18.52 Fee Schedule $319.76 $18.52 Fee Schedule $997.83 $18.52 Fee Schedule 74.74% $13.84 Percent of Billed Charges 68.24% $12.64 Percent of Billed Charges 65.00% $12.04 Percent of Billed Charges 67.00% $12.41 Percent of Billed Charges 77.50% $14.35 Percent of Billed Charges 79.97% $14.81 Percent of Billed Charges 55.00% $10.19 Percent of Billed Charges 49.55% $9.18 Percent of Billed Charges 55.00% $10.19 Percent of Billed Charges 55.00% $10.19 Percent of Billed Charges 78.94% $14.62 Percent of Billed Charges 74.00% $13.70 Percent of Billed Charges 92.50% $17.13 Percent of Billed Charges 55.00% $10.19 Percent of Billed Charges 85.00% $15.74 Percent of Billed Charges 63.00% $11.67 Percent of Billed Charges 63.00% $11.67 Percent of Billed Charges 75.00% $13.89 Percent of Billed Charges 66.24% $12.27 Percent of Billed Charges 165.81% $18.52 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $29.45 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $11.11 Percent of Billed Charges HC CLONIDINE LABCORP 300 CPT G0480 90 Outpatient $176.89 $87.65 $281.26 $176.89 $319.76 $176.89 Fee Schedule $319.76 $176.89 Fee Schedule $997.83 $176.89 Fee Schedule 74.74% $132.21 Percent of Billed Charges 68.24% $120.71 Percent of Billed Charges 65.00% $114.98 Percent of Billed Charges 67.00% $118.52 Percent of Billed Charges 77.50% $137.09 Percent of Billed Charges 79.97% $141.46 Percent of Billed Charges 55.00% $97.29 Percent of Billed Charges 49.55% $87.65 Percent of Billed Charges 55.00% $97.29 Percent of Billed Charges 55.00% $97.29 Percent of Billed Charges 78.94% $139.64 Percent of Billed Charges 74.00% $130.90 Percent of Billed Charges 92.50% $163.62 Percent of Billed Charges 55.00% $97.29 Percent of Billed Charges 85.00% $150.36 Percent of Billed Charges 63.00% $111.44 Percent of Billed Charges 63.00% $111.44 Percent of Billed Charges 75.00% $132.67 Percent of Billed Charges 66.24% $117.17 Percent of Billed Charges 165.81% $148.13 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $281.26 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $106.13 Percent of Billed Charges HC CLORAZEPATE LABCORP 300 CPT G0480 90 Outpatient $20.52 $10.17 $170.85 $20.52 $319.76 $20.52 Fee Schedule $319.76 $20.52 Fee Schedule $997.83 $20.52 Fee Schedule 74.74% $15.34 Percent of Billed Charges 68.24% $14.00 Percent of Billed Charges 65.00% $13.34 Percent of Billed Charges 67.00% $13.75 Percent of Billed Charges 77.50% $15.90 Percent of Billed Charges 79.97% $16.41 Percent of Billed Charges 55.00% $11.29 Percent of Billed Charges 49.55% $10.17 Percent of Billed Charges 55.00% $11.29 Percent of Billed Charges 55.00% $11.29 Percent of Billed Charges 78.94% $16.20 Percent of Billed Charges 74.00% $15.18 Percent of Billed Charges 92.50% $18.98 Percent of Billed Charges 55.00% $11.29 Percent of Billed Charges 85.00% $17.44 Percent of Billed Charges 63.00% $12.93 Percent of Billed Charges 63.00% $12.93 Percent of Billed Charges 75.00% $15.39 Percent of Billed Charges 66.24% $13.59 Percent of Billed Charges 165.81% $20.52 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $32.63 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $12.31 Percent of Billed Charges HC CMV IGG LABCORP 300 CPT 86644 90 Outpatient $14.00 $6.94 $27.52 $14.00 $78.44 $14.00 Fee Schedule $78.44 $14.00 Fee Schedule $125.48 $14.00 Fee Schedule 74.74% $10.46 Percent of Billed Charges 68.24% $9.55 Percent of Billed Charges 65.00% $9.10 Percent of Billed Charges 67.00% $9.38 Percent of Billed Charges 77.50% $10.85 Percent of Billed Charges 79.97% $11.20 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 49.55% $6.94 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 78.94% $11.05 Percent of Billed Charges 74.00% $10.36 Percent of Billed Charges 92.50% $12.95 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 85.00% $11.90 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 75.00% $10.50 Percent of Billed Charges 66.24% $9.27 Percent of Billed Charges 165.81% $14.00 Fee Schedule 166.07% $23.90 Fee Schedule 176.26% $25.36 Fee Schedule 129.00% $18.56 Fee Schedule 191.24% $27.52 Fee Schedule 159.00% $22.26 Fee Schedule 145.00% $20.87 Fee Schedule 60.00% $8.40 Percent of Billed Charges HC CMV IGM LABCORP 300 CPT 86645 90 Outpatient $15.00 $7.43 $32.22 $15.00 $91.80 $15.00 Fee Schedule $91.80 $15.00 Fee Schedule $146.93 $15.00 Fee Schedule 74.74% $11.21 Percent of Billed Charges 68.24% $10.24 Percent of Billed Charges 65.00% $9.75 Percent of Billed Charges 67.00% $10.05 Percent of Billed Charges 77.50% $11.63 Percent of Billed Charges 79.97% $12.00 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 49.55% $7.43 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 78.94% $11.84 Percent of Billed Charges 74.00% $11.10 Percent of Billed Charges 92.50% $13.88 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 85.00% $12.75 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 75.00% $11.25 Percent of Billed Charges 66.24% $9.94 Percent of Billed Charges 165.81% $15.00 Fee Schedule 166.07% $27.98 Fee Schedule 176.26% $29.70 Fee Schedule 129.00% $21.74 Fee Schedule 191.24% $32.22 Fee Schedule 159.00% $23.85 Fee Schedule 145.00% $24.43 Fee Schedule 60.00% $9.00 Percent of Billed Charges HC CMV PCR BONE MARROW VIRAC 300 CPT 87799 90 Outpatient $172.13 $55.26 $273.69 $172.13 $233.40 $172.13 Fee Schedule $233.40 $172.13 Fee Schedule $373.56 $172.13 Fee Schedule 74.74% $128.65 Percent of Billed Charges 68.24% $117.46 Percent of Billed Charges 65.00% $111.88 Percent of Billed Charges 67.00% $115.33 Percent of Billed Charges 77.50% $133.40 Percent of Billed Charges 79.97% $137.65 Percent of Billed Charges 55.00% $94.67 Percent of Billed Charges 49.55% $85.29 Percent of Billed Charges 55.00% $94.67 Percent of Billed Charges 55.00% $94.67 Percent of Billed Charges 78.94% $135.88 Percent of Billed Charges 74.00% $127.38 Percent of Billed Charges 92.50% $159.22 Percent of Billed Charges 55.00% $94.67 Percent of Billed Charges 85.00% $146.31 Percent of Billed Charges 63.00% $108.44 Percent of Billed Charges 63.00% $108.44 Percent of Billed Charges 75.00% $129.10 Percent of Billed Charges 66.24% $114.02 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $273.69 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $103.28 Percent of Billed Charges HC CMV PCR QL FOCUS 300 CPT 87496 90 Outpatient $268.20 $45.27 $426.44 $268.20 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $268.20 Fee Schedule 74.74% $200.45 Percent of Billed Charges 68.24% $183.02 Percent of Billed Charges 65.00% $174.33 Percent of Billed Charges 67.00% $179.69 Percent of Billed Charges 77.50% $207.86 Percent of Billed Charges 79.97% $214.48 Percent of Billed Charges 55.00% $147.51 Percent of Billed Charges 49.55% $132.89 Percent of Billed Charges 55.00% $147.51 Percent of Billed Charges 55.00% $147.51 Percent of Billed Charges 78.94% $211.72 Percent of Billed Charges 74.00% $198.47 Percent of Billed Charges 92.50% $248.09 Percent of Billed Charges 55.00% $147.51 Percent of Billed Charges 85.00% $227.97 Percent of Billed Charges 63.00% $168.97 Percent of Billed Charges 63.00% $168.97 Percent of Billed Charges 75.00% $201.15 Percent of Billed Charges 66.24% $177.66 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $426.44 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $160.92 Percent of Billed Charges HC CMV PCR STANFORD 300 CPT 87497 90 Outpatient $188.00 $55.26 $298.92 $188.00 $233.40 $188.00 Fee Schedule $233.40 $188.00 Fee Schedule $373.56 $188.00 Fee Schedule 74.74% $140.51 Percent of Billed Charges 68.24% $128.29 Percent of Billed Charges 65.00% $122.20 Percent of Billed Charges 67.00% $125.96 Percent of Billed Charges 77.50% $145.70 Percent of Billed Charges 79.97% $150.34 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 49.55% $93.15 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 78.94% $148.41 Percent of Billed Charges 74.00% $139.12 Percent of Billed Charges 92.50% $173.90 Percent of Billed Charges 55.00% $103.40 Percent of Billed Charges 85.00% $159.80 Percent of Billed Charges 63.00% $118.44 Percent of Billed Charges 63.00% $118.44 Percent of Billed Charges 75.00% $141.00 Percent of Billed Charges 66.24% $124.53 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $298.92 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $112.80 Percent of Billed Charges "HC CMV QNT PCR, BLD LABCORP" 300 CPT 87497 90 Outpatient $85.00 $42.12 $135.15 $85.00 $233.40 $85.00 Fee Schedule $233.40 $85.00 Fee Schedule $373.56 $85.00 Fee Schedule 74.74% $63.53 Percent of Billed Charges 68.24% $58.00 Percent of Billed Charges 65.00% $55.25 Percent of Billed Charges 67.00% $56.95 Percent of Billed Charges 77.50% $65.88 Percent of Billed Charges 79.97% $67.97 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 49.55% $42.12 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 78.94% $67.10 Percent of Billed Charges 74.00% $62.90 Percent of Billed Charges 92.50% $78.63 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 85.00% $72.25 Percent of Billed Charges 63.00% $53.55 Percent of Billed Charges 63.00% $53.55 Percent of Billed Charges 75.00% $63.75 Percent of Billed Charges 66.24% $56.30 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $135.15 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $51.00 Percent of Billed Charges HC CMV QUANT URINE PCR LABCORP 300 CPT 87497 90 Outpatient $128.75 $55.26 $204.71 $128.75 $233.40 $128.75 Fee Schedule $233.40 $128.75 Fee Schedule $373.56 $128.75 Fee Schedule 74.74% $96.23 Percent of Billed Charges 68.24% $87.86 Percent of Billed Charges 65.00% $83.69 Percent of Billed Charges 67.00% $86.26 Percent of Billed Charges 77.50% $99.78 Percent of Billed Charges 79.97% $102.96 Percent of Billed Charges 55.00% $70.81 Percent of Billed Charges 49.55% $63.80 Percent of Billed Charges 55.00% $70.81 Percent of Billed Charges 55.00% $70.81 Percent of Billed Charges 78.94% $101.64 Percent of Billed Charges 74.00% $95.28 Percent of Billed Charges 92.50% $119.09 Percent of Billed Charges 55.00% $70.81 Percent of Billed Charges 85.00% $109.44 Percent of Billed Charges 63.00% $81.11 Percent of Billed Charges 63.00% $81.11 Percent of Billed Charges 75.00% $96.56 Percent of Billed Charges 66.24% $85.28 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $204.71 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $77.25 Percent of Billed Charges HC CNS DEMYELINATING EVAL MAYO 300 CPT 86255 90 Outpatient $800.00 $15.54 " $1,272.00 " $800.00 $65.64 $65.64 Fee Schedule $65.64 $65.64 Fee Schedule $105.08 $99.65 Fee Schedule 74.74% $597.92 Percent of Billed Charges 68.24% $545.92 Percent of Billed Charges 65.00% $520.00 Percent of Billed Charges 67.00% $536.00 Percent of Billed Charges 77.50% $620.00 Percent of Billed Charges 79.97% $639.76 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 49.55% $396.40 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 78.94% $631.52 Percent of Billed Charges 74.00% $592.00 Percent of Billed Charges 92.50% $740.00 Percent of Billed Charges 55.00% $440.00 Percent of Billed Charges 85.00% $680.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 63.00% $504.00 Percent of Billed Charges 75.00% $600.00 Percent of Billed Charges 66.24% $529.92 Percent of Billed Charges 165.81% $19.98 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% " $1,272.00 " Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $480.00 Percent of Billed Charges HC COCAINE CONFIRM URINE QUEST 300 CPT G0480 90 Outpatient $26.71 $13.23 $170.85 $26.71 $319.76 $26.71 Fee Schedule $319.76 $26.71 Fee Schedule $997.83 $26.71 Fee Schedule 74.74% $19.96 Percent of Billed Charges 68.24% $18.23 Percent of Billed Charges 65.00% $17.36 Percent of Billed Charges 67.00% $17.90 Percent of Billed Charges 77.50% $20.70 Percent of Billed Charges 79.97% $21.36 Percent of Billed Charges 55.00% $14.69 Percent of Billed Charges 49.55% $13.23 Percent of Billed Charges 55.00% $14.69 Percent of Billed Charges 55.00% $14.69 Percent of Billed Charges 78.94% $21.08 Percent of Billed Charges 74.00% $19.77 Percent of Billed Charges 92.50% $24.71 Percent of Billed Charges 55.00% $14.69 Percent of Billed Charges 85.00% $22.70 Percent of Billed Charges 63.00% $16.83 Percent of Billed Charges 63.00% $16.83 Percent of Billed Charges 75.00% $20.03 Percent of Billed Charges 66.24% $17.69 Percent of Billed Charges 165.81% $26.71 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $42.47 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $16.03 Percent of Billed Charges HC COCCI SERL IMMU DIF UCD 300 CPT 86331 90 Outpatient $45.00 $15.45 $71.55 $45.00 $65.28 $45.00 Fee Schedule $65.28 $45.00 Fee Schedule $104.47 $45.00 Fee Schedule 74.74% $33.63 Percent of Billed Charges 68.24% $30.71 Percent of Billed Charges 65.00% $29.25 Percent of Billed Charges 67.00% $30.15 Percent of Billed Charges 77.50% $34.88 Percent of Billed Charges 79.97% $35.99 Percent of Billed Charges 55.00% $24.75 Percent of Billed Charges 49.55% $22.30 Percent of Billed Charges 55.00% $24.75 Percent of Billed Charges 55.00% $24.75 Percent of Billed Charges 78.94% $35.52 Percent of Billed Charges 74.00% $33.30 Percent of Billed Charges 92.50% $41.63 Percent of Billed Charges 55.00% $24.75 Percent of Billed Charges 85.00% $38.25 Percent of Billed Charges 63.00% $28.35 Percent of Billed Charges 63.00% $28.35 Percent of Billed Charges 75.00% $33.75 Percent of Billed Charges 66.24% $29.81 Percent of Billed Charges 165.81% $19.86 Fee Schedule 166.07% $19.90 Fee Schedule 176.26% $21.12 Fee Schedule 129.00% $15.45 Fee Schedule 191.24% $22.91 Fee Schedule 159.00% $71.55 Fee Schedule 145.00% $17.37 Fee Schedule 60.00% $27.00 Percent of Billed Charges HC COCCI SEROL COM FIX UCD 300 CPT 86171 90 Outpatient $53.00 $12.91 $84.27 $53.00 $54.56 $53.00 Fee Schedule $54.56 $53.00 Fee Schedule $87.29 $53.00 Fee Schedule 74.74% $39.61 Percent of Billed Charges 68.24% $36.17 Percent of Billed Charges 65.00% $34.45 Percent of Billed Charges 67.00% $35.51 Percent of Billed Charges 77.50% $41.08 Percent of Billed Charges 79.97% $42.38 Percent of Billed Charges 55.00% $29.15 Percent of Billed Charges 49.55% $26.26 Percent of Billed Charges 55.00% $29.15 Percent of Billed Charges 55.00% $29.15 Percent of Billed Charges 78.94% $41.84 Percent of Billed Charges 74.00% $39.22 Percent of Billed Charges 92.50% $49.03 Percent of Billed Charges 55.00% $29.15 Percent of Billed Charges 85.00% $45.05 Percent of Billed Charges 63.00% $33.39 Percent of Billed Charges 63.00% $33.39 Percent of Billed Charges 75.00% $39.75 Percent of Billed Charges 66.24% $35.11 Percent of Billed Charges 165.81% $16.60 Fee Schedule 166.07% $16.62 Fee Schedule 176.26% $17.64 Fee Schedule 129.00% $12.91 Fee Schedule 191.24% $19.14 Fee Schedule 159.00% $84.27 Fee Schedule 145.00% $14.51 Fee Schedule 60.00% $31.80 Percent of Billed Charges HC COENZYME Q10 LABCORP 300 CPT 82542 90 Outpatient $19.00 $9.41 $46.07 $19.00 $98.40 $19.00 Fee Schedule $98.40 $19.00 Fee Schedule $210.06 $19.00 Fee Schedule 74.74% $14.20 Percent of Billed Charges 68.24% $12.97 Percent of Billed Charges 65.00% $12.35 Percent of Billed Charges 67.00% $12.73 Percent of Billed Charges 77.50% $14.73 Percent of Billed Charges 79.97% $15.19 Percent of Billed Charges 55.00% $10.45 Percent of Billed Charges 49.55% $9.41 Percent of Billed Charges 55.00% $10.45 Percent of Billed Charges 55.00% $10.45 Percent of Billed Charges 78.94% $15.00 Percent of Billed Charges 74.00% $14.06 Percent of Billed Charges 92.50% $17.58 Percent of Billed Charges 55.00% $10.45 Percent of Billed Charges 85.00% $16.15 Percent of Billed Charges 63.00% $11.97 Percent of Billed Charges 63.00% $11.97 Percent of Billed Charges 75.00% $14.25 Percent of Billed Charges 66.24% $12.59 Percent of Billed Charges 165.81% $19.00 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $30.21 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $11.40 Percent of Billed Charges HC COLD AGGLUTININ LABCORP 300 CPT 86157 90 Outpatient $16.98 $8.41 $27.00 $16.98 $43.92 $16.98 Fee Schedule $43.92 $16.98 Fee Schedule $70.28 $16.98 Fee Schedule 74.74% $12.69 Percent of Billed Charges 68.24% $11.59 Percent of Billed Charges 65.00% $11.04 Percent of Billed Charges 67.00% $11.38 Percent of Billed Charges 77.50% $13.16 Percent of Billed Charges 79.97% $13.58 Percent of Billed Charges 55.00% $9.34 Percent of Billed Charges 49.55% $8.41 Percent of Billed Charges 55.00% $9.34 Percent of Billed Charges 55.00% $9.34 Percent of Billed Charges 78.94% $13.40 Percent of Billed Charges 74.00% $12.57 Percent of Billed Charges 92.50% $15.71 Percent of Billed Charges 55.00% $9.34 Percent of Billed Charges 85.00% $14.43 Percent of Billed Charges 63.00% $10.70 Percent of Billed Charges 63.00% $10.70 Percent of Billed Charges 75.00% $12.74 Percent of Billed Charges 66.24% $11.25 Percent of Billed Charges 165.81% $13.36 Fee Schedule 166.07% $13.39 Fee Schedule 176.26% $14.21 Fee Schedule 129.00% $10.40 Fee Schedule 191.24% $15.41 Fee Schedule 159.00% $27.00 Fee Schedule 145.00% $11.69 Fee Schedule 60.00% $10.19 Percent of Billed Charges HC COLD AGGLUTININ TITER 300 CPT 86157 Outpatient $336.00 $10.40 $534.24 $336.00 $43.92 $43.92 Fee Schedule $43.92 $43.92 Fee Schedule $70.28 $66.66 Fee Schedule 74.74% $251.13 Percent of Billed Charges 68.24% $229.29 Percent of Billed Charges 65.00% $218.40 Percent of Billed Charges 67.00% $225.12 Percent of Billed Charges 77.50% $260.40 Percent of Billed Charges 79.97% $268.70 Percent of Billed Charges 55.00% $184.80 Percent of Billed Charges 49.55% $166.49 Percent of Billed Charges 55.00% $184.80 Percent of Billed Charges 55.00% $184.80 Percent of Billed Charges 78.94% $265.24 Percent of Billed Charges 74.00% $248.64 Percent of Billed Charges 92.50% $310.80 Percent of Billed Charges 55.00% $184.80 Percent of Billed Charges 85.00% $285.60 Percent of Billed Charges 63.00% $211.68 Percent of Billed Charges 63.00% $211.68 Percent of Billed Charges 75.00% $252.00 Percent of Billed Charges 66.24% $222.57 Percent of Billed Charges 165.81% $13.36 Fee Schedule 166.07% $13.39 Fee Schedule 176.26% $14.21 Fee Schedule 129.00% $10.40 Fee Schedule 191.24% $15.41 Fee Schedule 159.00% $534.24 Fee Schedule 145.00% $11.69 Fee Schedule 60.00% $201.60 Percent of Billed Charges HC COMP TOX PNL BLD QUEST 300 CPT G0480 90 Outpatient $111.00 $55.00 $176.49 $111.00 $319.76 $111.00 Fee Schedule $319.76 $111.00 Fee Schedule $997.83 $111.00 Fee Schedule 74.74% $82.96 Percent of Billed Charges 68.24% $75.75 Percent of Billed Charges 65.00% $72.15 Percent of Billed Charges 67.00% $74.37 Percent of Billed Charges 77.50% $86.03 Percent of Billed Charges 79.97% $88.77 Percent of Billed Charges 55.00% $61.05 Percent of Billed Charges 49.55% $55.00 Percent of Billed Charges 55.00% $61.05 Percent of Billed Charges 55.00% $61.05 Percent of Billed Charges 78.94% $87.62 Percent of Billed Charges 74.00% $82.14 Percent of Billed Charges 92.50% $102.68 Percent of Billed Charges 55.00% $61.05 Percent of Billed Charges 85.00% $94.35 Percent of Billed Charges 63.00% $69.93 Percent of Billed Charges 63.00% $69.93 Percent of Billed Charges 75.00% $83.25 Percent of Billed Charges 66.24% $73.53 Percent of Billed Charges 165.81% $111.00 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $176.49 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $66.60 Percent of Billed Charges HC COMP TOX PNL UR QUEST 300 CPT G0482 90 Outpatient $200.72 $99.46 $354.85 $200.72 $664.12 $200.72 Fee Schedule $664.12 $200.72 Fee Schedule " $1,733.01 " $200.72 Fee Schedule 74.74% $150.02 Percent of Billed Charges 68.24% $136.97 Percent of Billed Charges 65.00% $130.47 Percent of Billed Charges 67.00% $134.48 Percent of Billed Charges 77.50% $155.56 Percent of Billed Charges 79.97% $160.52 Percent of Billed Charges 55.00% $110.40 Percent of Billed Charges 49.55% $99.46 Percent of Billed Charges 55.00% $110.40 Percent of Billed Charges 55.00% $110.40 Percent of Billed Charges 78.94% $158.45 Percent of Billed Charges 74.00% $148.53 Percent of Billed Charges 92.50% $185.67 Percent of Billed Charges 55.00% $110.40 Percent of Billed Charges 85.00% $170.61 Percent of Billed Charges 63.00% $126.45 Percent of Billed Charges 63.00% $126.45 Percent of Billed Charges 75.00% $150.54 Percent of Billed Charges 66.24% $132.96 Percent of Billed Charges 165.81% $200.72 Fee Schedule 166.07% $308.14 Fee Schedule 176.26% $327.05 Fee Schedule 129.00% $239.36 Fee Schedule 191.24% $354.85 Fee Schedule 159.00% $319.14 Fee Schedule 145.00% $269.05 Fee Schedule 60.00% $120.43 Percent of Billed Charges HC COMPLEMENT FUNCTION NJC 300 CPT 86161 90 Outpatient $84.07 $15.48 $133.67 $84.07 $65.40 $65.40 Fee Schedule $65.40 $65.40 Fee Schedule $104.64 $84.07 Fee Schedule 74.74% $62.83 Percent of Billed Charges 68.24% $57.37 Percent of Billed Charges 65.00% $54.65 Percent of Billed Charges 67.00% $56.33 Percent of Billed Charges 77.50% $65.15 Percent of Billed Charges 79.97% $67.23 Percent of Billed Charges 55.00% $46.24 Percent of Billed Charges 49.55% $41.66 Percent of Billed Charges 55.00% $46.24 Percent of Billed Charges 55.00% $46.24 Percent of Billed Charges 78.94% $66.36 Percent of Billed Charges 74.00% $62.21 Percent of Billed Charges 92.50% $77.76 Percent of Billed Charges 55.00% $46.24 Percent of Billed Charges 85.00% $71.46 Percent of Billed Charges 63.00% $52.96 Percent of Billed Charges 63.00% $52.96 Percent of Billed Charges 75.00% $63.05 Percent of Billed Charges 66.24% $55.69 Percent of Billed Charges 165.81% $19.90 Fee Schedule 166.07% $19.93 Fee Schedule 176.26% $21.15 Fee Schedule 129.00% $15.48 Fee Schedule 191.24% $22.95 Fee Schedule 159.00% $133.67 Fee Schedule 145.00% $17.40 Fee Schedule 60.00% $50.44 Percent of Billed Charges HC CONNEXIN 26 (GJB2) SEQ ARUP 300 CPT 81252 90 Outpatient $483.75 $- $769.16 $483.75 $404.48 $404.48 Fee Schedule $404.48 $404.48 Fee Schedule $881.77 $483.75 Fee Schedule 74.74% $361.55 Percent of Billed Charges 68.24% $330.11 Percent of Billed Charges 65.00% $314.44 Percent of Billed Charges 67.00% $324.11 Percent of Billed Charges 77.50% $374.91 Percent of Billed Charges 79.97% $386.85 Percent of Billed Charges 55.00% $266.06 Percent of Billed Charges 49.55% $239.70 Percent of Billed Charges 55.00% $266.06 Percent of Billed Charges 55.00% $266.06 Percent of Billed Charges 78.94% $381.87 Percent of Billed Charges 74.00% $357.98 Percent of Billed Charges 92.50% $447.47 Percent of Billed Charges 55.00% $266.06 Percent of Billed Charges 85.00% $411.19 Percent of Billed Charges 63.00% $304.76 Percent of Billed Charges 63.00% $304.76 Percent of Billed Charges 75.00% $362.81 Percent of Billed Charges 66.24% $320.44 Percent of Billed Charges 35.00% $169.31 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $769.16 Fee Schedule 145.00% $- Fee Schedule 60.00% $290.25 Percent of Billed Charges HC COPPER LABCORP 300 CPT 82525 90 Outpatient $3.00 $1.49 $23.73 $3.00 $67.60 $3.00 Fee Schedule $67.60 $3.00 Fee Schedule $108.22 $3.00 Fee Schedule 74.74% $2.24 Percent of Billed Charges 68.24% $2.05 Percent of Billed Charges 65.00% $1.95 Percent of Billed Charges 67.00% $2.01 Percent of Billed Charges 77.50% $2.33 Percent of Billed Charges 79.97% $2.40 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 49.55% $1.49 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 78.94% $2.37 Percent of Billed Charges 74.00% $2.22 Percent of Billed Charges 92.50% $2.78 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 85.00% $2.55 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 75.00% $2.25 Percent of Billed Charges 66.24% $1.99 Percent of Billed Charges 165.81% $3.00 Fee Schedule 166.07% $20.61 Fee Schedule 176.26% $21.87 Fee Schedule 129.00% $16.01 Fee Schedule 191.24% $23.73 Fee Schedule 159.00% $4.77 Fee Schedule 145.00% $17.99 Fee Schedule 60.00% $1.80 Percent of Billed Charges "HC COPPER, LIVER ARUP" 300 CPT 82525 90 Outpatient $104.00 $16.01 $165.36 $104.00 $67.60 $67.60 Fee Schedule $67.60 $67.60 Fee Schedule $108.22 $102.63 Fee Schedule 74.74% $77.73 Percent of Billed Charges 68.24% $70.97 Percent of Billed Charges 65.00% $67.60 Percent of Billed Charges 67.00% $69.68 Percent of Billed Charges 77.50% $80.60 Percent of Billed Charges 79.97% $83.17 Percent of Billed Charges 55.00% $57.20 Percent of Billed Charges 49.55% $51.53 Percent of Billed Charges 55.00% $57.20 Percent of Billed Charges 55.00% $57.20 Percent of Billed Charges 78.94% $82.10 Percent of Billed Charges 74.00% $76.96 Percent of Billed Charges 92.50% $96.20 Percent of Billed Charges 55.00% $57.20 Percent of Billed Charges 85.00% $88.40 Percent of Billed Charges 63.00% $65.52 Percent of Billed Charges 63.00% $65.52 Percent of Billed Charges 75.00% $78.00 Percent of Billed Charges 66.24% $68.89 Percent of Billed Charges 165.81% $20.58 Fee Schedule 166.07% $20.61 Fee Schedule 176.26% $21.87 Fee Schedule 129.00% $16.01 Fee Schedule 191.24% $23.73 Fee Schedule 159.00% $165.36 Fee Schedule 145.00% $17.99 Fee Schedule 60.00% $62.40 Percent of Billed Charges "HC COPPER,RANDOM URINE LABCORP" 300 CPT 82525 90 Outpatient $8.00 $3.96 $23.73 $8.00 $67.60 $8.00 Fee Schedule $67.60 $8.00 Fee Schedule $108.22 $8.00 Fee Schedule 74.74% $5.98 Percent of Billed Charges 68.24% $5.46 Percent of Billed Charges 65.00% $5.20 Percent of Billed Charges 67.00% $5.36 Percent of Billed Charges 77.50% $6.20 Percent of Billed Charges 79.97% $6.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 49.55% $3.96 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 78.94% $6.32 Percent of Billed Charges 74.00% $5.92 Percent of Billed Charges 92.50% $7.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 85.00% $6.80 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 75.00% $6.00 Percent of Billed Charges 66.24% $5.30 Percent of Billed Charges 165.81% $8.00 Fee Schedule 166.07% $20.61 Fee Schedule 176.26% $21.87 Fee Schedule 129.00% $16.01 Fee Schedule 191.24% $23.73 Fee Schedule 159.00% $12.72 Fee Schedule 145.00% $17.99 Fee Schedule 60.00% $4.80 Percent of Billed Charges HC CORTICOSTERONE LABCORP 300 CPT 82528 90 Outpatient $19.10 $9.46 $43.07 $19.10 $122.68 $19.10 Fee Schedule $122.68 $19.10 Fee Schedule $196.37 $19.10 Fee Schedule 74.74% $14.28 Percent of Billed Charges 68.24% $13.03 Percent of Billed Charges 65.00% $12.42 Percent of Billed Charges 67.00% $12.80 Percent of Billed Charges 77.50% $14.80 Percent of Billed Charges 79.97% $15.27 Percent of Billed Charges 55.00% $10.51 Percent of Billed Charges 49.55% $9.46 Percent of Billed Charges 55.00% $10.51 Percent of Billed Charges 55.00% $10.51 Percent of Billed Charges 78.94% $15.08 Percent of Billed Charges 74.00% $14.13 Percent of Billed Charges 92.50% $17.67 Percent of Billed Charges 55.00% $10.51 Percent of Billed Charges 85.00% $16.24 Percent of Billed Charges 63.00% $12.03 Percent of Billed Charges 63.00% $12.03 Percent of Billed Charges 75.00% $14.33 Percent of Billed Charges 66.24% $12.65 Percent of Billed Charges 165.81% $19.10 Fee Schedule 166.07% $37.40 Fee Schedule 176.26% $39.69 Fee Schedule 129.00% $29.05 Fee Schedule 191.24% $43.07 Fee Schedule 159.00% $30.37 Fee Schedule 145.00% $32.65 Fee Schedule 60.00% $11.46 Percent of Billed Charges HC CORTISOL URINE FREE ARUP 300 CPT 82530 90 Outpatient $18.48 $9.16 $31.96 $18.48 $91.04 $18.48 Fee Schedule $91.04 $18.48 Fee Schedule $145.71 $18.48 Fee Schedule 74.74% $13.81 Percent of Billed Charges 68.24% $12.61 Percent of Billed Charges 65.00% $12.01 Percent of Billed Charges 67.00% $12.38 Percent of Billed Charges 77.50% $14.32 Percent of Billed Charges 79.97% $14.78 Percent of Billed Charges 55.00% $10.16 Percent of Billed Charges 49.55% $9.16 Percent of Billed Charges 55.00% $10.16 Percent of Billed Charges 55.00% $10.16 Percent of Billed Charges 78.94% $14.59 Percent of Billed Charges 74.00% $13.68 Percent of Billed Charges 92.50% $17.09 Percent of Billed Charges 55.00% $10.16 Percent of Billed Charges 85.00% $15.71 Percent of Billed Charges 63.00% $11.64 Percent of Billed Charges 63.00% $11.64 Percent of Billed Charges 75.00% $13.86 Percent of Billed Charges 66.24% $12.24 Percent of Billed Charges 165.81% $18.48 Fee Schedule 166.07% $27.75 Fee Schedule 176.26% $29.45 Fee Schedule 129.00% $21.56 Fee Schedule 191.24% $31.96 Fee Schedule 159.00% $29.38 Fee Schedule 145.00% $24.23 Fee Schedule 60.00% $11.09 Percent of Billed Charges "HC CORTISOL,FREE LABCORP" 300 CPT 82530 90 Outpatient $50.00 $21.56 $79.50 $50.00 $91.04 $50.00 Fee Schedule $91.04 $50.00 Fee Schedule $145.71 $50.00 Fee Schedule 74.74% $37.37 Percent of Billed Charges 68.24% $34.12 Percent of Billed Charges 65.00% $32.50 Percent of Billed Charges 67.00% $33.50 Percent of Billed Charges 77.50% $38.75 Percent of Billed Charges 79.97% $39.99 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 49.55% $24.78 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 78.94% $39.47 Percent of Billed Charges 74.00% $37.00 Percent of Billed Charges 92.50% $46.25 Percent of Billed Charges 55.00% $27.50 Percent of Billed Charges 85.00% $42.50 Percent of Billed Charges 63.00% $31.50 Percent of Billed Charges 63.00% $31.50 Percent of Billed Charges 75.00% $37.50 Percent of Billed Charges 66.24% $33.12 Percent of Billed Charges 165.81% $27.71 Fee Schedule 166.07% $27.75 Fee Schedule 176.26% $29.45 Fee Schedule 129.00% $21.56 Fee Schedule 191.24% $31.96 Fee Schedule 159.00% $79.50 Fee Schedule 145.00% $24.23 Fee Schedule 60.00% $30.00 Percent of Billed Charges HC COVID-19 ANTIBODY 300 CPT 86769 Outpatient $79.00 $39.14 $125.61 $79.00 $168.52 $79.00 Fee Schedule $168.52 $79.00 Fee Schedule $367.37 $75.00 Fee Schedule 74.74% $59.04 Percent of Billed Charges 68.24% $53.91 Percent of Billed Charges 65.00% $51.35 Percent of Billed Charges 67.00% $52.93 Percent of Billed Charges 77.50% $61.23 Percent of Billed Charges 79.97% $63.18 Percent of Billed Charges 55.00% $43.45 Percent of Billed Charges 49.55% $39.14 Percent of Billed Charges 55.00% $43.45 Percent of Billed Charges 55.00% $43.45 Percent of Billed Charges 78.94% $62.36 Percent of Billed Charges 74.00% $58.46 Percent of Billed Charges 92.50% $73.08 Percent of Billed Charges 55.00% $43.45 Percent of Billed Charges 85.00% $67.15 Percent of Billed Charges 63.00% $49.77 Percent of Billed Charges 63.00% $49.77 Percent of Billed Charges 75.00% $59.25 Percent of Billed Charges 66.24% $52.33 Percent of Billed Charges 165.81% $69.86 Fee Schedule 166.07% $69.97 Fee Schedule 176.26% $74.26 Fee Schedule 129.00% $54.35 Fee Schedule 191.24% $80.57 Fee Schedule 159.00% $125.61 Fee Schedule 145.00% $61.09 Fee Schedule 60.00% $47.40 Percent of Billed Charges HC COXSACKIE A TITER ARUP 300 CPT 86658 90 Outpatient $22.70 $11.25 $36.09 $22.70 $71.00 $22.70 Fee Schedule $71.00 $22.70 Fee Schedule $113.62 $22.70 Fee Schedule 74.74% $16.97 Percent of Billed Charges 68.24% $15.49 Percent of Billed Charges 65.00% $14.76 Percent of Billed Charges 67.00% $15.21 Percent of Billed Charges 77.50% $17.59 Percent of Billed Charges 79.97% $18.15 Percent of Billed Charges 55.00% $12.49 Percent of Billed Charges 49.55% $11.25 Percent of Billed Charges 55.00% $12.49 Percent of Billed Charges 55.00% $12.49 Percent of Billed Charges 78.94% $17.92 Percent of Billed Charges 74.00% $16.80 Percent of Billed Charges 92.50% $21.00 Percent of Billed Charges 55.00% $12.49 Percent of Billed Charges 85.00% $19.30 Percent of Billed Charges 63.00% $14.30 Percent of Billed Charges 63.00% $14.30 Percent of Billed Charges 75.00% $17.03 Percent of Billed Charges 66.24% $15.04 Percent of Billed Charges 165.81% $21.61 Fee Schedule 166.07% $21.64 Fee Schedule 176.26% $22.97 Fee Schedule 129.00% $16.81 Fee Schedule 191.24% $24.92 Fee Schedule 159.00% $36.09 Fee Schedule 145.00% $18.89 Fee Schedule 60.00% $13.62 Percent of Billed Charges HC COXSACKIE B TITER ARUP 300 CPT 86658 90 Outpatient $112.20 $16.81 $178.40 $112.20 $71.00 $71.00 Fee Schedule $71.00 $71.00 Fee Schedule $113.62 $107.76 Fee Schedule 74.74% $83.86 Percent of Billed Charges 68.24% $76.57 Percent of Billed Charges 65.00% $72.93 Percent of Billed Charges 67.00% $75.17 Percent of Billed Charges 77.50% $86.96 Percent of Billed Charges 79.97% $89.73 Percent of Billed Charges 55.00% $61.71 Percent of Billed Charges 49.55% $55.60 Percent of Billed Charges 55.00% $61.71 Percent of Billed Charges 55.00% $61.71 Percent of Billed Charges 78.94% $88.57 Percent of Billed Charges 74.00% $83.03 Percent of Billed Charges 92.50% $103.79 Percent of Billed Charges 55.00% $61.71 Percent of Billed Charges 85.00% $95.37 Percent of Billed Charges 63.00% $70.69 Percent of Billed Charges 63.00% $70.69 Percent of Billed Charges 75.00% $84.15 Percent of Billed Charges 66.24% $74.32 Percent of Billed Charges 165.81% $21.61 Fee Schedule 166.07% $21.64 Fee Schedule 176.26% $22.97 Fee Schedule 129.00% $16.81 Fee Schedule 191.24% $24.92 Fee Schedule 159.00% $178.40 Fee Schedule 145.00% $18.89 Fee Schedule 60.00% $67.32 Percent of Billed Charges HC C-PEPTIDE LABCORP 300 CPT 84681 90 Outpatient $3.00 $1.49 $39.80 $3.00 $113.40 $3.00 Fee Schedule $113.40 $3.00 Fee Schedule $181.46 $3.00 Fee Schedule 74.74% $2.24 Percent of Billed Charges 68.24% $2.05 Percent of Billed Charges 65.00% $1.95 Percent of Billed Charges 67.00% $2.01 Percent of Billed Charges 77.50% $2.33 Percent of Billed Charges 79.97% $2.40 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 49.55% $1.49 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 78.94% $2.37 Percent of Billed Charges 74.00% $2.22 Percent of Billed Charges 92.50% $2.78 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 85.00% $2.55 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 75.00% $2.25 Percent of Billed Charges 66.24% $1.99 Percent of Billed Charges 165.81% $3.00 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $4.77 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $1.80 Percent of Billed Charges "HC CREATINE/GUADINOACETATE URINE, BAYLOR - 83789" 300 CPT 83789 90 Outpatient $150.00 $31.10 $238.50 $150.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.24 $199.39 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $39.98 Fee Schedule 166.07% $40.04 Fee Schedule 176.26% $42.50 Fee Schedule 129.00% $31.10 Fee Schedule 191.24% $46.11 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $34.96 Fee Schedule 60.00% $90.00 Percent of Billed Charges "HC CREATINE/GUADINOACETATE BLOOD, BAYLOR - 83789" 300 CPT 83789 90 Outpatient $150.00 $31.10 $238.50 $150.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.24 $199.39 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $39.98 Fee Schedule 166.07% $40.04 Fee Schedule 176.26% $42.50 Fee Schedule 129.00% $31.10 Fee Schedule 191.24% $46.11 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $34.96 Fee Schedule 60.00% $90.00 Percent of Billed Charges "HC CREATININE,BODY FLUID ARUP" 300 CPT 82570 90 Outpatient $8.03 $3.98 $12.77 $8.03 $28.20 $8.03 Fee Schedule $28.20 $8.03 Fee Schedule $45.17 $8.03 Fee Schedule 74.74% $6.00 Percent of Billed Charges 68.24% $5.48 Percent of Billed Charges 65.00% $5.22 Percent of Billed Charges 67.00% $5.38 Percent of Billed Charges 77.50% $6.22 Percent of Billed Charges 79.97% $6.42 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 49.55% $3.98 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 78.94% $6.34 Percent of Billed Charges 74.00% $5.94 Percent of Billed Charges 92.50% $7.43 Percent of Billed Charges 55.00% $4.42 Percent of Billed Charges 85.00% $6.83 Percent of Billed Charges 63.00% $5.06 Percent of Billed Charges 63.00% $5.06 Percent of Billed Charges 75.00% $6.02 Percent of Billed Charges 66.24% $5.32 Percent of Billed Charges 165.81% $8.03 Fee Schedule 166.07% $8.60 Fee Schedule 176.26% $9.13 Fee Schedule 129.00% $6.68 Fee Schedule 191.24% $9.91 Fee Schedule 159.00% $12.77 Fee Schedule 145.00% $7.51 Fee Schedule 60.00% $4.82 Percent of Billed Charges HC CROSSMATCH - ANTIGLOBULIN 300 CPT 86922 Outpatient $705.00 $- " $1,120.95 " $705.00 $412.08 $412.08 Fee Schedule $412.08 $412.08 Fee Schedule 56.78% $400.30 Percent of Billed Charges 74.74% $526.92 Percent of Billed Charges 68.24% $481.09 Percent of Billed Charges 65.00% $458.25 Percent of Billed Charges 67.00% $472.35 Percent of Billed Charges 77.50% $546.38 Percent of Billed Charges 79.97% $563.79 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 49.55% $349.33 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 78.94% $556.53 Percent of Billed Charges 74.00% $521.70 Percent of Billed Charges 92.50% $652.13 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 85.00% $599.25 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 75.00% $528.75 Percent of Billed Charges 66.24% $466.99 Percent of Billed Charges 35.00% $246.75 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,120.95 " Fee Schedule 145.00% $- Fee Schedule 60.00% $423.00 Percent of Billed Charges HC CROSSMATCH - ELECTRONIC 300 CPT 86923 Outpatient $391.00 $- $621.69 $391.00 $412.08 $391.00 Fee Schedule $412.08 $391.00 Fee Schedule 56.78% $222.01 Percent of Billed Charges 74.74% $292.23 Percent of Billed Charges 68.24% $266.82 Percent of Billed Charges 65.00% $254.15 Percent of Billed Charges 67.00% $261.97 Percent of Billed Charges 77.50% $303.03 Percent of Billed Charges 79.97% $312.68 Percent of Billed Charges 55.00% $215.05 Percent of Billed Charges 49.55% $193.74 Percent of Billed Charges 55.00% $215.05 Percent of Billed Charges 55.00% $215.05 Percent of Billed Charges 78.94% $308.66 Percent of Billed Charges 74.00% $289.34 Percent of Billed Charges 92.50% $361.68 Percent of Billed Charges 55.00% $215.05 Percent of Billed Charges 85.00% $332.35 Percent of Billed Charges 63.00% $246.33 Percent of Billed Charges 63.00% $246.33 Percent of Billed Charges 75.00% $293.25 Percent of Billed Charges 66.24% $259.00 Percent of Billed Charges 35.00% $136.85 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $621.69 Fee Schedule 145.00% $- Fee Schedule 60.00% $234.60 Percent of Billed Charges HC CROSSMATCH - PLATELET 300 CPT 86922 Outpatient $705.00 $- " $1,120.95 " $705.00 $412.08 $412.08 Fee Schedule $412.08 $412.08 Fee Schedule 56.78% $400.30 Percent of Billed Charges 74.74% $526.92 Percent of Billed Charges 68.24% $481.09 Percent of Billed Charges 65.00% $458.25 Percent of Billed Charges 67.00% $472.35 Percent of Billed Charges 77.50% $546.38 Percent of Billed Charges 79.97% $563.79 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 49.55% $349.33 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 78.94% $556.53 Percent of Billed Charges 74.00% $521.70 Percent of Billed Charges 92.50% $652.13 Percent of Billed Charges 55.00% $387.75 Percent of Billed Charges 85.00% $599.25 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 63.00% $444.15 Percent of Billed Charges 75.00% $528.75 Percent of Billed Charges 66.24% $466.99 Percent of Billed Charges 35.00% $246.75 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,120.95 " Fee Schedule 145.00% $- Fee Schedule 60.00% $423.00 Percent of Billed Charges HC CROSSMATCH -IMMEDIATE SPIN 300 CPT 86920 Outpatient $468.00 $- $744.12 $468.00 $412.08 $412.08 Fee Schedule $412.08 $412.08 Fee Schedule 56.78% $265.73 Percent of Billed Charges 74.74% $349.78 Percent of Billed Charges 68.24% $319.36 Percent of Billed Charges 65.00% $304.20 Percent of Billed Charges 67.00% $313.56 Percent of Billed Charges 77.50% $362.70 Percent of Billed Charges 79.97% $374.26 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 49.55% $231.89 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 78.94% $369.44 Percent of Billed Charges 74.00% $346.32 Percent of Billed Charges 92.50% $432.90 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 85.00% $397.80 Percent of Billed Charges 63.00% $294.84 Percent of Billed Charges 63.00% $294.84 Percent of Billed Charges 75.00% $351.00 Percent of Billed Charges 66.24% $310.00 Percent of Billed Charges 35.00% $163.80 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $744.12 Fee Schedule 145.00% $- Fee Schedule 60.00% $280.80 Percent of Billed Charges HC CRP HIGH SENSITIVITY LABCORP 300 CPT 86141 90 Outpatient $5.00 $2.48 $24.77 $5.00 $70.52 $5.00 Fee Schedule $70.52 $5.00 Fee Schedule $112.92 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $21.51 Fee Schedule 176.26% $22.83 Fee Schedule 129.00% $16.71 Fee Schedule 191.24% $24.77 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $18.78 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC CRYOFIBRINOGEN 300 CPT 82585 90 Outpatient $9.35 $4.63 $27.04 $9.35 $46.76 $9.35 Fee Schedule $46.76 $9.35 Fee Schedule $123.30 $9.35 Fee Schedule 74.74% $6.99 Percent of Billed Charges 68.24% $6.38 Percent of Billed Charges 65.00% $6.08 Percent of Billed Charges 67.00% $6.26 Percent of Billed Charges 77.50% $7.25 Percent of Billed Charges 79.97% $7.48 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 49.55% $4.63 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 78.94% $7.38 Percent of Billed Charges 74.00% $6.92 Percent of Billed Charges 92.50% $8.65 Percent of Billed Charges 55.00% $5.14 Percent of Billed Charges 85.00% $7.95 Percent of Billed Charges 63.00% $5.89 Percent of Billed Charges 63.00% $5.89 Percent of Billed Charges 75.00% $7.01 Percent of Billed Charges 66.24% $6.19 Percent of Billed Charges 165.81% $9.35 Fee Schedule 166.07% $23.48 Fee Schedule 176.26% $24.92 Fee Schedule 129.00% $18.24 Fee Schedule 191.24% $27.04 Fee Schedule 159.00% $14.87 Fee Schedule 145.00% $20.50 Fee Schedule 60.00% $5.61 Percent of Billed Charges HC CRYOGLOBULIN LABCORP 300 CPT 82595 90 Outpatient $4.10 $2.03 $12.37 $4.10 $35.24 $4.10 Fee Schedule $35.24 $4.10 Fee Schedule $56.42 $4.10 Fee Schedule 74.74% $3.06 Percent of Billed Charges 68.24% $2.80 Percent of Billed Charges 65.00% $2.67 Percent of Billed Charges 67.00% $2.75 Percent of Billed Charges 77.50% $3.18 Percent of Billed Charges 79.97% $3.28 Percent of Billed Charges 55.00% $2.26 Percent of Billed Charges 49.55% $2.03 Percent of Billed Charges 55.00% $2.26 Percent of Billed Charges 55.00% $2.26 Percent of Billed Charges 78.94% $3.24 Percent of Billed Charges 74.00% $3.03 Percent of Billed Charges 92.50% $3.79 Percent of Billed Charges 55.00% $2.26 Percent of Billed Charges 85.00% $3.49 Percent of Billed Charges 63.00% $2.58 Percent of Billed Charges 63.00% $2.58 Percent of Billed Charges 75.00% $3.08 Percent of Billed Charges 66.24% $2.72 Percent of Billed Charges 165.81% $4.10 Fee Schedule 166.07% $10.74 Fee Schedule 176.26% $11.40 Fee Schedule 129.00% $8.35 Fee Schedule 191.24% $12.37 Fee Schedule 159.00% $6.52 Fee Schedule 145.00% $9.38 Fee Schedule 60.00% $2.46 Percent of Billed Charges HC CRYPTOCOCCUS AG CSF LABCORP 300 CPT 87899 90 Outpatient $10.95 $5.43 $30.73 $10.95 $65.32 $10.95 Fee Schedule $65.32 $10.95 Fee Schedule $140.13 $10.95 Fee Schedule 74.74% $8.18 Percent of Billed Charges 68.24% $7.47 Percent of Billed Charges 65.00% $7.12 Percent of Billed Charges 67.00% $7.34 Percent of Billed Charges 77.50% $8.49 Percent of Billed Charges 79.97% $8.76 Percent of Billed Charges 55.00% $6.02 Percent of Billed Charges 49.55% $5.43 Percent of Billed Charges 55.00% $6.02 Percent of Billed Charges 55.00% $6.02 Percent of Billed Charges 78.94% $8.64 Percent of Billed Charges 74.00% $8.10 Percent of Billed Charges 92.50% $10.13 Percent of Billed Charges 55.00% $6.02 Percent of Billed Charges 85.00% $9.31 Percent of Billed Charges 63.00% $6.90 Percent of Billed Charges 63.00% $6.90 Percent of Billed Charges 75.00% $8.21 Percent of Billed Charges 66.24% $7.25 Percent of Billed Charges 165.81% $10.95 Fee Schedule 166.07% $26.69 Fee Schedule 176.26% $28.32 Fee Schedule 129.00% $20.73 Fee Schedule 191.24% $30.73 Fee Schedule 159.00% $17.41 Fee Schedule 145.00% $23.30 Fee Schedule 60.00% $6.57 Percent of Billed Charges HC CRYPTOCOCCUS AG LABCORP 300 CPT 87899 90 Outpatient $11.00 $5.45 $30.73 $11.00 $65.32 $11.00 Fee Schedule $65.32 $11.00 Fee Schedule $140.13 $11.00 Fee Schedule 74.74% $8.22 Percent of Billed Charges 68.24% $7.51 Percent of Billed Charges 65.00% $7.15 Percent of Billed Charges 67.00% $7.37 Percent of Billed Charges 77.50% $8.53 Percent of Billed Charges 79.97% $8.80 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 49.55% $5.45 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 78.94% $8.68 Percent of Billed Charges 74.00% $8.14 Percent of Billed Charges 92.50% $10.18 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 85.00% $9.35 Percent of Billed Charges 63.00% $6.93 Percent of Billed Charges 63.00% $6.93 Percent of Billed Charges 75.00% $8.25 Percent of Billed Charges 66.24% $7.29 Percent of Billed Charges 165.81% $11.00 Fee Schedule 166.07% $26.69 Fee Schedule 176.26% $28.32 Fee Schedule 129.00% $20.73 Fee Schedule 191.24% $30.73 Fee Schedule 159.00% $17.49 Fee Schedule 145.00% $23.30 Fee Schedule 60.00% $6.60 Percent of Billed Charges HC CSF 4HYDROXYBUTYIC MEDNEURO 300 CPT 82542 90 Outpatient $181.00 $31.08 $287.79 $181.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $181.00 Fee Schedule 74.74% $135.28 Percent of Billed Charges 68.24% $123.51 Percent of Billed Charges 65.00% $117.65 Percent of Billed Charges 67.00% $121.27 Percent of Billed Charges 77.50% $140.28 Percent of Billed Charges 79.97% $144.75 Percent of Billed Charges 55.00% $99.55 Percent of Billed Charges 49.55% $89.69 Percent of Billed Charges 55.00% $99.55 Percent of Billed Charges 55.00% $99.55 Percent of Billed Charges 78.94% $142.88 Percent of Billed Charges 74.00% $133.94 Percent of Billed Charges 92.50% $167.43 Percent of Billed Charges 55.00% $99.55 Percent of Billed Charges 85.00% $153.85 Percent of Billed Charges 63.00% $114.03 Percent of Billed Charges 63.00% $114.03 Percent of Billed Charges 75.00% $135.75 Percent of Billed Charges 66.24% $119.89 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $287.79 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $108.60 Percent of Billed Charges HC CT/NG NAA LABCORP 300 CPT 87491 90 Outpatient $11.50 $5.70 $67.11 $11.50 $191.20 $11.50 Fee Schedule $191.20 $11.50 Fee Schedule $305.98 $11.50 Fee Schedule 74.74% $8.60 Percent of Billed Charges 68.24% $7.85 Percent of Billed Charges 65.00% $7.48 Percent of Billed Charges 67.00% $7.71 Percent of Billed Charges 77.50% $8.91 Percent of Billed Charges 79.97% $9.20 Percent of Billed Charges 55.00% $6.33 Percent of Billed Charges 49.55% $5.70 Percent of Billed Charges 55.00% $6.33 Percent of Billed Charges 55.00% $6.33 Percent of Billed Charges 78.94% $9.08 Percent of Billed Charges 74.00% $8.51 Percent of Billed Charges 92.50% $10.64 Percent of Billed Charges 55.00% $6.33 Percent of Billed Charges 85.00% $9.78 Percent of Billed Charges 63.00% $7.25 Percent of Billed Charges 63.00% $7.25 Percent of Billed Charges 75.00% $8.63 Percent of Billed Charges 66.24% $7.62 Percent of Billed Charges 165.81% $11.50 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $18.29 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $6.90 Percent of Billed Charges HC CT/NG NAA LABCORP 300 CPT 87591 90 Outpatient $10.00 $4.96 $67.11 $10.00 $191.20 $10.00 Fee Schedule $191.20 $10.00 Fee Schedule $305.98 $10.00 Fee Schedule 74.74% $7.47 Percent of Billed Charges 68.24% $6.82 Percent of Billed Charges 65.00% $6.50 Percent of Billed Charges 67.00% $6.70 Percent of Billed Charges 77.50% $7.75 Percent of Billed Charges 79.97% $8.00 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 49.55% $4.96 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 78.94% $7.89 Percent of Billed Charges 74.00% $7.40 Percent of Billed Charges 92.50% $9.25 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 85.00% $8.50 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 75.00% $7.50 Percent of Billed Charges 66.24% $6.62 Percent of Billed Charges 165.81% $10.00 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $15.90 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $6.00 Percent of Billed Charges HC C-TELOPEPTIDE (CTX) LABCORP 300 CPT 82523 90 Outpatient $69.50 $24.10 $110.51 $69.50 $101.84 $69.50 Fee Schedule $101.84 $69.50 Fee Schedule $162.89 $69.50 Fee Schedule 74.74% $51.94 Percent of Billed Charges 68.24% $47.43 Percent of Billed Charges 65.00% $45.18 Percent of Billed Charges 67.00% $46.57 Percent of Billed Charges 77.50% $53.86 Percent of Billed Charges 79.97% $55.58 Percent of Billed Charges 55.00% $38.23 Percent of Billed Charges 49.55% $34.44 Percent of Billed Charges 55.00% $38.23 Percent of Billed Charges 55.00% $38.23 Percent of Billed Charges 78.94% $54.86 Percent of Billed Charges 74.00% $51.43 Percent of Billed Charges 92.50% $64.29 Percent of Billed Charges 55.00% $38.23 Percent of Billed Charges 85.00% $59.08 Percent of Billed Charges 63.00% $43.79 Percent of Billed Charges 63.00% $43.79 Percent of Billed Charges 75.00% $52.13 Percent of Billed Charges 66.24% $46.04 Percent of Billed Charges 165.81% $30.97 Fee Schedule 166.07% $31.02 Fee Schedule 176.26% $32.93 Fee Schedule 129.00% $24.10 Fee Schedule 191.24% $35.72 Fee Schedule 159.00% $110.51 Fee Schedule 145.00% $27.09 Fee Schedule 60.00% $41.70 Percent of Billed Charges HC CTNGMYCO LABCORP 300 CPT 87798 90 Outpatient $32.45 $16.08 $67.11 $32.45 $191.20 $32.45 Fee Schedule $191.20 $32.45 Fee Schedule $305.98 $32.45 Fee Schedule 74.74% $24.25 Percent of Billed Charges 68.24% $22.14 Percent of Billed Charges 65.00% $21.09 Percent of Billed Charges 67.00% $21.74 Percent of Billed Charges 77.50% $25.15 Percent of Billed Charges 79.97% $25.95 Percent of Billed Charges 55.00% $17.85 Percent of Billed Charges 49.55% $16.08 Percent of Billed Charges 55.00% $17.85 Percent of Billed Charges 55.00% $17.85 Percent of Billed Charges 78.94% $25.62 Percent of Billed Charges 74.00% $24.01 Percent of Billed Charges 92.50% $30.02 Percent of Billed Charges 55.00% $17.85 Percent of Billed Charges 85.00% $27.58 Percent of Billed Charges 63.00% $20.44 Percent of Billed Charges 63.00% $20.44 Percent of Billed Charges 75.00% $24.34 Percent of Billed Charges 66.24% $21.49 Percent of Billed Charges 165.81% $32.45 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $51.60 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $19.47 Percent of Billed Charges HC CVM DNA QN RT PCR 300 CPT 87497 90 Outpatient $88.00 $43.60 $139.92 $88.00 $233.40 $88.00 Fee Schedule $233.40 $88.00 Fee Schedule $373.56 $88.00 Fee Schedule 74.74% $65.77 Percent of Billed Charges 68.24% $60.05 Percent of Billed Charges 65.00% $57.20 Percent of Billed Charges 67.00% $58.96 Percent of Billed Charges 77.50% $68.20 Percent of Billed Charges 79.97% $70.37 Percent of Billed Charges 55.00% $48.40 Percent of Billed Charges 49.55% $43.60 Percent of Billed Charges 55.00% $48.40 Percent of Billed Charges 55.00% $48.40 Percent of Billed Charges 78.94% $69.47 Percent of Billed Charges 74.00% $65.12 Percent of Billed Charges 92.50% $81.40 Percent of Billed Charges 55.00% $48.40 Percent of Billed Charges 85.00% $74.80 Percent of Billed Charges 63.00% $55.44 Percent of Billed Charges 63.00% $55.44 Percent of Billed Charges 75.00% $66.00 Percent of Billed Charges 66.24% $58.29 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $139.92 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $52.80 Percent of Billed Charges "HC CYANIDE,BLOOD QUEST" 300 CPT 82600 90 Outpatient $15.00 $7.43 $37.10 $15.00 $105.72 $15.00 Fee Schedule $105.72 $15.00 Fee Schedule $169.17 $15.00 Fee Schedule 74.74% $11.21 Percent of Billed Charges 68.24% $10.24 Percent of Billed Charges 65.00% $9.75 Percent of Billed Charges 67.00% $10.05 Percent of Billed Charges 77.50% $11.63 Percent of Billed Charges 79.97% $12.00 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 49.55% $7.43 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 78.94% $11.84 Percent of Billed Charges 74.00% $11.10 Percent of Billed Charges 92.50% $13.88 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 85.00% $12.75 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 75.00% $11.25 Percent of Billed Charges 66.24% $9.94 Percent of Billed Charges 165.81% $15.00 Fee Schedule 166.07% $32.22 Fee Schedule 176.26% $34.19 Fee Schedule 129.00% $25.03 Fee Schedule 191.24% $37.10 Fee Schedule 159.00% $23.85 Fee Schedule 145.00% $28.13 Fee Schedule 60.00% $9.00 Percent of Billed Charges HC CYCLOSPORINE ARUP 300 CPT 80158 90 Outpatient $26.75 $13.25 $42.53 $26.75 $98.36 $26.75 Fee Schedule $98.36 $26.75 Fee Schedule $157.40 $26.75 Fee Schedule 74.74% $19.99 Percent of Billed Charges 68.24% $18.25 Percent of Billed Charges 65.00% $17.39 Percent of Billed Charges 67.00% $17.92 Percent of Billed Charges 77.50% $20.73 Percent of Billed Charges 79.97% $21.39 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 49.55% $13.25 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 78.94% $21.12 Percent of Billed Charges 74.00% $19.80 Percent of Billed Charges 92.50% $24.74 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 85.00% $22.74 Percent of Billed Charges 63.00% $16.85 Percent of Billed Charges 63.00% $16.85 Percent of Billed Charges 75.00% $20.06 Percent of Billed Charges 66.24% $17.72 Percent of Billed Charges 165.81% $26.75 Fee Schedule 166.07% $29.98 Fee Schedule 176.26% $31.81 Fee Schedule 129.00% $23.28 Fee Schedule 191.24% $34.52 Fee Schedule 159.00% $42.53 Fee Schedule 145.00% $26.17 Fee Schedule 60.00% $16.05 Percent of Billed Charges HC CYSTATIN C LABCORP 300 CPT 82610 90 Outpatient $85.00 $23.89 $135.15 $85.00 $74.08 $74.08 Fee Schedule $74.08 $74.08 Fee Schedule $161.49 $85.00 Fee Schedule 74.74% $63.53 Percent of Billed Charges 68.24% $58.00 Percent of Billed Charges 65.00% $55.25 Percent of Billed Charges 67.00% $56.95 Percent of Billed Charges 77.50% $65.88 Percent of Billed Charges 79.97% $67.97 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 49.55% $42.12 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 78.94% $67.10 Percent of Billed Charges 74.00% $62.90 Percent of Billed Charges 92.50% $78.63 Percent of Billed Charges 55.00% $46.75 Percent of Billed Charges 85.00% $72.25 Percent of Billed Charges 63.00% $53.55 Percent of Billed Charges 63.00% $53.55 Percent of Billed Charges 75.00% $63.75 Percent of Billed Charges 66.24% $56.30 Percent of Billed Charges 165.81% $30.71 Fee Schedule 166.07% $30.76 Fee Schedule 176.26% $32.64 Fee Schedule 129.00% $23.89 Fee Schedule 191.24% $35.42 Fee Schedule 159.00% $135.15 Fee Schedule 145.00% $26.85 Fee Schedule 60.00% $51.00 Percent of Billed Charges HC CYSTIC FIBROSIS SCREEN QUEST 300 CPT 81220 90 Outpatient $150.00 $74.33 $480.89 $150.00 " $2,226.40 " $150.00 Fee Schedule " $2,226.40 " $150.00 Fee Schedule " $4,853.55 " $150.00 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $150.00 Fee Schedule 166.07% $417.60 Fee Schedule 176.26% $443.22 Fee Schedule 129.00% $324.38 Fee Schedule 191.24% $480.89 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $364.62 Fee Schedule 60.00% $90.00 Percent of Billed Charges HC CYSTICERCUSAB/BLD ARUP 300 CPT 86682 90 Outpatient $21.40 $10.60 $34.03 $21.40 $70.88 $21.40 Fee Schedule $70.88 $21.40 Fee Schedule $113.45 $21.40 Fee Schedule 74.74% $15.99 Percent of Billed Charges 68.24% $14.60 Percent of Billed Charges 65.00% $13.91 Percent of Billed Charges 67.00% $14.34 Percent of Billed Charges 77.50% $16.59 Percent of Billed Charges 79.97% $17.11 Percent of Billed Charges 55.00% $11.77 Percent of Billed Charges 49.55% $10.60 Percent of Billed Charges 55.00% $11.77 Percent of Billed Charges 55.00% $11.77 Percent of Billed Charges 78.94% $16.89 Percent of Billed Charges 74.00% $15.84 Percent of Billed Charges 92.50% $19.80 Percent of Billed Charges 55.00% $11.77 Percent of Billed Charges 85.00% $18.19 Percent of Billed Charges 63.00% $13.48 Percent of Billed Charges 63.00% $13.48 Percent of Billed Charges 75.00% $16.05 Percent of Billed Charges 66.24% $14.18 Percent of Billed Charges 165.81% $21.40 Fee Schedule 166.07% $21.61 Fee Schedule 176.26% $22.93 Fee Schedule 129.00% $16.78 Fee Schedule 191.24% $24.88 Fee Schedule 159.00% $34.03 Fee Schedule 145.00% $18.86 Fee Schedule 60.00% $12.84 Percent of Billed Charges "HC CYSTINE URINE,QUANT ARUP" 300 CPT 82131 90 Outpatient $68.05 $29.64 $108.20 $68.05 $91.92 $68.05 Fee Schedule $91.92 $68.05 Fee Schedule $200.39 $68.05 Fee Schedule 74.74% $50.86 Percent of Billed Charges 68.24% $46.44 Percent of Billed Charges 65.00% $44.23 Percent of Billed Charges 67.00% $45.59 Percent of Billed Charges 77.50% $52.74 Percent of Billed Charges 79.97% $54.42 Percent of Billed Charges 55.00% $37.43 Percent of Billed Charges 49.55% $33.72 Percent of Billed Charges 55.00% $37.43 Percent of Billed Charges 55.00% $37.43 Percent of Billed Charges 78.94% $53.72 Percent of Billed Charges 74.00% $50.36 Percent of Billed Charges 92.50% $62.95 Percent of Billed Charges 55.00% $37.43 Percent of Billed Charges 85.00% $57.84 Percent of Billed Charges 63.00% $42.87 Percent of Billed Charges 63.00% $42.87 Percent of Billed Charges 75.00% $51.04 Percent of Billed Charges 66.24% $45.08 Percent of Billed Charges 165.81% $38.10 Fee Schedule 166.07% $38.16 Fee Schedule 176.26% $40.50 Fee Schedule 129.00% $29.64 Fee Schedule 191.24% $43.95 Fee Schedule 159.00% $108.20 Fee Schedule 145.00% $33.32 Fee Schedule 60.00% $40.83 Percent of Billed Charges HC CYTOGEN INTERP/REPORT QUE 300 CPT 88291 90 Outpatient $114.63 $56.80 $182.26 $114.63 $128.88 $114.63 Fee Schedule $128.88 $114.63 Fee Schedule 56.78% $65.09 Percent of Billed Charges 74.74% $85.67 Percent of Billed Charges 68.24% $78.22 Percent of Billed Charges 65.00% $74.51 Percent of Billed Charges 67.00% $76.80 Percent of Billed Charges 77.50% $88.84 Percent of Billed Charges 79.97% $91.67 Percent of Billed Charges 55.00% $63.05 Percent of Billed Charges 49.55% $56.80 Percent of Billed Charges 55.00% $63.05 Percent of Billed Charges 55.00% $63.05 Percent of Billed Charges 78.94% $90.49 Percent of Billed Charges 74.00% $84.83 Percent of Billed Charges 92.50% $106.03 Percent of Billed Charges 55.00% $63.05 Percent of Billed Charges 85.00% $97.44 Percent of Billed Charges 63.00% $72.22 Percent of Billed Charges 63.00% $72.22 Percent of Billed Charges 75.00% $85.97 Percent of Billed Charges 66.24% $75.93 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $182.26 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $68.78 Percent of Billed Charges HC CYTOLOGY URINE ARUP 300 CPT 88108 90 Outpatient $87.00 $43.11 $197.70 $87.00 $122.04 $87.00 Fee Schedule $122.04 $87.00 Fee Schedule 56.78% $49.40 Percent of Billed Charges 74.74% $65.02 Percent of Billed Charges 68.24% $59.37 Percent of Billed Charges 65.00% $56.55 Percent of Billed Charges 67.00% $58.29 Percent of Billed Charges 77.50% $67.43 Percent of Billed Charges 79.97% $69.57 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 49.55% $43.11 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 78.94% $68.68 Percent of Billed Charges 74.00% $64.38 Percent of Billed Charges 92.50% $80.48 Percent of Billed Charges 55.00% $47.85 Percent of Billed Charges 85.00% $73.95 Percent of Billed Charges 63.00% $54.81 Percent of Billed Charges 63.00% $54.81 Percent of Billed Charges 75.00% $65.25 Percent of Billed Charges 66.24% $57.63 Percent of Billed Charges 165.81% $87.00 Fee Schedule 166.07% $171.68 Fee Schedule 176.26% $182.22 Fee Schedule 129.00% $133.36 Fee Schedule 191.24% $197.70 Fee Schedule 159.00% $138.33 Fee Schedule 145.00% $149.90 Fee Schedule 60.00% $52.20 Percent of Billed Charges "HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED" 300 CPT 87496 Outpatient $468.00 $45.27 $744.12 $468.00 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $290.19 Fee Schedule 74.74% $349.78 Percent of Billed Charges 68.24% $319.36 Percent of Billed Charges 65.00% $304.20 Percent of Billed Charges 67.00% $313.56 Percent of Billed Charges 77.50% $362.70 Percent of Billed Charges 79.97% $374.26 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 49.55% $231.89 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 78.94% $369.44 Percent of Billed Charges 74.00% $346.32 Percent of Billed Charges 92.50% $432.90 Percent of Billed Charges 55.00% $257.40 Percent of Billed Charges 85.00% $397.80 Percent of Billed Charges 63.00% $294.84 Percent of Billed Charges 63.00% $294.84 Percent of Billed Charges 75.00% $351.00 Percent of Billed Charges 66.24% $310.00 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $744.12 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $280.80 Percent of Billed Charges HC DAU BREAST MILK NMS 300 CPT 80307 90 Outpatient $348.00 $80.16 $553.32 $348.00 $319.24 $319.24 Fee Schedule $319.24 $319.24 Fee Schedule $541.86 $312.00 Fee Schedule 74.74% $260.10 Percent of Billed Charges 68.24% $237.48 Percent of Billed Charges 65.00% $226.20 Percent of Billed Charges 67.00% $233.16 Percent of Billed Charges 77.50% $269.70 Percent of Billed Charges 79.97% $278.30 Percent of Billed Charges 55.00% $191.40 Percent of Billed Charges 49.55% $172.43 Percent of Billed Charges 55.00% $191.40 Percent of Billed Charges 55.00% $191.40 Percent of Billed Charges 78.94% $274.71 Percent of Billed Charges 74.00% $257.52 Percent of Billed Charges 92.50% $321.90 Percent of Billed Charges 55.00% $191.40 Percent of Billed Charges 85.00% $295.80 Percent of Billed Charges 63.00% $219.24 Percent of Billed Charges 63.00% $219.24 Percent of Billed Charges 75.00% $261.00 Percent of Billed Charges 66.24% $230.52 Percent of Billed Charges 165.81% $103.03 Fee Schedule 166.07% $103.20 Fee Schedule 176.26% $109.53 Fee Schedule 129.00% $80.16 Fee Schedule 191.24% $118.84 Fee Schedule 159.00% $553.32 Fee Schedule 145.00% $90.10 Fee Schedule 60.00% $208.80 Percent of Billed Charges HC DENGUE FEVER ABS ARUP 300 CPT 86790 90 Outpatient $38.06 $16.62 $60.52 $38.06 $70.20 $38.06 Fee Schedule $70.20 $38.06 Fee Schedule $112.31 $38.06 Fee Schedule 74.74% $28.45 Percent of Billed Charges 68.24% $25.97 Percent of Billed Charges 65.00% $24.74 Percent of Billed Charges 67.00% $25.50 Percent of Billed Charges 77.50% $29.50 Percent of Billed Charges 79.97% $30.44 Percent of Billed Charges 55.00% $20.93 Percent of Billed Charges 49.55% $18.86 Percent of Billed Charges 55.00% $20.93 Percent of Billed Charges 55.00% $20.93 Percent of Billed Charges 78.94% $30.04 Percent of Billed Charges 74.00% $28.16 Percent of Billed Charges 92.50% $35.21 Percent of Billed Charges 55.00% $20.93 Percent of Billed Charges 85.00% $32.35 Percent of Billed Charges 63.00% $23.98 Percent of Billed Charges 63.00% $23.98 Percent of Billed Charges 75.00% $28.55 Percent of Billed Charges 66.24% $25.21 Percent of Billed Charges 165.81% $21.36 Fee Schedule 166.07% $21.39 Fee Schedule 176.26% $22.70 Fee Schedule 129.00% $16.62 Fee Schedule 191.24% $24.63 Fee Schedule 159.00% $60.52 Fee Schedule 145.00% $18.68 Fee Schedule 60.00% $22.84 Percent of Billed Charges HC DEOXYCORTICOSTERONE LABCORP 300 CPT 82633 90 Outpatient $55.00 $27.25 $87.45 $55.00 $168.80 $55.00 Fee Schedule $168.80 $55.00 Fee Schedule $270.15 $55.00 Fee Schedule 74.74% $41.11 Percent of Billed Charges 68.24% $37.53 Percent of Billed Charges 65.00% $35.75 Percent of Billed Charges 67.00% $36.85 Percent of Billed Charges 77.50% $42.63 Percent of Billed Charges 79.97% $43.98 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 49.55% $27.25 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 78.94% $43.42 Percent of Billed Charges 74.00% $40.70 Percent of Billed Charges 92.50% $50.88 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 85.00% $46.75 Percent of Billed Charges 63.00% $34.65 Percent of Billed Charges 63.00% $34.65 Percent of Billed Charges 75.00% $41.25 Percent of Billed Charges 66.24% $36.43 Percent of Billed Charges 165.81% $51.37 Fee Schedule 166.07% $51.45 Fee Schedule 176.26% $54.61 Fee Schedule 129.00% $39.96 Fee Schedule 191.24% $59.25 Fee Schedule 159.00% $87.45 Fee Schedule 145.00% $44.92 Fee Schedule 60.00% $33.00 Percent of Billed Charges "HC DETECT AGENT NOS, DNA, AMP - ADDITIONAL CHARGE" 300 CPT 87798 Outpatient $416.00 $45.27 $661.44 $416.00 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $290.19 Fee Schedule 74.74% $310.92 Percent of Billed Charges 68.24% $283.88 Percent of Billed Charges 65.00% $270.40 Percent of Billed Charges 67.00% $278.72 Percent of Billed Charges 77.50% $322.40 Percent of Billed Charges 79.97% $332.68 Percent of Billed Charges 55.00% $228.80 Percent of Billed Charges 49.55% $206.13 Percent of Billed Charges 55.00% $228.80 Percent of Billed Charges 55.00% $228.80 Percent of Billed Charges 78.94% $328.39 Percent of Billed Charges 74.00% $307.84 Percent of Billed Charges 92.50% $384.80 Percent of Billed Charges 55.00% $228.80 Percent of Billed Charges 85.00% $353.60 Percent of Billed Charges 63.00% $262.08 Percent of Billed Charges 63.00% $262.08 Percent of Billed Charges 75.00% $312.00 Percent of Billed Charges 66.24% $275.56 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $661.44 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $249.60 Percent of Billed Charges HC DHEA LABCORP 300 CPT 82626 90 Outpatient $5.00 $2.48 $48.33 $5.00 $137.68 $5.00 Fee Schedule $137.68 $5.00 Fee Schedule $220.35 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $41.97 Fee Schedule 176.26% $44.54 Fee Schedule 129.00% $32.60 Fee Schedule 191.24% $48.33 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $36.64 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC DHEA SULFATE LABCORP 300 CPT 82627 90 Outpatient $4.00 $1.98 $42.51 $4.00 $121.16 $4.00 Fee Schedule $121.16 $4.00 Fee Schedule $193.85 $4.00 Fee Schedule 74.74% $2.99 Percent of Billed Charges 68.24% $2.73 Percent of Billed Charges 65.00% $2.60 Percent of Billed Charges 67.00% $2.68 Percent of Billed Charges 77.50% $3.10 Percent of Billed Charges 79.97% $3.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 49.55% $1.98 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 78.94% $3.16 Percent of Billed Charges 74.00% $2.96 Percent of Billed Charges 92.50% $3.70 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 85.00% $3.40 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 75.00% $3.00 Percent of Billed Charges 66.24% $2.65 Percent of Billed Charges 165.81% $4.00 Fee Schedule 166.07% $36.92 Fee Schedule 176.26% $39.18 Fee Schedule 129.00% $28.68 Fee Schedule 191.24% $42.51 Fee Schedule 159.00% $6.36 Fee Schedule 145.00% $32.23 Fee Schedule 60.00% $2.40 Percent of Billed Charges HC DHT LABCORP 300 CPT G0480 90 Outpatient $90.00 $44.60 $170.85 $90.00 $319.76 $90.00 Fee Schedule $319.76 $90.00 Fee Schedule $997.83 $90.00 Fee Schedule 74.74% $67.27 Percent of Billed Charges 68.24% $61.42 Percent of Billed Charges 65.00% $58.50 Percent of Billed Charges 67.00% $60.30 Percent of Billed Charges 77.50% $69.75 Percent of Billed Charges 79.97% $71.97 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 49.55% $44.60 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 78.94% $71.05 Percent of Billed Charges 74.00% $66.60 Percent of Billed Charges 92.50% $83.25 Percent of Billed Charges 55.00% $49.50 Percent of Billed Charges 85.00% $76.50 Percent of Billed Charges 63.00% $56.70 Percent of Billed Charges 63.00% $56.70 Percent of Billed Charges 75.00% $67.50 Percent of Billed Charges 66.24% $59.62 Percent of Billed Charges 165.81% $90.00 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $143.10 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $54.00 Percent of Billed Charges "HC DHT, FREE LABCORP" 300 CPT 84999 90 Outpatient $255.00 $- $405.45 $255.00 50.00% $127.50 Percent of Billed Charges 50.00% $127.50 Percent of Billed Charges 56.78% $144.79 Percent of Billed Charges 74.74% $190.59 Percent of Billed Charges 68.24% $174.01 Percent of Billed Charges 65.00% $165.75 Percent of Billed Charges 67.00% $170.85 Percent of Billed Charges 77.50% $197.63 Percent of Billed Charges 79.97% $203.92 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 49.55% $126.35 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 78.94% $201.30 Percent of Billed Charges 74.00% $188.70 Percent of Billed Charges 92.50% $235.88 Percent of Billed Charges 55.00% $140.25 Percent of Billed Charges 85.00% $216.75 Percent of Billed Charges 63.00% $160.65 Percent of Billed Charges 63.00% $160.65 Percent of Billed Charges 75.00% $191.25 Percent of Billed Charges 66.24% $168.91 Percent of Billed Charges 35.00% $89.25 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $405.45 Fee Schedule 145.00% $- Fee Schedule 60.00% $153.00 Percent of Billed Charges HC DIGOXIN ST. AGNES 300 CPT 80162 90 Outpatient $106.40 $17.13 $169.18 $106.40 $72.36 $72.36 Fee Schedule $72.36 $72.36 Fee Schedule $115.80 $106.40 Fee Schedule 74.74% $79.52 Percent of Billed Charges 68.24% $72.61 Percent of Billed Charges 65.00% $69.16 Percent of Billed Charges 67.00% $71.29 Percent of Billed Charges 77.50% $82.46 Percent of Billed Charges 79.97% $85.09 Percent of Billed Charges 55.00% $58.52 Percent of Billed Charges 49.55% $52.72 Percent of Billed Charges 55.00% $58.52 Percent of Billed Charges 55.00% $58.52 Percent of Billed Charges 78.94% $83.99 Percent of Billed Charges 74.00% $78.74 Percent of Billed Charges 92.50% $98.42 Percent of Billed Charges 55.00% $58.52 Percent of Billed Charges 85.00% $90.44 Percent of Billed Charges 63.00% $67.03 Percent of Billed Charges 63.00% $67.03 Percent of Billed Charges 75.00% $79.80 Percent of Billed Charges 66.24% $70.48 Percent of Billed Charges 165.81% $22.02 Fee Schedule 166.07% $22.05 Fee Schedule 176.26% $23.41 Fee Schedule 129.00% $17.13 Fee Schedule 191.24% $25.40 Fee Schedule 159.00% $169.18 Fee Schedule 145.00% $19.26 Fee Schedule 60.00% $63.84 Percent of Billed Charges HC DIPTHERIA AB LABCORP 300 CPT 86317 90 Outpatient $6.50 $3.22 $28.67 $6.50 $81.68 $6.50 Fee Schedule $81.68 $6.50 Fee Schedule $130.71 $6.50 Fee Schedule 74.74% $4.86 Percent of Billed Charges 68.24% $4.44 Percent of Billed Charges 65.00% $4.23 Percent of Billed Charges 67.00% $4.36 Percent of Billed Charges 77.50% $5.04 Percent of Billed Charges 79.97% $5.20 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 49.55% $3.22 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 78.94% $5.13 Percent of Billed Charges 74.00% $4.81 Percent of Billed Charges 92.50% $6.01 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 85.00% $5.53 Percent of Billed Charges 63.00% $4.10 Percent of Billed Charges 63.00% $4.10 Percent of Billed Charges 75.00% $4.88 Percent of Billed Charges 66.24% $4.31 Percent of Billed Charges 165.81% $6.50 Fee Schedule 166.07% $24.89 Fee Schedule 176.26% $26.42 Fee Schedule 129.00% $19.34 Fee Schedule 191.24% $28.67 Fee Schedule 159.00% $10.34 Fee Schedule 145.00% $21.74 Fee Schedule 60.00% $3.90 Percent of Billed Charges HC DISACCHARIDASES LABCORP 300 CPT 82657 90 Outpatient $75.00 $28.60 $119.25 $75.00 $98.40 $75.00 Fee Schedule $98.40 $75.00 Fee Schedule $193.32 $115.00 Fee Schedule 74.74% $56.06 Percent of Billed Charges 68.24% $51.18 Percent of Billed Charges 65.00% $48.75 Percent of Billed Charges 67.00% $50.25 Percent of Billed Charges 77.50% $58.13 Percent of Billed Charges 79.97% $59.98 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 49.55% $37.16 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 78.94% $59.21 Percent of Billed Charges 74.00% $55.50 Percent of Billed Charges 92.50% $69.38 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 85.00% $63.75 Percent of Billed Charges 63.00% $47.25 Percent of Billed Charges 63.00% $47.25 Percent of Billed Charges 75.00% $56.25 Percent of Billed Charges 66.24% $49.68 Percent of Billed Charges 165.81% $36.76 Fee Schedule 166.07% $36.82 Fee Schedule 176.26% $39.08 Fee Schedule 129.00% $28.60 Fee Schedule 191.24% $42.40 Fee Schedule 159.00% $119.25 Fee Schedule 145.00% $32.15 Fee Schedule 60.00% $45.00 Percent of Billed Charges HC DOSE ASSURE 300 CPT 80299 90 Outpatient $200.00 $24.05 $318.00 $200.00 $74.64 $74.64 Fee Schedule $74.64 $74.64 Fee Schedule $162.54 $154.15 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 165.81% $30.91 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $120.00 Percent of Billed Charges HC DOSE ASSURE CHEMILUMINESCENT ASSAY 300 CPT 82397 90 Outpatient $200.00 $18.21 $318.00 $200.00 $76.96 $76.96 Fee Schedule $76.96 $76.96 Fee Schedule $123.13 $116.77 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 165.81% $23.41 Fee Schedule 166.07% $23.45 Fee Schedule 176.26% $24.89 Fee Schedule 129.00% $18.21 Fee Schedule 191.24% $27.00 Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $20.47 Fee Schedule 60.00% $120.00 Percent of Billed Charges HC DRVVT 300 CPT 85613 90 Outpatient $12.63 $6.26 $20.08 $12.63 $52.20 $12.63 Fee Schedule $52.20 $12.63 Fee Schedule $83.54 $12.63 Fee Schedule 74.74% $9.44 Percent of Billed Charges 68.24% $8.62 Percent of Billed Charges 65.00% $8.21 Percent of Billed Charges 67.00% $8.46 Percent of Billed Charges 77.50% $9.79 Percent of Billed Charges 79.97% $10.10 Percent of Billed Charges 55.00% $6.95 Percent of Billed Charges 49.55% $6.26 Percent of Billed Charges 55.00% $6.95 Percent of Billed Charges 55.00% $6.95 Percent of Billed Charges 78.94% $9.97 Percent of Billed Charges 74.00% $9.35 Percent of Billed Charges 92.50% $11.68 Percent of Billed Charges 55.00% $6.95 Percent of Billed Charges 85.00% $10.74 Percent of Billed Charges 63.00% $7.96 Percent of Billed Charges 63.00% $7.96 Percent of Billed Charges 75.00% $9.47 Percent of Billed Charges 66.24% $8.37 Percent of Billed Charges 165.81% $12.63 Fee Schedule 166.07% $15.91 Fee Schedule 176.26% $16.89 Fee Schedule 129.00% $12.36 Fee Schedule 191.24% $18.32 Fee Schedule 159.00% $20.08 Fee Schedule 145.00% $13.89 Fee Schedule 60.00% $7.58 Percent of Billed Charges HC E CHAFFEENSIS ABS ARUP 300 CPT 86666 90 Outpatient $28.38 $13.13 $45.12 $28.38 $55.48 $28.38 Fee Schedule $55.48 $28.38 Fee Schedule $88.77 $28.38 Fee Schedule 74.74% $21.21 Percent of Billed Charges 68.24% $19.37 Percent of Billed Charges 65.00% $18.45 Percent of Billed Charges 67.00% $19.01 Percent of Billed Charges 77.50% $21.99 Percent of Billed Charges 79.97% $22.70 Percent of Billed Charges 55.00% $15.61 Percent of Billed Charges 49.55% $14.06 Percent of Billed Charges 55.00% $15.61 Percent of Billed Charges 55.00% $15.61 Percent of Billed Charges 78.94% $22.40 Percent of Billed Charges 74.00% $21.00 Percent of Billed Charges 92.50% $26.25 Percent of Billed Charges 55.00% $15.61 Percent of Billed Charges 85.00% $24.12 Percent of Billed Charges 63.00% $17.88 Percent of Billed Charges 63.00% $17.88 Percent of Billed Charges 75.00% $21.29 Percent of Billed Charges 66.24% $18.80 Percent of Billed Charges 165.81% $16.88 Fee Schedule 166.07% $16.91 Fee Schedule 176.26% $17.94 Fee Schedule 129.00% $13.13 Fee Schedule 191.24% $19.47 Fee Schedule 159.00% $45.12 Fee Schedule 145.00% $14.76 Fee Schedule 60.00% $17.03 Percent of Billed Charges HC EBV DNA QL RT PCR 300 CPT 87798 90 Outpatient $135.00 $45.27 $214.65 $135.00 $191.20 $135.00 Fee Schedule $191.20 $135.00 Fee Schedule $305.98 $135.00 Fee Schedule 74.74% $100.90 Percent of Billed Charges 68.24% $92.12 Percent of Billed Charges 65.00% $87.75 Percent of Billed Charges 67.00% $90.45 Percent of Billed Charges 77.50% $104.63 Percent of Billed Charges 79.97% $107.96 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 49.55% $66.89 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 78.94% $106.57 Percent of Billed Charges 74.00% $99.90 Percent of Billed Charges 92.50% $124.88 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 85.00% $114.75 Percent of Billed Charges 63.00% $85.05 Percent of Billed Charges 63.00% $85.05 Percent of Billed Charges 75.00% $101.25 Percent of Billed Charges 66.24% $89.42 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $214.65 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $81.00 Percent of Billed Charges "HC EBV DNA, QN RT PCR QUEST" 300 CPT 87799 90 Outpatient $135.00 $55.26 $214.65 $135.00 $233.40 $135.00 Fee Schedule $233.40 $135.00 Fee Schedule $373.56 $135.00 Fee Schedule 74.74% $100.90 Percent of Billed Charges 68.24% $92.12 Percent of Billed Charges 65.00% $87.75 Percent of Billed Charges 67.00% $90.45 Percent of Billed Charges 77.50% $104.63 Percent of Billed Charges 79.97% $107.96 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 49.55% $66.89 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 78.94% $106.57 Percent of Billed Charges 74.00% $99.90 Percent of Billed Charges 92.50% $124.88 Percent of Billed Charges 55.00% $74.25 Percent of Billed Charges 85.00% $114.75 Percent of Billed Charges 63.00% $85.05 Percent of Billed Charges 63.00% $85.05 Percent of Billed Charges 75.00% $101.25 Percent of Billed Charges 66.24% $89.42 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $214.65 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $81.00 Percent of Billed Charges HC EBV NUCLEAR AG AB LABCORP 300 CPT 86664 90 Outpatient $5.00 $2.48 $29.24 $5.00 $83.36 $5.00 Fee Schedule $83.36 $5.00 Fee Schedule $133.33 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $25.39 Fee Schedule 176.26% $26.95 Fee Schedule 129.00% $19.72 Fee Schedule 191.24% $29.24 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $22.17 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC EBV PANEL LABCORP 300 CPT 86663 90 Outpatient $5.00 $2.48 $25.09 $5.00 $71.48 $5.00 Fee Schedule $71.48 $5.00 Fee Schedule $114.41 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $21.79 Fee Schedule 176.26% $23.13 Fee Schedule 129.00% $16.92 Fee Schedule 191.24% $25.09 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $19.02 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC EBV PANEL LABCORP 300 CPT 86664 90 Outpatient $5.00 $2.48 $29.24 $5.00 $83.36 $5.00 Fee Schedule $83.36 $5.00 Fee Schedule $133.33 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $25.39 Fee Schedule 176.26% $26.95 Fee Schedule 129.00% $19.72 Fee Schedule 191.24% $29.24 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $22.17 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC EBV PANEL LABCORP 300 CPT 86665 90 Outpatient $4.00 $1.98 $34.69 $4.00 $98.88 $4.00 Fee Schedule $98.88 $4.00 Fee Schedule $158.18 $4.00 Fee Schedule 74.74% $2.99 Percent of Billed Charges 68.24% $2.73 Percent of Billed Charges 65.00% $2.60 Percent of Billed Charges 67.00% $2.68 Percent of Billed Charges 77.50% $3.10 Percent of Billed Charges 79.97% $3.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 49.55% $1.98 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 78.94% $3.16 Percent of Billed Charges 74.00% $2.96 Percent of Billed Charges 92.50% $3.70 Percent of Billed Charges 55.00% $2.20 Percent of Billed Charges 85.00% $3.40 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 63.00% $2.52 Percent of Billed Charges 75.00% $3.00 Percent of Billed Charges 66.24% $2.65 Percent of Billed Charges 165.81% $4.00 Fee Schedule 166.07% $30.13 Fee Schedule 176.26% $31.97 Fee Schedule 129.00% $23.40 Fee Schedule 191.24% $34.69 Fee Schedule 159.00% $6.36 Fee Schedule 145.00% $26.30 Fee Schedule 60.00% $2.40 Percent of Billed Charges HC EBV QUAL PCR LABCORP 300 CPT 87798 90 Outpatient $234.50 $45.27 $372.86 $234.50 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $234.50 Fee Schedule 74.74% $175.27 Percent of Billed Charges 68.24% $160.02 Percent of Billed Charges 65.00% $152.43 Percent of Billed Charges 67.00% $157.12 Percent of Billed Charges 77.50% $181.74 Percent of Billed Charges 79.97% $187.53 Percent of Billed Charges 55.00% $128.98 Percent of Billed Charges 49.55% $116.19 Percent of Billed Charges 55.00% $128.98 Percent of Billed Charges 55.00% $128.98 Percent of Billed Charges 78.94% $185.11 Percent of Billed Charges 74.00% $173.53 Percent of Billed Charges 92.50% $216.91 Percent of Billed Charges 55.00% $128.98 Percent of Billed Charges 85.00% $199.33 Percent of Billed Charges 63.00% $147.74 Percent of Billed Charges 63.00% $147.74 Percent of Billed Charges 75.00% $175.88 Percent of Billed Charges 66.24% $155.33 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $372.86 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $140.70 Percent of Billed Charges HC EBV QUANT PCR PLASMA LABCORP 300 CPT 87799 90 Outpatient $120.00 $55.26 $190.80 $120.00 $233.40 $120.00 Fee Schedule $233.40 $120.00 Fee Schedule $373.56 $120.00 Fee Schedule 74.74% $89.69 Percent of Billed Charges 68.24% $81.89 Percent of Billed Charges 65.00% $78.00 Percent of Billed Charges 67.00% $80.40 Percent of Billed Charges 77.50% $93.00 Percent of Billed Charges 79.97% $95.96 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 49.55% $59.46 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 78.94% $94.73 Percent of Billed Charges 74.00% $88.80 Percent of Billed Charges 92.50% $111.00 Percent of Billed Charges 55.00% $66.00 Percent of Billed Charges 85.00% $102.00 Percent of Billed Charges 63.00% $75.60 Percent of Billed Charges 63.00% $75.60 Percent of Billed Charges 75.00% $90.00 Percent of Billed Charges 66.24% $79.49 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $190.80 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $72.00 Percent of Billed Charges "HC EBV QUANT PCR, BLOOD LABCORP" 300 CPT 87799 90 Outpatient $435.25 $55.26 $692.05 $435.25 $233.40 $233.40 Fee Schedule $233.40 $233.40 Fee Schedule $373.56 $354.29 Fee Schedule 74.74% $325.31 Percent of Billed Charges 68.24% $297.01 Percent of Billed Charges 65.00% $282.91 Percent of Billed Charges 67.00% $291.62 Percent of Billed Charges 77.50% $337.32 Percent of Billed Charges 79.97% $348.07 Percent of Billed Charges 55.00% $239.39 Percent of Billed Charges 49.55% $215.67 Percent of Billed Charges 55.00% $239.39 Percent of Billed Charges 55.00% $239.39 Percent of Billed Charges 78.94% $343.59 Percent of Billed Charges 74.00% $322.09 Percent of Billed Charges 92.50% $402.61 Percent of Billed Charges 55.00% $239.39 Percent of Billed Charges 85.00% $369.96 Percent of Billed Charges 63.00% $274.21 Percent of Billed Charges 63.00% $274.21 Percent of Billed Charges 75.00% $326.44 Percent of Billed Charges 66.24% $288.31 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $692.05 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $261.15 Percent of Billed Charges HC ECHINOCOCCUS AB IGG ARUP 300 CPT 86682 90 Outpatient $20.70 $10.26 $32.91 $20.70 $70.88 $20.70 Fee Schedule $70.88 $20.70 Fee Schedule $113.45 $20.70 Fee Schedule 74.74% $15.47 Percent of Billed Charges 68.24% $14.13 Percent of Billed Charges 65.00% $13.46 Percent of Billed Charges 67.00% $13.87 Percent of Billed Charges 77.50% $16.04 Percent of Billed Charges 79.97% $16.55 Percent of Billed Charges 55.00% $11.39 Percent of Billed Charges 49.55% $10.26 Percent of Billed Charges 55.00% $11.39 Percent of Billed Charges 55.00% $11.39 Percent of Billed Charges 78.94% $16.34 Percent of Billed Charges 74.00% $15.32 Percent of Billed Charges 92.50% $19.15 Percent of Billed Charges 55.00% $11.39 Percent of Billed Charges 85.00% $17.60 Percent of Billed Charges 63.00% $13.04 Percent of Billed Charges 63.00% $13.04 Percent of Billed Charges 75.00% $15.53 Percent of Billed Charges 66.24% $13.71 Percent of Billed Charges 165.81% $20.70 Fee Schedule 166.07% $21.61 Fee Schedule 176.26% $22.93 Fee Schedule 129.00% $16.78 Fee Schedule 191.24% $24.88 Fee Schedule 159.00% $32.91 Fee Schedule 145.00% $18.86 Fee Schedule 60.00% $12.42 Percent of Billed Charges HC ECHO VIRUS TITER ARUP 300 CPT 86658 90 Outpatient $127.00 $16.81 $201.93 $127.00 $71.00 $71.00 Fee Schedule $71.00 $71.00 Fee Schedule $113.62 $107.76 Fee Schedule 74.74% $94.92 Percent of Billed Charges 68.24% $86.66 Percent of Billed Charges 65.00% $82.55 Percent of Billed Charges 67.00% $85.09 Percent of Billed Charges 77.50% $98.43 Percent of Billed Charges 79.97% $101.56 Percent of Billed Charges 55.00% $69.85 Percent of Billed Charges 49.55% $62.93 Percent of Billed Charges 55.00% $69.85 Percent of Billed Charges 55.00% $69.85 Percent of Billed Charges 78.94% $100.25 Percent of Billed Charges 74.00% $93.98 Percent of Billed Charges 92.50% $117.48 Percent of Billed Charges 55.00% $69.85 Percent of Billed Charges 85.00% $107.95 Percent of Billed Charges 63.00% $80.01 Percent of Billed Charges 63.00% $80.01 Percent of Billed Charges 75.00% $95.25 Percent of Billed Charges 66.24% $84.12 Percent of Billed Charges 165.81% $21.61 Fee Schedule 166.07% $21.64 Fee Schedule 176.26% $22.97 Fee Schedule 129.00% $16.81 Fee Schedule 191.24% $24.92 Fee Schedule 159.00% $201.93 Fee Schedule 145.00% $18.89 Fee Schedule 60.00% $76.20 Percent of Billed Charges HC ELECTROPHORESIS 300 CPT 82664 90 Outpatient $5.00 $2.48 $92.01 $5.00 $187.20 $5.00 Fee Schedule $187.20 $5.00 Fee Schedule $536.28 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $79.90 Fee Schedule 176.26% $84.80 Fee Schedule 129.00% $62.06 Fee Schedule 191.24% $92.01 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $69.76 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC ENC1 MAYO 300 CPT 83519 90 Outpatient $446.00 $23.74 $709.14 $446.00 $73.60 $73.60 Fee Schedule $73.60 $73.60 Fee Schedule $160.45 $152.17 Fee Schedule 74.74% $333.34 Percent of Billed Charges 68.24% $304.35 Percent of Billed Charges 65.00% $289.90 Percent of Billed Charges 67.00% $298.82 Percent of Billed Charges 77.50% $345.65 Percent of Billed Charges 79.97% $356.67 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 49.55% $220.99 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 78.94% $352.07 Percent of Billed Charges 74.00% $330.04 Percent of Billed Charges 92.50% $412.55 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 85.00% $379.10 Percent of Billed Charges 63.00% $280.98 Percent of Billed Charges 63.00% $280.98 Percent of Billed Charges 75.00% $334.50 Percent of Billed Charges 66.24% $295.43 Percent of Billed Charges 165.81% $30.51 Fee Schedule 166.07% $30.56 Fee Schedule 176.26% $32.43 Fee Schedule 129.00% $23.74 Fee Schedule 191.24% $35.19 Fee Schedule 159.00% $709.14 Fee Schedule 145.00% $26.68 Fee Schedule 60.00% $267.60 Percent of Billed Charges HC ENC1 MAYO 300 CPT 86255 90 Outpatient $447.00 $15.54 $710.73 $447.00 $65.64 $65.64 Fee Schedule $65.64 $65.64 Fee Schedule $105.08 $99.65 Fee Schedule 74.74% $334.09 Percent of Billed Charges 68.24% $305.03 Percent of Billed Charges 65.00% $290.55 Percent of Billed Charges 67.00% $299.49 Percent of Billed Charges 77.50% $346.43 Percent of Billed Charges 79.97% $357.47 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 49.55% $221.49 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 78.94% $352.86 Percent of Billed Charges 74.00% $330.78 Percent of Billed Charges 92.50% $413.48 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 85.00% $379.95 Percent of Billed Charges 63.00% $281.61 Percent of Billed Charges 63.00% $281.61 Percent of Billed Charges 75.00% $335.25 Percent of Billed Charges 66.24% $296.09 Percent of Billed Charges 165.81% $19.98 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% $710.73 Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $268.20 Percent of Billed Charges HC ENC1 MAYO 300 CPT 86341 90 Outpatient $447.00 $30.41 $710.73 $447.00 $107.80 $107.80 Fee Schedule $107.80 $107.80 Fee Schedule $205.53 $194.92 Fee Schedule 74.74% $334.09 Percent of Billed Charges 68.24% $305.03 Percent of Billed Charges 65.00% $290.55 Percent of Billed Charges 67.00% $299.49 Percent of Billed Charges 77.50% $346.43 Percent of Billed Charges 79.97% $357.47 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 49.55% $221.49 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 78.94% $352.86 Percent of Billed Charges 74.00% $330.78 Percent of Billed Charges 92.50% $413.48 Percent of Billed Charges 55.00% $245.85 Percent of Billed Charges 85.00% $379.95 Percent of Billed Charges 63.00% $281.61 Percent of Billed Charges 63.00% $281.61 Percent of Billed Charges 75.00% $335.25 Percent of Billed Charges 66.24% $296.09 Percent of Billed Charges 165.81% $39.08 Fee Schedule 166.07% $39.14 Fee Schedule 176.26% $41.54 Fee Schedule 129.00% $30.41 Fee Schedule 191.24% $45.08 Fee Schedule 159.00% $710.73 Fee Schedule 145.00% $34.18 Fee Schedule 60.00% $268.20 Percent of Billed Charges HC ENCEPHALOPATHY AUTOIMMUNE MAYO 300 CPT 83519 90 Outpatient $465.00 $23.74 $739.35 $465.00 $73.60 $73.60 Fee Schedule $73.60 $73.60 Fee Schedule $160.45 $152.17 Fee Schedule 74.74% $347.54 Percent of Billed Charges 68.24% $317.32 Percent of Billed Charges 65.00% $302.25 Percent of Billed Charges 67.00% $311.55 Percent of Billed Charges 77.50% $360.38 Percent of Billed Charges 79.97% $371.86 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 49.55% $230.41 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 78.94% $367.07 Percent of Billed Charges 74.00% $344.10 Percent of Billed Charges 92.50% $430.13 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 85.00% $395.25 Percent of Billed Charges 63.00% $292.95 Percent of Billed Charges 63.00% $292.95 Percent of Billed Charges 75.00% $348.75 Percent of Billed Charges 66.24% $308.02 Percent of Billed Charges 165.81% $30.51 Fee Schedule 166.07% $30.56 Fee Schedule 176.26% $32.43 Fee Schedule 129.00% $23.74 Fee Schedule 191.24% $35.19 Fee Schedule 159.00% $739.35 Fee Schedule 145.00% $26.68 Fee Schedule 60.00% $279.00 Percent of Billed Charges HC ENCEPHALOPATHY AUTOIMMUNE MAYO 300 CPT 86255 90 Outpatient $465.00 $15.54 $739.35 $465.00 $65.64 $65.64 Fee Schedule $65.64 $65.64 Fee Schedule $105.08 $99.65 Fee Schedule 74.74% $347.54 Percent of Billed Charges 68.24% $317.32 Percent of Billed Charges 65.00% $302.25 Percent of Billed Charges 67.00% $311.55 Percent of Billed Charges 77.50% $360.38 Percent of Billed Charges 79.97% $371.86 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 49.55% $230.41 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 78.94% $367.07 Percent of Billed Charges 74.00% $344.10 Percent of Billed Charges 92.50% $430.13 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 85.00% $395.25 Percent of Billed Charges 63.00% $292.95 Percent of Billed Charges 63.00% $292.95 Percent of Billed Charges 75.00% $348.75 Percent of Billed Charges 66.24% $308.02 Percent of Billed Charges 165.81% $19.98 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% $739.35 Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $279.00 Percent of Billed Charges HC ENCEPHALOPATHY AUTOIMMUNE MAYO 300 CPT 86341 90 Outpatient $465.00 $30.41 $739.35 $465.00 $107.80 $107.80 Fee Schedule $107.80 $107.80 Fee Schedule $205.53 $194.92 Fee Schedule 74.74% $347.54 Percent of Billed Charges 68.24% $317.32 Percent of Billed Charges 65.00% $302.25 Percent of Billed Charges 67.00% $311.55 Percent of Billed Charges 77.50% $360.38 Percent of Billed Charges 79.97% $371.86 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 49.55% $230.41 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 78.94% $367.07 Percent of Billed Charges 74.00% $344.10 Percent of Billed Charges 92.50% $430.13 Percent of Billed Charges 55.00% $255.75 Percent of Billed Charges 85.00% $395.25 Percent of Billed Charges 63.00% $292.95 Percent of Billed Charges 63.00% $292.95 Percent of Billed Charges 75.00% $348.75 Percent of Billed Charges 66.24% $308.02 Percent of Billed Charges 165.81% $39.08 Fee Schedule 166.07% $39.14 Fee Schedule 176.26% $41.54 Fee Schedule 129.00% $30.41 Fee Schedule 191.24% $45.08 Fee Schedule 159.00% $739.35 Fee Schedule 145.00% $34.18 Fee Schedule 60.00% $279.00 Percent of Billed Charges HC ENDOMYSIAL IGA LABCORP 300 CPT 86255 90 Outpatient $5.00 $2.48 $23.04 $5.00 $65.64 $5.00 Fee Schedule $65.64 $5.00 Fee Schedule $105.08 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC ENTAMOEBA HISTO AG ARUP 300 CPT 87337 90 Outpatient $22.23 $11.01 $35.35 $22.23 $65.32 $22.23 Fee Schedule $65.32 $22.23 Fee Schedule $104.47 $22.23 Fee Schedule 74.74% $16.61 Percent of Billed Charges 68.24% $15.17 Percent of Billed Charges 65.00% $14.45 Percent of Billed Charges 67.00% $14.89 Percent of Billed Charges 77.50% $17.23 Percent of Billed Charges 79.97% $17.78 Percent of Billed Charges 55.00% $12.23 Percent of Billed Charges 49.55% $11.01 Percent of Billed Charges 55.00% $12.23 Percent of Billed Charges 55.00% $12.23 Percent of Billed Charges 78.94% $17.55 Percent of Billed Charges 74.00% $16.45 Percent of Billed Charges 92.50% $20.56 Percent of Billed Charges 55.00% $12.23 Percent of Billed Charges 85.00% $18.90 Percent of Billed Charges 63.00% $14.00 Percent of Billed Charges 63.00% $14.00 Percent of Billed Charges 75.00% $16.67 Percent of Billed Charges 66.24% $14.73 Percent of Billed Charges 165.81% $19.86 Fee Schedule 166.07% $19.90 Fee Schedule 176.26% $21.12 Fee Schedule 129.00% $15.45 Fee Schedule 191.24% $22.91 Fee Schedule 159.00% $35.35 Fee Schedule 145.00% $17.37 Fee Schedule 60.00% $13.34 Percent of Billed Charges HC ENTAMOEBA HISTOLYTICA AB ARUP 300 CPT 86753 90 Outpatient $11.35 $5.62 $23.69 $11.35 $67.48 $11.35 Fee Schedule $67.48 $11.35 Fee Schedule $108.04 $11.35 Fee Schedule 74.74% $8.48 Percent of Billed Charges 68.24% $7.75 Percent of Billed Charges 65.00% $7.38 Percent of Billed Charges 67.00% $7.60 Percent of Billed Charges 77.50% $8.80 Percent of Billed Charges 79.97% $9.08 Percent of Billed Charges 55.00% $6.24 Percent of Billed Charges 49.55% $5.62 Percent of Billed Charges 55.00% $6.24 Percent of Billed Charges 55.00% $6.24 Percent of Billed Charges 78.94% $8.96 Percent of Billed Charges 74.00% $8.40 Percent of Billed Charges 92.50% $10.50 Percent of Billed Charges 55.00% $6.24 Percent of Billed Charges 85.00% $9.65 Percent of Billed Charges 63.00% $7.15 Percent of Billed Charges 63.00% $7.15 Percent of Billed Charges 75.00% $8.51 Percent of Billed Charges 66.24% $7.52 Percent of Billed Charges 165.81% $11.35 Fee Schedule 166.07% $20.58 Fee Schedule 176.26% $21.84 Fee Schedule 129.00% $15.98 Fee Schedule 191.24% $23.69 Fee Schedule 159.00% $18.05 Fee Schedule 145.00% $17.97 Fee Schedule 60.00% $6.81 Percent of Billed Charges "HC ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED" 300 CPT 87498 Outpatient $426.00 $45.27 $677.34 $426.00 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $290.19 Fee Schedule 74.74% $318.39 Percent of Billed Charges 68.24% $290.70 Percent of Billed Charges 65.00% $276.90 Percent of Billed Charges 67.00% $285.42 Percent of Billed Charges 77.50% $330.15 Percent of Billed Charges 79.97% $340.67 Percent of Billed Charges 55.00% $234.30 Percent of Billed Charges 49.55% $211.08 Percent of Billed Charges 55.00% $234.30 Percent of Billed Charges 55.00% $234.30 Percent of Billed Charges 78.94% $336.28 Percent of Billed Charges 74.00% $315.24 Percent of Billed Charges 92.50% $394.05 Percent of Billed Charges 55.00% $234.30 Percent of Billed Charges 85.00% $362.10 Percent of Billed Charges 63.00% $268.38 Percent of Billed Charges 63.00% $268.38 Percent of Billed Charges 75.00% $319.50 Percent of Billed Charges 66.24% $282.18 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $677.34 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $255.60 Percent of Billed Charges HC EOSINOPHILA PANEL BY FISH CG MCG; INT & REP 300 CPT 88291 90 Outpatient $240.00 $61.06 $381.60 $240.00 $128.88 $128.88 Fee Schedule $128.88 $128.88 Fee Schedule 56.78% $136.27 Percent of Billed Charges 74.74% $179.38 Percent of Billed Charges 68.24% $163.78 Percent of Billed Charges 65.00% $156.00 Percent of Billed Charges 67.00% $160.80 Percent of Billed Charges 77.50% $186.00 Percent of Billed Charges 79.97% $191.93 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 49.55% $118.92 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 78.94% $189.46 Percent of Billed Charges 74.00% $177.60 Percent of Billed Charges 92.50% $222.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 85.00% $204.00 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 75.00% $180.00 Percent of Billed Charges 66.24% $158.98 Percent of Billed Charges 165.81% $78.48 Fee Schedule 166.07% $78.60 Fee Schedule 176.26% $83.42 Fee Schedule 129.00% $61.06 Fee Schedule 191.24% $90.51 Fee Schedule 159.00% $381.60 Fee Schedule 145.00% $68.63 Fee Schedule 60.00% $144.00 Percent of Billed Charges HC EOSINOPHILA PANEL BY FISH MCG; DNA PROBE EA 300 CPT 88271 90 Outpatient $240.00 $27.63 $381.60 $240.00 $116.68 $116.68 Fee Schedule $116.68 $116.68 Fee Schedule $186.78 $177.14 Fee Schedule 74.74% $179.38 Percent of Billed Charges 68.24% $163.78 Percent of Billed Charges 65.00% $156.00 Percent of Billed Charges 67.00% $160.80 Percent of Billed Charges 77.50% $186.00 Percent of Billed Charges 79.97% $191.93 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 49.55% $118.92 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 78.94% $189.46 Percent of Billed Charges 74.00% $177.60 Percent of Billed Charges 92.50% $222.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 85.00% $204.00 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 75.00% $180.00 Percent of Billed Charges 66.24% $158.98 Percent of Billed Charges 165.81% $35.52 Fee Schedule 166.07% $35.57 Fee Schedule 176.26% $37.75 Fee Schedule 129.00% $27.63 Fee Schedule 191.24% $40.96 Fee Schedule 159.00% $381.60 Fee Schedule 145.00% $31.06 Fee Schedule 60.00% $144.00 Percent of Billed Charges HC EOSINOPHILA PANEL BY FISH MCG; IP SITU 100-300 CELLS 300 CPT 88275 90 Outpatient $240.00 $66.04 $381.60 $240.00 $218.80 $218.80 Fee Schedule $218.80 $218.80 Fee Schedule $446.38 $240.00 Fee Schedule 74.74% $179.38 Percent of Billed Charges 68.24% $163.78 Percent of Billed Charges 65.00% $156.00 Percent of Billed Charges 67.00% $160.80 Percent of Billed Charges 77.50% $186.00 Percent of Billed Charges 79.97% $191.93 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 49.55% $118.92 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 78.94% $189.46 Percent of Billed Charges 74.00% $177.60 Percent of Billed Charges 92.50% $222.00 Percent of Billed Charges 55.00% $132.00 Percent of Billed Charges 85.00% $204.00 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 63.00% $151.20 Percent of Billed Charges 75.00% $180.00 Percent of Billed Charges 66.24% $158.98 Percent of Billed Charges 165.81% $84.88 Fee Schedule 166.07% $85.01 Fee Schedule 176.26% $90.23 Fee Schedule 129.00% $66.04 Fee Schedule 191.24% $97.90 Fee Schedule 159.00% $381.60 Fee Schedule 145.00% $74.23 Fee Schedule 60.00% $144.00 Percent of Billed Charges HC EPILEPSY AUTOIMMUNE MAYO 300 CPT 83519 90 Outpatient $446.00 $23.74 $709.14 $446.00 $73.60 $73.60 Fee Schedule $73.60 $73.60 Fee Schedule $160.45 $152.17 Fee Schedule 74.74% $333.34 Percent of Billed Charges 68.24% $304.35 Percent of Billed Charges 65.00% $289.90 Percent of Billed Charges 67.00% $298.82 Percent of Billed Charges 77.50% $345.65 Percent of Billed Charges 79.97% $356.67 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 49.55% $220.99 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 78.94% $352.07 Percent of Billed Charges 74.00% $330.04 Percent of Billed Charges 92.50% $412.55 Percent of Billed Charges 55.00% $245.30 Percent of Billed Charges 85.00% $379.10 Percent of Billed Charges 63.00% $280.98 Percent of Billed Charges 63.00% $280.98 Percent of Billed Charges 75.00% $334.50 Percent of Billed Charges 66.24% $295.43 Percent of Billed Charges 165.81% $30.51 Fee Schedule 166.07% $30.56 Fee Schedule 176.26% $32.43 Fee Schedule 129.00% $23.74 Fee Schedule 191.24% $35.19 Fee Schedule 159.00% $709.14 Fee Schedule 145.00% $26.68 Fee Schedule 60.00% $267.60 Percent of Billed Charges HC ERYTHROCYTOSIS PNL MAYO 300 CPT 82820 90 Outpatient $230.17 $17.21 $365.97 $230.17 $54.44 $54.44 Fee Schedule $54.44 $54.44 Fee Schedule $116.32 $110.32 Fee Schedule 74.74% $172.03 Percent of Billed Charges 68.24% $157.07 Percent of Billed Charges 65.00% $149.61 Percent of Billed Charges 67.00% $154.21 Percent of Billed Charges 77.50% $178.38 Percent of Billed Charges 79.97% $184.07 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 49.55% $114.05 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 78.94% $181.70 Percent of Billed Charges 74.00% $170.33 Percent of Billed Charges 92.50% $212.91 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 85.00% $195.64 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 75.00% $172.63 Percent of Billed Charges 66.24% $152.46 Percent of Billed Charges 165.81% $22.12 Fee Schedule 166.07% $22.15 Fee Schedule 176.26% $23.51 Fee Schedule 129.00% $17.21 Fee Schedule 191.24% $25.51 Fee Schedule 159.00% $365.97 Fee Schedule 145.00% $19.34 Fee Schedule 60.00% $138.10 Percent of Billed Charges HC ERYTHROCYTOSIS PNL MAYO 300 CPT 83020 90 Outpatient $230.17 $16.60 $365.97 $230.17 $70.12 $70.12 Fee Schedule $70.12 $70.12 Fee Schedule $112.23 $106.43 Fee Schedule 74.74% $172.03 Percent of Billed Charges 68.24% $157.07 Percent of Billed Charges 65.00% $149.61 Percent of Billed Charges 67.00% $154.21 Percent of Billed Charges 77.50% $178.38 Percent of Billed Charges 79.97% $184.07 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 49.55% $114.05 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 78.94% $181.70 Percent of Billed Charges 74.00% $170.33 Percent of Billed Charges 92.50% $212.91 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 85.00% $195.64 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 75.00% $172.63 Percent of Billed Charges 66.24% $152.46 Percent of Billed Charges 165.81% $21.34 Fee Schedule 166.07% $21.37 Fee Schedule 176.26% $22.68 Fee Schedule 129.00% $16.60 Fee Schedule 191.24% $24.61 Fee Schedule 159.00% $365.97 Fee Schedule 145.00% $18.66 Fee Schedule 60.00% $138.10 Percent of Billed Charges HC ERYTHROCYTOSIS PNL MAYO 300 CPT 83021 90 Outpatient $230.17 $23.30 $365.97 $230.17 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $157.48 $149.36 Fee Schedule 74.74% $172.03 Percent of Billed Charges 68.24% $157.07 Percent of Billed Charges 65.00% $149.61 Percent of Billed Charges 67.00% $154.21 Percent of Billed Charges 77.50% $178.38 Percent of Billed Charges 79.97% $184.07 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 49.55% $114.05 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 78.94% $181.70 Percent of Billed Charges 74.00% $170.33 Percent of Billed Charges 92.50% $212.91 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 85.00% $195.64 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 75.00% $172.63 Percent of Billed Charges 66.24% $152.46 Percent of Billed Charges 165.81% $29.95 Fee Schedule 166.07% $29.99 Fee Schedule 176.26% $31.83 Fee Schedule 129.00% $23.30 Fee Schedule 191.24% $34.54 Fee Schedule 159.00% $365.97 Fee Schedule 145.00% $26.19 Fee Schedule 60.00% $138.10 Percent of Billed Charges HC ERYTHROCYTOSIS PNL MAYO 300 CPT 83789 90 Outpatient $230.17 $31.10 $365.97 $230.17 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.24 $199.39 Fee Schedule 74.74% $172.03 Percent of Billed Charges 68.24% $157.07 Percent of Billed Charges 65.00% $149.61 Percent of Billed Charges 67.00% $154.21 Percent of Billed Charges 77.50% $178.38 Percent of Billed Charges 79.97% $184.07 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 49.55% $114.05 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 78.94% $181.70 Percent of Billed Charges 74.00% $170.33 Percent of Billed Charges 92.50% $212.91 Percent of Billed Charges 55.00% $126.59 Percent of Billed Charges 85.00% $195.64 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 63.00% $145.01 Percent of Billed Charges 75.00% $172.63 Percent of Billed Charges 66.24% $152.46 Percent of Billed Charges 165.81% $39.98 Fee Schedule 166.07% $40.04 Fee Schedule 176.26% $42.50 Fee Schedule 129.00% $31.10 Fee Schedule 191.24% $46.11 Fee Schedule 159.00% $365.97 Fee Schedule 145.00% $34.96 Fee Schedule 60.00% $138.10 Percent of Billed Charges HC ERYTHROPOIETIN LABCORP 300 CPT 82668 90 Outpatient $12.00 $5.95 $35.93 $12.00 $102.40 $12.00 Fee Schedule $102.40 $12.00 Fee Schedule $163.85 $12.00 Fee Schedule 74.74% $8.97 Percent of Billed Charges 68.24% $8.19 Percent of Billed Charges 65.00% $7.80 Percent of Billed Charges 67.00% $8.04 Percent of Billed Charges 77.50% $9.30 Percent of Billed Charges 79.97% $9.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 49.55% $5.95 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 78.94% $9.47 Percent of Billed Charges 74.00% $8.88 Percent of Billed Charges 92.50% $11.10 Percent of Billed Charges 55.00% $6.60 Percent of Billed Charges 85.00% $10.20 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 63.00% $7.56 Percent of Billed Charges 75.00% $9.00 Percent of Billed Charges 66.24% $7.95 Percent of Billed Charges 165.81% $12.00 Fee Schedule 166.07% $31.20 Fee Schedule 176.26% $33.12 Fee Schedule 129.00% $24.24 Fee Schedule 191.24% $35.93 Fee Schedule 159.00% $19.08 Fee Schedule 145.00% $27.25 Fee Schedule 60.00% $7.20 Percent of Billed Charges HC ESBL SCREEN 300 CPT 87081 Outpatient $332.00 $8.55 $527.88 $332.00 $36.12 $36.12 Fee Schedule $36.12 $36.12 Fee Schedule $57.81 $54.83 Fee Schedule 74.74% $248.14 Percent of Billed Charges 68.24% $226.56 Percent of Billed Charges 65.00% $215.80 Percent of Billed Charges 67.00% $222.44 Percent of Billed Charges 77.50% $257.30 Percent of Billed Charges 79.97% $265.50 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 49.55% $164.51 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 78.94% $262.08 Percent of Billed Charges 74.00% $245.68 Percent of Billed Charges 92.50% $307.10 Percent of Billed Charges 55.00% $182.60 Percent of Billed Charges 85.00% $282.20 Percent of Billed Charges 63.00% $209.16 Percent of Billed Charges 63.00% $209.16 Percent of Billed Charges 75.00% $249.00 Percent of Billed Charges 66.24% $219.92 Percent of Billed Charges 165.81% $10.99 Fee Schedule 166.07% $11.01 Fee Schedule 176.26% $11.69 Fee Schedule 129.00% $8.55 Fee Schedule 191.24% $12.68 Fee Schedule 159.00% $527.88 Fee Schedule 145.00% $9.61 Fee Schedule 60.00% $199.20 Percent of Billed Charges HC ESTRADIOL QUEST 300 CPT 82670 90 Outpatient $16.00 $7.93 $53.43 $16.00 $152.24 $16.00 Fee Schedule $152.24 $16.00 Fee Schedule $243.64 $16.00 Fee Schedule 74.74% $11.96 Percent of Billed Charges 68.24% $10.92 Percent of Billed Charges 65.00% $10.40 Percent of Billed Charges 67.00% $10.72 Percent of Billed Charges 77.50% $12.40 Percent of Billed Charges 79.97% $12.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 49.55% $7.93 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 78.94% $12.63 Percent of Billed Charges 74.00% $11.84 Percent of Billed Charges 92.50% $14.80 Percent of Billed Charges 55.00% $8.80 Percent of Billed Charges 85.00% $13.60 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 63.00% $10.08 Percent of Billed Charges 75.00% $12.00 Percent of Billed Charges 66.24% $10.60 Percent of Billed Charges 165.81% $16.00 Fee Schedule 166.07% $46.40 Fee Schedule 176.26% $49.25 Fee Schedule 129.00% $36.04 Fee Schedule 191.24% $53.43 Fee Schedule 159.00% $25.44 Fee Schedule 145.00% $40.51 Fee Schedule 60.00% $9.60 Percent of Billed Charges HC ESTRADIOL LABCORP 300 CPT 82670 90 Outpatient $2.75 $1.36 $53.43 $2.75 $152.24 $2.75 Fee Schedule $152.24 $2.75 Fee Schedule $243.64 $2.75 Fee Schedule 74.74% $2.06 Percent of Billed Charges 68.24% $1.88 Percent of Billed Charges 65.00% $1.79 Percent of Billed Charges 67.00% $1.84 Percent of Billed Charges 77.50% $2.13 Percent of Billed Charges 79.97% $2.20 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 49.55% $1.36 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 78.94% $2.17 Percent of Billed Charges 74.00% $2.04 Percent of Billed Charges 92.50% $2.54 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 85.00% $2.34 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 75.00% $2.06 Percent of Billed Charges 66.24% $1.82 Percent of Billed Charges 165.81% $2.75 Fee Schedule 166.07% $46.40 Fee Schedule 176.26% $49.25 Fee Schedule 129.00% $36.04 Fee Schedule 191.24% $53.43 Fee Schedule 159.00% $4.37 Fee Schedule 145.00% $40.51 Fee Schedule 60.00% $1.65 Percent of Billed Charges "HC ESTRADIOL, FREE LABCORP" 300 CPT 82670 90 Outpatient $75.00 $36.04 $119.25 $75.00 $152.24 $75.00 Fee Schedule $152.24 $75.00 Fee Schedule $243.64 $75.00 Fee Schedule 74.74% $56.06 Percent of Billed Charges 68.24% $51.18 Percent of Billed Charges 65.00% $48.75 Percent of Billed Charges 67.00% $50.25 Percent of Billed Charges 77.50% $58.13 Percent of Billed Charges 79.97% $59.98 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 49.55% $37.16 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 78.94% $59.21 Percent of Billed Charges 74.00% $55.50 Percent of Billed Charges 92.50% $69.38 Percent of Billed Charges 55.00% $41.25 Percent of Billed Charges 85.00% $63.75 Percent of Billed Charges 63.00% $47.25 Percent of Billed Charges 63.00% $47.25 Percent of Billed Charges 75.00% $56.25 Percent of Billed Charges 66.24% $49.68 Percent of Billed Charges 165.81% $46.33 Fee Schedule 166.07% $46.40 Fee Schedule 176.26% $49.25 Fee Schedule 129.00% $36.04 Fee Schedule 191.24% $53.43 Fee Schedule 159.00% $119.25 Fee Schedule 145.00% $40.51 Fee Schedule 60.00% $45.00 Percent of Billed Charges HC ESTROGEN LABCORP 300 CPT 82672 90 Outpatient $7.00 $3.47 $41.50 $7.00 $118.24 $7.00 Fee Schedule $118.24 $7.00 Fee Schedule $189.22 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $36.04 Fee Schedule 176.26% $38.25 Fee Schedule 129.00% $27.99 Fee Schedule 191.24% $41.50 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $31.47 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC ESTRONE LABCORP 300 CPT 82679 90 Outpatient $7.00 $3.47 $47.71 $7.00 $136.00 $7.00 Fee Schedule $136.00 $7.00 Fee Schedule $217.56 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $41.43 Fee Schedule 176.26% $43.98 Fee Schedule 129.00% $32.19 Fee Schedule 191.24% $47.71 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $36.18 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC ETHOSUXIMIDE LABCORP 300 CPT 80168 90 Outpatient $10.00 $4.96 $31.25 $10.00 $89.04 $10.00 Fee Schedule $89.04 $10.00 Fee Schedule $142.48 $10.00 Fee Schedule 74.74% $7.47 Percent of Billed Charges 68.24% $6.82 Percent of Billed Charges 65.00% $6.50 Percent of Billed Charges 67.00% $6.70 Percent of Billed Charges 77.50% $7.75 Percent of Billed Charges 79.97% $8.00 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 49.55% $4.96 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 78.94% $7.89 Percent of Billed Charges 74.00% $7.40 Percent of Billed Charges 92.50% $9.25 Percent of Billed Charges 55.00% $5.50 Percent of Billed Charges 85.00% $8.50 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 63.00% $6.30 Percent of Billed Charges 75.00% $7.50 Percent of Billed Charges 66.24% $6.62 Percent of Billed Charges 165.81% $10.00 Fee Schedule 166.07% $27.14 Fee Schedule 176.26% $28.80 Fee Schedule 129.00% $21.08 Fee Schedule 191.24% $31.25 Fee Schedule 159.00% $15.90 Fee Schedule 145.00% $23.69 Fee Schedule 60.00% $6.00 Percent of Billed Charges HC ETHOTOIN LA 300 CPT 80299 90 Outpatient $41.25 $20.44 $65.59 $41.25 $74.64 $41.25 Fee Schedule $74.64 $41.25 Fee Schedule $162.54 $41.25 Fee Schedule 74.74% $30.83 Percent of Billed Charges 68.24% $28.15 Percent of Billed Charges 65.00% $26.81 Percent of Billed Charges 67.00% $27.64 Percent of Billed Charges 77.50% $31.97 Percent of Billed Charges 79.97% $32.99 Percent of Billed Charges 55.00% $22.69 Percent of Billed Charges 49.55% $20.44 Percent of Billed Charges 55.00% $22.69 Percent of Billed Charges 55.00% $22.69 Percent of Billed Charges 78.94% $32.56 Percent of Billed Charges 74.00% $30.53 Percent of Billed Charges 92.50% $38.16 Percent of Billed Charges 55.00% $22.69 Percent of Billed Charges 85.00% $35.06 Percent of Billed Charges 63.00% $25.99 Percent of Billed Charges 63.00% $25.99 Percent of Billed Charges 75.00% $30.94 Percent of Billed Charges 66.24% $27.32 Percent of Billed Charges 165.81% $30.91 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $65.59 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $24.75 Percent of Billed Charges "HC ETHYLENE GLYCOL,BLOOD M" 300 CPT 82693 90 Outpatient $75.81 $19.22 $120.54 $75.81 $81.16 $75.81 Fee Schedule $81.16 $75.81 Fee Schedule $129.93 $75.81 Fee Schedule 74.74% $56.66 Percent of Billed Charges 68.24% $51.73 Percent of Billed Charges 65.00% $49.28 Percent of Billed Charges 67.00% $50.79 Percent of Billed Charges 77.50% $58.75 Percent of Billed Charges 79.97% $60.63 Percent of Billed Charges 55.00% $41.70 Percent of Billed Charges 49.55% $37.56 Percent of Billed Charges 55.00% $41.70 Percent of Billed Charges 55.00% $41.70 Percent of Billed Charges 78.94% $59.84 Percent of Billed Charges 74.00% $56.10 Percent of Billed Charges 92.50% $70.12 Percent of Billed Charges 55.00% $41.70 Percent of Billed Charges 85.00% $64.44 Percent of Billed Charges 63.00% $47.76 Percent of Billed Charges 63.00% $47.76 Percent of Billed Charges 75.00% $56.86 Percent of Billed Charges 66.24% $50.22 Percent of Billed Charges 165.81% $24.71 Fee Schedule 166.07% $24.74 Fee Schedule 176.26% $26.26 Fee Schedule 129.00% $19.22 Fee Schedule 191.24% $28.49 Fee Schedule 159.00% $120.54 Fee Schedule 145.00% $21.61 Fee Schedule 60.00% $45.49 Percent of Billed Charges HC EUGLOBULIN CLOT LYSIS QUEST 300 CPT 85360 90 Outpatient $66.18 $10.85 $105.23 $66.18 $45.80 $45.80 Fee Schedule $45.80 $45.80 Fee Schedule $73.34 $66.18 Fee Schedule 74.74% $49.46 Percent of Billed Charges 68.24% $45.16 Percent of Billed Charges 65.00% $43.02 Percent of Billed Charges 67.00% $44.34 Percent of Billed Charges 77.50% $51.29 Percent of Billed Charges 79.97% $52.92 Percent of Billed Charges 55.00% $36.40 Percent of Billed Charges 49.55% $32.79 Percent of Billed Charges 55.00% $36.40 Percent of Billed Charges 55.00% $36.40 Percent of Billed Charges 78.94% $52.24 Percent of Billed Charges 74.00% $48.97 Percent of Billed Charges 92.50% $61.22 Percent of Billed Charges 55.00% $36.40 Percent of Billed Charges 85.00% $56.25 Percent of Billed Charges 63.00% $41.69 Percent of Billed Charges 63.00% $41.69 Percent of Billed Charges 75.00% $49.64 Percent of Billed Charges 66.24% $43.84 Percent of Billed Charges 165.81% $13.94 Fee Schedule 166.07% $13.97 Fee Schedule 176.26% $14.82 Fee Schedule 129.00% $10.85 Fee Schedule 191.24% $16.08 Fee Schedule 159.00% $105.23 Fee Schedule 145.00% $12.19 Fee Schedule 60.00% $39.71 Percent of Billed Charges HC EVEROLIMUS LABCORP 300 CPT 80169 90 Outpatient $51.17 $17.71 $81.36 $51.17 $74.84 $51.17 Fee Schedule $74.84 $51.17 Fee Schedule $119.73 $51.17 Fee Schedule 74.74% $38.24 Percent of Billed Charges 68.24% $34.92 Percent of Billed Charges 65.00% $33.26 Percent of Billed Charges 67.00% $34.28 Percent of Billed Charges 77.50% $39.66 Percent of Billed Charges 79.97% $40.92 Percent of Billed Charges 55.00% $28.14 Percent of Billed Charges 49.55% $25.35 Percent of Billed Charges 55.00% $28.14 Percent of Billed Charges 55.00% $28.14 Percent of Billed Charges 78.94% $40.39 Percent of Billed Charges 74.00% $37.87 Percent of Billed Charges 92.50% $47.33 Percent of Billed Charges 55.00% $28.14 Percent of Billed Charges 85.00% $43.49 Percent of Billed Charges 63.00% $32.24 Percent of Billed Charges 63.00% $32.24 Percent of Billed Charges 75.00% $38.38 Percent of Billed Charges 66.24% $33.90 Percent of Billed Charges 165.81% $22.77 Fee Schedule 166.07% $22.80 Fee Schedule 176.26% $24.20 Fee Schedule 129.00% $17.71 Fee Schedule 191.24% $26.26 Fee Schedule 159.00% $81.36 Fee Schedule 145.00% $19.91 Fee Schedule 60.00% $30.70 Percent of Billed Charges "HC EXAM OF TISSUE, LEVEL II PA" 300 CPT 88302 90 Outpatient $16.24 $8.05 $26.39 $16.24 $122.04 $16.24 Fee Schedule $122.04 $16.24 Fee Schedule 56.78% $9.22 Percent of Billed Charges 74.74% $12.14 Percent of Billed Charges 68.24% $11.08 Percent of Billed Charges 65.00% $10.56 Percent of Billed Charges 67.00% $10.88 Percent of Billed Charges 77.50% $12.59 Percent of Billed Charges 79.97% $12.99 Percent of Billed Charges 55.00% $8.93 Percent of Billed Charges 49.55% $8.05 Percent of Billed Charges 55.00% $8.93 Percent of Billed Charges 55.00% $8.93 Percent of Billed Charges 78.94% $12.82 Percent of Billed Charges 74.00% $12.02 Percent of Billed Charges 92.50% $15.02 Percent of Billed Charges 55.00% $8.93 Percent of Billed Charges 85.00% $13.80 Percent of Billed Charges 63.00% $10.23 Percent of Billed Charges 63.00% $10.23 Percent of Billed Charges 75.00% $12.18 Percent of Billed Charges 66.24% $10.76 Percent of Billed Charges 165.81% $16.24 Fee Schedule 166.07% $22.92 Fee Schedule 176.26% $24.32 Fee Schedule 129.00% $17.80 Fee Schedule 191.24% $26.39 Fee Schedule 159.00% $25.82 Fee Schedule 145.00% $20.01 Fee Schedule 60.00% $9.74 Percent of Billed Charges "HC EXAM OF TISSUE,LEVEL III PA" 300 CPT 88304 90 Outpatient $21.74 $10.77 $34.57 $21.74 $191.00 $21.74 Fee Schedule $191.00 $21.74 Fee Schedule 56.78% $12.34 Percent of Billed Charges 74.74% $16.25 Percent of Billed Charges 68.24% $14.84 Percent of Billed Charges 65.00% $14.13 Percent of Billed Charges 67.00% $14.57 Percent of Billed Charges 77.50% $16.85 Percent of Billed Charges 79.97% $17.39 Percent of Billed Charges 55.00% $11.96 Percent of Billed Charges 49.55% $10.77 Percent of Billed Charges 55.00% $11.96 Percent of Billed Charges 55.00% $11.96 Percent of Billed Charges 78.94% $17.16 Percent of Billed Charges 74.00% $16.09 Percent of Billed Charges 92.50% $20.11 Percent of Billed Charges 55.00% $11.96 Percent of Billed Charges 85.00% $18.48 Percent of Billed Charges 63.00% $13.70 Percent of Billed Charges 63.00% $13.70 Percent of Billed Charges 75.00% $16.31 Percent of Billed Charges 66.24% $14.40 Percent of Billed Charges 165.81% $21.74 Fee Schedule 166.07% $25.29 Fee Schedule 176.26% $26.84 Fee Schedule 129.00% $19.65 Fee Schedule 191.24% $29.13 Fee Schedule 159.00% $34.57 Fee Schedule 145.00% $22.08 Fee Schedule 60.00% $13.04 Percent of Billed Charges "HC EXAM OF TISSUE,LEVEL IV PA" 300 CPT 88305 90 Outpatient $28.37 $14.06 $46.17 $28.37 $191.00 $28.37 Fee Schedule $191.00 $28.37 Fee Schedule 56.78% $16.11 Percent of Billed Charges 74.74% $21.20 Percent of Billed Charges 68.24% $19.36 Percent of Billed Charges 65.00% $18.44 Percent of Billed Charges 67.00% $19.01 Percent of Billed Charges 77.50% $21.99 Percent of Billed Charges 79.97% $22.69 Percent of Billed Charges 55.00% $15.60 Percent of Billed Charges 49.55% $14.06 Percent of Billed Charges 55.00% $15.60 Percent of Billed Charges 55.00% $15.60 Percent of Billed Charges 78.94% $22.40 Percent of Billed Charges 74.00% $20.99 Percent of Billed Charges 92.50% $26.24 Percent of Billed Charges 55.00% $15.60 Percent of Billed Charges 85.00% $24.11 Percent of Billed Charges 63.00% $17.87 Percent of Billed Charges 63.00% $17.87 Percent of Billed Charges 75.00% $21.28 Percent of Billed Charges 66.24% $18.79 Percent of Billed Charges 165.81% $28.37 Fee Schedule 166.07% $40.09 Fee Schedule 176.26% $42.55 Fee Schedule 129.00% $31.14 Fee Schedule 191.24% $46.17 Fee Schedule 159.00% $45.11 Fee Schedule 145.00% $35.00 Fee Schedule 60.00% $17.02 Percent of Billed Charges "HC EXAM OF TISSUE,LEVEL V PA" 300 CPT 88307 90 Outpatient $40.04 $19.84 $67.16 $40.04 $837.68 $40.04 Fee Schedule $837.68 $40.04 Fee Schedule 56.78% $22.73 Percent of Billed Charges 74.74% $29.93 Percent of Billed Charges 68.24% $27.32 Percent of Billed Charges 65.00% $26.03 Percent of Billed Charges 67.00% $26.83 Percent of Billed Charges 77.50% $31.03 Percent of Billed Charges 79.97% $32.02 Percent of Billed Charges 55.00% $22.02 Percent of Billed Charges 49.55% $19.84 Percent of Billed Charges 55.00% $22.02 Percent of Billed Charges 55.00% $22.02 Percent of Billed Charges 78.94% $31.61 Percent of Billed Charges 74.00% $29.63 Percent of Billed Charges 92.50% $37.04 Percent of Billed Charges 55.00% $22.02 Percent of Billed Charges 85.00% $34.03 Percent of Billed Charges 63.00% $25.23 Percent of Billed Charges 63.00% $25.23 Percent of Billed Charges 75.00% $30.03 Percent of Billed Charges 66.24% $26.52 Percent of Billed Charges 165.81% $40.04 Fee Schedule 166.07% $58.32 Fee Schedule 176.26% $61.90 Fee Schedule 129.00% $45.30 Fee Schedule 191.24% $67.16 Fee Schedule 159.00% $63.66 Fee Schedule 145.00% $50.92 Fee Schedule 60.00% $24.02 Percent of Billed Charges "HC EXAM OF TISSUE,LEVEL VI PA" 300 CPT 88309 90 Outpatient $59.49 $29.48 $182.42 $59.49 " $1,762.12 " $59.49 Fee Schedule " $1,762.12 " $59.49 Fee Schedule 56.78% $33.78 Percent of Billed Charges 74.74% $44.46 Percent of Billed Charges 68.24% $40.60 Percent of Billed Charges 65.00% $38.67 Percent of Billed Charges 67.00% $39.86 Percent of Billed Charges 77.50% $46.10 Percent of Billed Charges 79.97% $47.57 Percent of Billed Charges 55.00% $32.72 Percent of Billed Charges 49.55% $29.48 Percent of Billed Charges 55.00% $32.72 Percent of Billed Charges 55.00% $32.72 Percent of Billed Charges 78.94% $46.96 Percent of Billed Charges 74.00% $44.02 Percent of Billed Charges 92.50% $55.03 Percent of Billed Charges 55.00% $32.72 Percent of Billed Charges 85.00% $50.57 Percent of Billed Charges 63.00% $37.48 Percent of Billed Charges 63.00% $37.48 Percent of Billed Charges 75.00% $44.62 Percent of Billed Charges 66.24% $39.41 Percent of Billed Charges 165.81% $59.49 Fee Schedule 166.07% $158.41 Fee Schedule 176.26% $168.13 Fee Schedule 129.00% $123.05 Fee Schedule 191.24% $182.42 Fee Schedule 159.00% $94.59 Fee Schedule 145.00% $138.32 Fee Schedule 60.00% $35.69 Percent of Billed Charges HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN 300 CPT 81241 90 Outpatient $98.60 $- $156.77 $98.60 $332.96 $98.60 Fee Schedule $332.96 $98.60 Fee Schedule $639.79 $98.60 Fee Schedule 74.74% $73.69 Percent of Billed Charges 68.24% $67.28 Percent of Billed Charges 65.00% $64.09 Percent of Billed Charges 67.00% $66.06 Percent of Billed Charges 77.50% $76.42 Percent of Billed Charges 79.97% $78.85 Percent of Billed Charges 55.00% $54.23 Percent of Billed Charges 49.55% $48.86 Percent of Billed Charges 55.00% $54.23 Percent of Billed Charges 55.00% $54.23 Percent of Billed Charges 78.94% $77.83 Percent of Billed Charges 74.00% $72.96 Percent of Billed Charges 92.50% $91.21 Percent of Billed Charges 55.00% $54.23 Percent of Billed Charges 85.00% $83.81 Percent of Billed Charges 63.00% $62.12 Percent of Billed Charges 63.00% $62.12 Percent of Billed Charges 75.00% $73.95 Percent of Billed Charges 66.24% $65.31 Percent of Billed Charges 35.00% $34.51 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $156.77 Fee Schedule 145.00% $- Fee Schedule 60.00% $59.16 Percent of Billed Charges HC FACTOR 13 ACTIVITY ARUP 300 CPT 85290 90 Outpatient $150.00 $21.08 $238.50 $150.00 $89.04 $89.04 Fee Schedule $89.04 $89.04 Fee Schedule $142.48 $135.13 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $27.09 Fee Schedule 166.07% $27.14 Fee Schedule 176.26% $28.80 Fee Schedule 129.00% $21.08 Fee Schedule 191.24% $31.25 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $23.69 Fee Schedule 60.00% $90.00 Percent of Billed Charges HC FACTOR II ACTIVITY ARUP 300 CPT 85210 90 Outpatient $43.10 $16.74 $68.53 $43.10 $70.76 $43.10 Fee Schedule $70.76 $43.10 Fee Schedule $113.19 $43.10 Fee Schedule 74.74% $32.21 Percent of Billed Charges 68.24% $29.41 Percent of Billed Charges 65.00% $28.02 Percent of Billed Charges 67.00% $28.88 Percent of Billed Charges 77.50% $33.40 Percent of Billed Charges 79.97% $34.47 Percent of Billed Charges 55.00% $23.71 Percent of Billed Charges 49.55% $21.36 Percent of Billed Charges 55.00% $23.71 Percent of Billed Charges 55.00% $23.71 Percent of Billed Charges 78.94% $34.02 Percent of Billed Charges 74.00% $31.89 Percent of Billed Charges 92.50% $39.87 Percent of Billed Charges 55.00% $23.71 Percent of Billed Charges 85.00% $36.64 Percent of Billed Charges 63.00% $27.15 Percent of Billed Charges 63.00% $27.15 Percent of Billed Charges 75.00% $32.33 Percent of Billed Charges 66.24% $28.55 Percent of Billed Charges 165.81% $21.52 Fee Schedule 166.07% $21.56 Fee Schedule 176.26% $22.88 Fee Schedule 129.00% $16.74 Fee Schedule 191.24% $24.82 Fee Schedule 159.00% $68.53 Fee Schedule 145.00% $18.82 Fee Schedule 60.00% $25.86 Percent of Billed Charges HC FACTOR II(PROTHROMBIN) LABCORP 300 CPT 81240 90 Outpatient $102.89 $- $163.60 $102.89 $268.12 $102.89 Fee Schedule $268.12 $102.89 Fee Schedule $572.82 $102.89 Fee Schedule 74.74% $76.90 Percent of Billed Charges 68.24% $70.21 Percent of Billed Charges 65.00% $66.88 Percent of Billed Charges 67.00% $68.94 Percent of Billed Charges 77.50% $79.74 Percent of Billed Charges 79.97% $82.28 Percent of Billed Charges 55.00% $56.59 Percent of Billed Charges 49.55% $50.98 Percent of Billed Charges 55.00% $56.59 Percent of Billed Charges 55.00% $56.59 Percent of Billed Charges 78.94% $81.22 Percent of Billed Charges 74.00% $76.14 Percent of Billed Charges 92.50% $95.17 Percent of Billed Charges 55.00% $56.59 Percent of Billed Charges 85.00% $87.46 Percent of Billed Charges 63.00% $64.82 Percent of Billed Charges 63.00% $64.82 Percent of Billed Charges 75.00% $77.17 Percent of Billed Charges 66.24% $68.15 Percent of Billed Charges 35.00% $36.01 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $163.60 Fee Schedule 145.00% $- Fee Schedule 60.00% $61.73 Percent of Billed Charges HC FACTOR IX ARUP 300 CPT 85250 90 Outpatient $37.40 $18.53 $59.47 $37.40 $103.76 $37.40 Fee Schedule $103.76 $37.40 Fee Schedule $166.03 $37.40 Fee Schedule 74.74% $27.95 Percent of Billed Charges 68.24% $25.52 Percent of Billed Charges 65.00% $24.31 Percent of Billed Charges 67.00% $25.06 Percent of Billed Charges 77.50% $28.99 Percent of Billed Charges 79.97% $29.91 Percent of Billed Charges 55.00% $20.57 Percent of Billed Charges 49.55% $18.53 Percent of Billed Charges 55.00% $20.57 Percent of Billed Charges 55.00% $20.57 Percent of Billed Charges 78.94% $29.52 Percent of Billed Charges 74.00% $27.68 Percent of Billed Charges 92.50% $34.60 Percent of Billed Charges 55.00% $20.57 Percent of Billed Charges 85.00% $31.79 Percent of Billed Charges 63.00% $23.56 Percent of Billed Charges 63.00% $23.56 Percent of Billed Charges 75.00% $28.05 Percent of Billed Charges 66.24% $24.77 Percent of Billed Charges 165.81% $31.57 Fee Schedule 166.07% $31.62 Fee Schedule 176.26% $33.56 Fee Schedule 129.00% $24.56 Fee Schedule 191.24% $36.41 Fee Schedule 159.00% $59.47 Fee Schedule 145.00% $27.61 Fee Schedule 60.00% $22.44 Percent of Billed Charges HC FACTOR V ACTIVITY ARUP 300 CPT 85220 90 Outpatient $24.05 $11.92 $38.24 $24.05 $96.16 $24.05 Fee Schedule $96.16 $24.05 Fee Schedule $153.91 $24.05 Fee Schedule 74.74% $17.97 Percent of Billed Charges 68.24% $16.41 Percent of Billed Charges 65.00% $15.63 Percent of Billed Charges 67.00% $16.11 Percent of Billed Charges 77.50% $18.64 Percent of Billed Charges 79.97% $19.23 Percent of Billed Charges 55.00% $13.23 Percent of Billed Charges 49.55% $11.92 Percent of Billed Charges 55.00% $13.23 Percent of Billed Charges 55.00% $13.23 Percent of Billed Charges 78.94% $18.99 Percent of Billed Charges 74.00% $17.80 Percent of Billed Charges 92.50% $22.25 Percent of Billed Charges 55.00% $13.23 Percent of Billed Charges 85.00% $20.44 Percent of Billed Charges 63.00% $15.15 Percent of Billed Charges 63.00% $15.15 Percent of Billed Charges 75.00% $18.04 Percent of Billed Charges 66.24% $15.93 Percent of Billed Charges 165.81% $24.05 Fee Schedule 166.07% $29.31 Fee Schedule 176.26% $31.11 Fee Schedule 129.00% $22.77 Fee Schedule 191.24% $33.75 Fee Schedule 159.00% $38.24 Fee Schedule 145.00% $25.59 Fee Schedule 60.00% $14.43 Percent of Billed Charges HC FACTOR VII ACTIVITY QUEST 300 CPT 85230 90 Outpatient $27.00 $13.38 $42.93 $27.00 $97.56 $27.00 Fee Schedule $97.56 $27.00 Fee Schedule $156.09 $27.00 Fee Schedule 74.74% $20.18 Percent of Billed Charges 68.24% $18.42 Percent of Billed Charges 65.00% $17.55 Percent of Billed Charges 67.00% $18.09 Percent of Billed Charges 77.50% $20.93 Percent of Billed Charges 79.97% $21.59 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 49.55% $13.38 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 78.94% $21.31 Percent of Billed Charges 74.00% $19.98 Percent of Billed Charges 92.50% $24.98 Percent of Billed Charges 55.00% $14.85 Percent of Billed Charges 85.00% $22.95 Percent of Billed Charges 63.00% $17.01 Percent of Billed Charges 63.00% $17.01 Percent of Billed Charges 75.00% $20.25 Percent of Billed Charges 66.24% $17.88 Percent of Billed Charges 165.81% $27.00 Fee Schedule 166.07% $29.73 Fee Schedule 176.26% $31.55 Fee Schedule 129.00% $23.09 Fee Schedule 191.24% $34.23 Fee Schedule 159.00% $42.93 Fee Schedule 145.00% $25.96 Fee Schedule 60.00% $16.20 Percent of Billed Charges HC FACTOR VIII ACT BLD CTR WISCON 300 CPT 85240 90 Outpatient $65.47 $23.09 $104.10 $65.47 $97.56 $65.47 Fee Schedule $97.56 $65.47 Fee Schedule $156.09 $65.47 Fee Schedule 74.74% $48.93 Percent of Billed Charges 68.24% $44.68 Percent of Billed Charges 65.00% $42.56 Percent of Billed Charges 67.00% $43.86 Percent of Billed Charges 77.50% $50.74 Percent of Billed Charges 79.97% $52.36 Percent of Billed Charges 55.00% $36.01 Percent of Billed Charges 49.55% $32.44 Percent of Billed Charges 55.00% $36.01 Percent of Billed Charges 55.00% $36.01 Percent of Billed Charges 78.94% $51.68 Percent of Billed Charges 74.00% $48.45 Percent of Billed Charges 92.50% $60.56 Percent of Billed Charges 55.00% $36.01 Percent of Billed Charges 85.00% $55.65 Percent of Billed Charges 63.00% $41.25 Percent of Billed Charges 63.00% $41.25 Percent of Billed Charges 75.00% $49.10 Percent of Billed Charges 66.24% $43.37 Percent of Billed Charges 165.81% $29.68 Fee Schedule 166.07% $29.73 Fee Schedule 176.26% $31.55 Fee Schedule 129.00% $23.09 Fee Schedule 191.24% $34.23 Fee Schedule 159.00% $104.10 Fee Schedule 145.00% $25.96 Fee Schedule 60.00% $39.28 Percent of Billed Charges HC FACTOR VIII ANTIGEN ARUP 300 CPT 85246 90 Outpatient $28.15 $13.95 $44.76 $28.15 $125.00 $28.15 Fee Schedule $125.00 $28.15 Fee Schedule $200.04 $28.15 Fee Schedule 74.74% $21.04 Percent of Billed Charges 68.24% $19.21 Percent of Billed Charges 65.00% $18.30 Percent of Billed Charges 67.00% $18.86 Percent of Billed Charges 77.50% $21.82 Percent of Billed Charges 79.97% $22.51 Percent of Billed Charges 55.00% $15.48 Percent of Billed Charges 49.55% $13.95 Percent of Billed Charges 55.00% $15.48 Percent of Billed Charges 55.00% $15.48 Percent of Billed Charges 78.94% $22.22 Percent of Billed Charges 74.00% $20.83 Percent of Billed Charges 92.50% $26.04 Percent of Billed Charges 55.00% $15.48 Percent of Billed Charges 85.00% $23.93 Percent of Billed Charges 63.00% $17.73 Percent of Billed Charges 63.00% $17.73 Percent of Billed Charges 75.00% $21.11 Percent of Billed Charges 66.24% $18.65 Percent of Billed Charges 165.81% $28.15 Fee Schedule 166.07% $38.10 Fee Schedule 176.26% $40.43 Fee Schedule 129.00% $29.59 Fee Schedule 191.24% $43.87 Fee Schedule 159.00% $44.76 Fee Schedule 145.00% $33.26 Fee Schedule 60.00% $16.89 Percent of Billed Charges HC FACTOR VIII RFLX TO BETH ARUP 300 CPT 85240 90 Outpatient $23.59 $11.69 $37.51 $23.59 $97.56 $23.59 Fee Schedule $97.56 $23.59 Fee Schedule $156.09 $23.59 Fee Schedule 74.74% $17.63 Percent of Billed Charges 68.24% $16.10 Percent of Billed Charges 65.00% $15.33 Percent of Billed Charges 67.00% $15.81 Percent of Billed Charges 77.50% $18.28 Percent of Billed Charges 79.97% $18.86 Percent of Billed Charges 55.00% $12.97 Percent of Billed Charges 49.55% $11.69 Percent of Billed Charges 55.00% $12.97 Percent of Billed Charges 55.00% $12.97 Percent of Billed Charges 78.94% $18.62 Percent of Billed Charges 74.00% $17.46 Percent of Billed Charges 92.50% $21.82 Percent of Billed Charges 55.00% $12.97 Percent of Billed Charges 85.00% $20.05 Percent of Billed Charges 63.00% $14.86 Percent of Billed Charges 63.00% $14.86 Percent of Billed Charges 75.00% $17.69 Percent of Billed Charges 66.24% $15.63 Percent of Billed Charges 165.81% $23.59 Fee Schedule 166.07% $29.73 Fee Schedule 176.26% $31.55 Fee Schedule 129.00% $23.09 Fee Schedule 191.24% $34.23 Fee Schedule 159.00% $37.51 Fee Schedule 145.00% $25.96 Fee Schedule 60.00% $14.15 Percent of Billed Charges HC FACTOR X ACTIVITY ARUP 300 CPT 85260 90 Outpatient $28.05 $13.90 $44.60 $28.05 $97.56 $28.05 Fee Schedule $97.56 $28.05 Fee Schedule $156.09 $28.05 Fee Schedule 74.74% $20.96 Percent of Billed Charges 68.24% $19.14 Percent of Billed Charges 65.00% $18.23 Percent of Billed Charges 67.00% $18.79 Percent of Billed Charges 77.50% $21.74 Percent of Billed Charges 79.97% $22.43 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 49.55% $13.90 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 78.94% $22.14 Percent of Billed Charges 74.00% $20.76 Percent of Billed Charges 92.50% $25.95 Percent of Billed Charges 55.00% $15.43 Percent of Billed Charges 85.00% $23.84 Percent of Billed Charges 63.00% $17.67 Percent of Billed Charges 63.00% $17.67 Percent of Billed Charges 75.00% $21.04 Percent of Billed Charges 66.24% $18.58 Percent of Billed Charges 165.81% $28.05 Fee Schedule 166.07% $29.73 Fee Schedule 176.26% $31.55 Fee Schedule 129.00% $23.09 Fee Schedule 191.24% $34.23 Fee Schedule 159.00% $44.60 Fee Schedule 145.00% $25.96 Fee Schedule 60.00% $16.83 Percent of Billed Charges HC FACTOR XI ACTIVITY ARUP 300 CPT 85270 90 Outpatient $48.13 $23.09 $76.53 $48.13 $97.56 $48.13 Fee Schedule $97.56 $48.13 Fee Schedule $156.09 $48.13 Fee Schedule 74.74% $35.97 Percent of Billed Charges 68.24% $32.84 Percent of Billed Charges 65.00% $31.28 Percent of Billed Charges 67.00% $32.25 Percent of Billed Charges 77.50% $37.30 Percent of Billed Charges 79.97% $38.49 Percent of Billed Charges 55.00% $26.47 Percent of Billed Charges 49.55% $23.85 Percent of Billed Charges 55.00% $26.47 Percent of Billed Charges 55.00% $26.47 Percent of Billed Charges 78.94% $37.99 Percent of Billed Charges 74.00% $35.62 Percent of Billed Charges 92.50% $44.52 Percent of Billed Charges 55.00% $26.47 Percent of Billed Charges 85.00% $40.91 Percent of Billed Charges 63.00% $30.32 Percent of Billed Charges 63.00% $30.32 Percent of Billed Charges 75.00% $36.10 Percent of Billed Charges 66.24% $31.88 Percent of Billed Charges 165.81% $29.68 Fee Schedule 166.07% $29.73 Fee Schedule 176.26% $31.55 Fee Schedule 129.00% $23.09 Fee Schedule 191.24% $34.23 Fee Schedule 159.00% $76.53 Fee Schedule 145.00% $25.96 Fee Schedule 60.00% $28.88 Percent of Billed Charges HC FACTOR XII ACTIVITY ARUP 300 CPT 85280 90 Outpatient $45.13 $22.36 $71.76 $45.13 $105.44 $45.13 Fee Schedule $105.44 $45.13 Fee Schedule $168.73 $45.13 Fee Schedule 74.74% $33.73 Percent of Billed Charges 68.24% $30.80 Percent of Billed Charges 65.00% $29.33 Percent of Billed Charges 67.00% $30.24 Percent of Billed Charges 77.50% $34.98 Percent of Billed Charges 79.97% $36.09 Percent of Billed Charges 55.00% $24.82 Percent of Billed Charges 49.55% $22.36 Percent of Billed Charges 55.00% $24.82 Percent of Billed Charges 55.00% $24.82 Percent of Billed Charges 78.94% $35.63 Percent of Billed Charges 74.00% $33.40 Percent of Billed Charges 92.50% $41.75 Percent of Billed Charges 55.00% $24.82 Percent of Billed Charges 85.00% $38.36 Percent of Billed Charges 63.00% $28.43 Percent of Billed Charges 63.00% $28.43 Percent of Billed Charges 75.00% $33.85 Percent of Billed Charges 66.24% $29.89 Percent of Billed Charges 165.81% $32.08 Fee Schedule 166.07% $32.13 Fee Schedule 176.26% $34.11 Fee Schedule 129.00% $24.96 Fee Schedule 191.24% $37.00 Fee Schedule 159.00% $71.76 Fee Schedule 145.00% $28.06 Fee Schedule 60.00% $27.08 Percent of Billed Charges HC FACTOR XIII 1:1 BILL 300 CPT 85291 90 Outpatient $33.50 $11.75 $53.27 $33.50 $48.48 $33.50 Fee Schedule $48.48 $33.50 Fee Schedule $79.44 $33.50 Fee Schedule 74.74% $25.04 Percent of Billed Charges 68.24% $22.86 Percent of Billed Charges 65.00% $21.78 Percent of Billed Charges 67.00% $22.45 Percent of Billed Charges 77.50% $25.96 Percent of Billed Charges 79.97% $26.79 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 49.55% $16.60 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 78.94% $26.44 Percent of Billed Charges 74.00% $24.79 Percent of Billed Charges 92.50% $30.99 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 85.00% $28.48 Percent of Billed Charges 63.00% $21.11 Percent of Billed Charges 63.00% $21.11 Percent of Billed Charges 75.00% $25.13 Percent of Billed Charges 66.24% $22.19 Percent of Billed Charges 165.81% $15.11 Fee Schedule 166.07% $15.13 Fee Schedule 176.26% $16.06 Fee Schedule 129.00% $11.75 Fee Schedule 191.24% $17.42 Fee Schedule 159.00% $53.27 Fee Schedule 145.00% $13.21 Fee Schedule 60.00% $20.10 Percent of Billed Charges HC FACTOR XIII ACTVITY ARUP 300 CPT 85291 90 Outpatient $33.50 $11.75 $53.27 $33.50 $48.48 $33.50 Fee Schedule $48.48 $33.50 Fee Schedule $79.44 $33.50 Fee Schedule 74.74% $25.04 Percent of Billed Charges 68.24% $22.86 Percent of Billed Charges 65.00% $21.78 Percent of Billed Charges 67.00% $22.45 Percent of Billed Charges 77.50% $25.96 Percent of Billed Charges 79.97% $26.79 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 49.55% $16.60 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 78.94% $26.44 Percent of Billed Charges 74.00% $24.79 Percent of Billed Charges 92.50% $30.99 Percent of Billed Charges 55.00% $18.43 Percent of Billed Charges 85.00% $28.48 Percent of Billed Charges 63.00% $21.11 Percent of Billed Charges 63.00% $21.11 Percent of Billed Charges 75.00% $25.13 Percent of Billed Charges 66.24% $22.19 Percent of Billed Charges 165.81% $15.11 Fee Schedule 166.07% $15.13 Fee Schedule 176.26% $16.06 Fee Schedule 129.00% $11.75 Fee Schedule 191.24% $17.42 Fee Schedule 159.00% $53.27 Fee Schedule 145.00% $13.21 Fee Schedule 60.00% $20.10 Percent of Billed Charges HC FATTY ACID MAYO 300 CPT 82726 90 Outpatient $100.79 $25.48 $160.26 $100.79 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $172.22 $100.79 Fee Schedule 74.74% $75.33 Percent of Billed Charges 68.24% $68.78 Percent of Billed Charges 65.00% $65.51 Percent of Billed Charges 67.00% $67.53 Percent of Billed Charges 77.50% $78.11 Percent of Billed Charges 79.97% $80.60 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 49.55% $49.94 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 78.94% $79.56 Percent of Billed Charges 74.00% $74.58 Percent of Billed Charges 92.50% $93.23 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 85.00% $85.67 Percent of Billed Charges 63.00% $63.50 Percent of Billed Charges 63.00% $63.50 Percent of Billed Charges 75.00% $75.59 Percent of Billed Charges 66.24% $66.76 Percent of Billed Charges 165.81% $32.75 Fee Schedule 166.07% $32.80 Fee Schedule 176.26% $34.81 Fee Schedule 129.00% $25.48 Fee Schedule 191.24% $37.77 Fee Schedule 159.00% $160.26 Fee Schedule 145.00% $28.64 Fee Schedule 60.00% $60.47 Percent of Billed Charges HC FATTY ACID PEROXISOMAL MA 300 CPT 82726 90 Outpatient $100.79 $25.48 $160.26 $100.79 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $172.22 $100.79 Fee Schedule 74.74% $75.33 Percent of Billed Charges 68.24% $68.78 Percent of Billed Charges 65.00% $65.51 Percent of Billed Charges 67.00% $67.53 Percent of Billed Charges 77.50% $78.11 Percent of Billed Charges 79.97% $80.60 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 49.55% $49.94 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 78.94% $79.56 Percent of Billed Charges 74.00% $74.58 Percent of Billed Charges 92.50% $93.23 Percent of Billed Charges 55.00% $55.43 Percent of Billed Charges 85.00% $85.67 Percent of Billed Charges 63.00% $63.50 Percent of Billed Charges 63.00% $63.50 Percent of Billed Charges 75.00% $75.59 Percent of Billed Charges 66.24% $66.76 Percent of Billed Charges 165.81% $32.75 Fee Schedule 166.07% $32.80 Fee Schedule 176.26% $34.81 Fee Schedule 129.00% $25.48 Fee Schedule 191.24% $37.77 Fee Schedule 159.00% $160.26 Fee Schedule 145.00% $28.64 Fee Schedule 60.00% $60.47 Percent of Billed Charges "HC FATTY ACID PNL, ESSENTIAL MAYO" 300 CPT 82542 90 Outpatient $138.69 $31.08 $220.52 $138.69 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $138.69 Fee Schedule 74.74% $103.66 Percent of Billed Charges 68.24% $94.64 Percent of Billed Charges 65.00% $90.15 Percent of Billed Charges 67.00% $92.92 Percent of Billed Charges 77.50% $107.48 Percent of Billed Charges 79.97% $110.91 Percent of Billed Charges 55.00% $76.28 Percent of Billed Charges 49.55% $68.72 Percent of Billed Charges 55.00% $76.28 Percent of Billed Charges 55.00% $76.28 Percent of Billed Charges 78.94% $109.48 Percent of Billed Charges 74.00% $102.63 Percent of Billed Charges 92.50% $128.29 Percent of Billed Charges 55.00% $76.28 Percent of Billed Charges 85.00% $117.89 Percent of Billed Charges 63.00% $87.37 Percent of Billed Charges 63.00% $87.37 Percent of Billed Charges 75.00% $104.02 Percent of Billed Charges 66.24% $91.87 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $220.52 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $83.21 Percent of Billed Charges HC FATTY ACIDS FREE LABCORP 300 CPT 82725 90 Outpatient $21.00 $10.41 $35.90 $21.00 $72.52 $21.00 Fee Schedule $72.52 $21.00 Fee Schedule $163.67 $21.00 Fee Schedule 74.74% $15.70 Percent of Billed Charges 68.24% $14.33 Percent of Billed Charges 65.00% $13.65 Percent of Billed Charges 67.00% $14.07 Percent of Billed Charges 77.50% $16.28 Percent of Billed Charges 79.97% $16.79 Percent of Billed Charges 55.00% $11.55 Percent of Billed Charges 49.55% $10.41 Percent of Billed Charges 55.00% $11.55 Percent of Billed Charges 55.00% $11.55 Percent of Billed Charges 78.94% $16.58 Percent of Billed Charges 74.00% $15.54 Percent of Billed Charges 92.50% $19.43 Percent of Billed Charges 55.00% $11.55 Percent of Billed Charges 85.00% $17.85 Percent of Billed Charges 63.00% $13.23 Percent of Billed Charges 63.00% $13.23 Percent of Billed Charges 75.00% $15.75 Percent of Billed Charges 66.24% $13.91 Percent of Billed Charges 165.81% $21.00 Fee Schedule 166.07% $31.17 Fee Schedule 176.26% $33.08 Fee Schedule 129.00% $24.21 Fee Schedule 191.24% $35.90 Fee Schedule 159.00% $33.39 Fee Schedule 145.00% $27.22 Fee Schedule 60.00% $12.60 Percent of Billed Charges HC FECAL FAT QUAL LABCORP 300 CPT 82705 90 Outpatient $4.50 $2.23 $9.75 $4.50 $27.72 $4.50 Fee Schedule $27.72 $4.50 Fee Schedule $44.47 $4.50 Fee Schedule 74.74% $3.36 Percent of Billed Charges 68.24% $3.07 Percent of Billed Charges 65.00% $2.93 Percent of Billed Charges 67.00% $3.02 Percent of Billed Charges 77.50% $3.49 Percent of Billed Charges 79.97% $3.60 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 49.55% $2.23 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 78.94% $3.55 Percent of Billed Charges 74.00% $3.33 Percent of Billed Charges 92.50% $4.16 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 85.00% $3.83 Percent of Billed Charges 63.00% $2.84 Percent of Billed Charges 63.00% $2.84 Percent of Billed Charges 75.00% $3.38 Percent of Billed Charges 66.24% $2.98 Percent of Billed Charges 165.81% $4.50 Fee Schedule 166.07% $8.47 Fee Schedule 176.26% $8.99 Fee Schedule 129.00% $6.58 Fee Schedule 191.24% $9.75 Fee Schedule 159.00% $7.16 Fee Schedule 145.00% $7.40 Fee Schedule 60.00% $2.70 Percent of Billed Charges HC FECAL FAT QUANT LABCORP 300 CPT 82710 90 Outpatient $13.00 $6.44 $32.13 $13.00 $91.56 $13.00 Fee Schedule $91.56 $13.00 Fee Schedule $146.50 $13.00 Fee Schedule 74.74% $9.72 Percent of Billed Charges 68.24% $8.87 Percent of Billed Charges 65.00% $8.45 Percent of Billed Charges 67.00% $8.71 Percent of Billed Charges 77.50% $10.08 Percent of Billed Charges 79.97% $10.40 Percent of Billed Charges 55.00% $7.15 Percent of Billed Charges 49.55% $6.44 Percent of Billed Charges 55.00% $7.15 Percent of Billed Charges 55.00% $7.15 Percent of Billed Charges 78.94% $10.26 Percent of Billed Charges 74.00% $9.62 Percent of Billed Charges 92.50% $12.03 Percent of Billed Charges 55.00% $7.15 Percent of Billed Charges 85.00% $11.05 Percent of Billed Charges 63.00% $8.19 Percent of Billed Charges 63.00% $8.19 Percent of Billed Charges 75.00% $9.75 Percent of Billed Charges 66.24% $8.61 Percent of Billed Charges 165.81% $13.00 Fee Schedule 166.07% $27.90 Fee Schedule 176.26% $29.61 Fee Schedule 129.00% $21.67 Fee Schedule 191.24% $32.13 Fee Schedule 159.00% $20.67 Fee Schedule 145.00% $24.36 Fee Schedule 60.00% $7.80 Percent of Billed Charges HC FELBAMATE LABCORP 300 CPT G0480 90 Outpatient $17.16 $8.50 $170.85 $17.16 $319.76 $17.16 Fee Schedule $319.76 $17.16 Fee Schedule $997.83 $17.16 Fee Schedule 74.74% $12.83 Percent of Billed Charges 68.24% $11.71 Percent of Billed Charges 65.00% $11.15 Percent of Billed Charges 67.00% $11.50 Percent of Billed Charges 77.50% $13.30 Percent of Billed Charges 79.97% $13.72 Percent of Billed Charges 55.00% $9.44 Percent of Billed Charges 49.55% $8.50 Percent of Billed Charges 55.00% $9.44 Percent of Billed Charges 55.00% $9.44 Percent of Billed Charges 78.94% $13.55 Percent of Billed Charges 74.00% $12.70 Percent of Billed Charges 92.50% $15.87 Percent of Billed Charges 55.00% $9.44 Percent of Billed Charges 85.00% $14.59 Percent of Billed Charges 63.00% $10.81 Percent of Billed Charges 63.00% $10.81 Percent of Billed Charges 75.00% $12.87 Percent of Billed Charges 66.24% $11.37 Percent of Billed Charges 165.81% $17.16 Fee Schedule 166.07% $148.37 Fee Schedule 176.26% $157.47 Fee Schedule 129.00% $115.25 Fee Schedule 191.24% $170.85 Fee Schedule 159.00% $27.28 Fee Schedule 145.00% $129.54 Fee Schedule 60.00% $10.30 Percent of Billed Charges "HC FIBRIN DEGRADPRODUCTS,D-DIMER, QUANT - D-DIMER,QUANTITATIVE" 300 CPT 85379 Outpatient $185.00 $13.13 $294.15 $185.00 $55.48 $55.48 Fee Schedule $55.48 $55.48 Fee Schedule $88.77 $84.19 Fee Schedule 74.74% $138.27 Percent of Billed Charges 68.24% $126.24 Percent of Billed Charges 65.00% $120.25 Percent of Billed Charges 67.00% $123.95 Percent of Billed Charges 77.50% $143.38 Percent of Billed Charges 79.97% $147.94 Percent of Billed Charges 55.00% $101.75 Percent of Billed Charges 49.55% $91.67 Percent of Billed Charges 55.00% $101.75 Percent of Billed Charges 55.00% $101.75 Percent of Billed Charges 78.94% $146.04 Percent of Billed Charges 74.00% $136.90 Percent of Billed Charges 92.50% $171.13 Percent of Billed Charges 55.00% $101.75 Percent of Billed Charges 85.00% $157.25 Percent of Billed Charges 63.00% $116.55 Percent of Billed Charges 63.00% $116.55 Percent of Billed Charges 75.00% $138.75 Percent of Billed Charges 66.24% $122.54 Percent of Billed Charges 165.81% $16.88 Fee Schedule 166.07% $16.91 Fee Schedule 176.26% $17.94 Fee Schedule 129.00% $13.13 Fee Schedule 191.24% $19.47 Fee Schedule 159.00% $294.15 Fee Schedule 145.00% $14.76 Fee Schedule 60.00% $111.00 Percent of Billed Charges HC FIBRINOGEN ANTIGEN 300 CPT 85385 90 Outpatient $47.70 $18.65 $75.84 $47.70 $46.28 $46.28 Fee Schedule $46.28 $46.28 Fee Schedule $126.09 $47.70 Fee Schedule 74.74% $35.65 Percent of Billed Charges 68.24% $32.55 Percent of Billed Charges 65.00% $31.01 Percent of Billed Charges 67.00% $31.96 Percent of Billed Charges 77.50% $36.97 Percent of Billed Charges 79.97% $38.15 Percent of Billed Charges 55.00% $26.24 Percent of Billed Charges 49.55% $23.64 Percent of Billed Charges 55.00% $26.24 Percent of Billed Charges 55.00% $26.24 Percent of Billed Charges 78.94% $37.65 Percent of Billed Charges 74.00% $35.30 Percent of Billed Charges 92.50% $44.12 Percent of Billed Charges 55.00% $26.24 Percent of Billed Charges 85.00% $40.55 Percent of Billed Charges 63.00% $30.05 Percent of Billed Charges 63.00% $30.05 Percent of Billed Charges 75.00% $35.78 Percent of Billed Charges 66.24% $31.60 Percent of Billed Charges 165.81% $23.98 Fee Schedule 166.07% $24.01 Fee Schedule 176.26% $25.49 Fee Schedule 129.00% $18.65 Fee Schedule 191.24% $27.65 Fee Schedule 159.00% $75.84 Fee Schedule 145.00% $20.97 Fee Schedule 60.00% $28.62 Percent of Billed Charges HC FIBROSPECT II PROMETHEUS 300 CPT 83883 90 Outpatient $350.00 $17.54 $556.50 $350.00 $74.08 $74.08 Fee Schedule $74.08 $74.08 Fee Schedule $118.59 $112.47 Fee Schedule 74.74% $261.59 Percent of Billed Charges 68.24% $238.84 Percent of Billed Charges 65.00% $227.50 Percent of Billed Charges 67.00% $234.50 Percent of Billed Charges 77.50% $271.25 Percent of Billed Charges 79.97% $279.90 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 49.55% $173.43 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 78.94% $276.29 Percent of Billed Charges 74.00% $259.00 Percent of Billed Charges 92.50% $323.75 Percent of Billed Charges 55.00% $192.50 Percent of Billed Charges 85.00% $297.50 Percent of Billed Charges 63.00% $220.50 Percent of Billed Charges 63.00% $220.50 Percent of Billed Charges 75.00% $262.50 Percent of Billed Charges 66.24% $231.84 Percent of Billed Charges 165.81% $22.55 Fee Schedule 166.07% $22.59 Fee Schedule 176.26% $23.97 Fee Schedule 129.00% $17.54 Fee Schedule 191.24% $26.01 Fee Schedule 159.00% $556.50 Fee Schedule 145.00% $19.72 Fee Schedule 60.00% $210.00 Percent of Billed Charges HC FIBROTEST-ACTITEST 300 CPT 81596 90 Outpatient $288.75 $93.13 $459.11 $288.75 $288.76 $288.75 Fee Schedule $288.76 $288.75 Fee Schedule $629.50 $288.75 Fee Schedule 74.74% $215.81 Percent of Billed Charges 68.24% $197.04 Percent of Billed Charges 65.00% $187.69 Percent of Billed Charges 67.00% $193.46 Percent of Billed Charges 77.50% $223.78 Percent of Billed Charges 79.97% $230.91 Percent of Billed Charges 55.00% $158.81 Percent of Billed Charges 49.55% $143.08 Percent of Billed Charges 55.00% $158.81 Percent of Billed Charges 55.00% $158.81 Percent of Billed Charges 78.94% $227.94 Percent of Billed Charges 74.00% $213.68 Percent of Billed Charges 92.50% $267.09 Percent of Billed Charges 55.00% $158.81 Percent of Billed Charges 85.00% $245.44 Percent of Billed Charges 63.00% $181.91 Percent of Billed Charges 63.00% $181.91 Percent of Billed Charges 75.00% $216.56 Percent of Billed Charges 66.24% $191.27 Percent of Billed Charges 165.81% $119.70 Fee Schedule 166.07% $119.89 Fee Schedule 176.26% $127.24 Fee Schedule 129.00% $93.13 Fee Schedule 191.24% $138.06 Fee Schedule 159.00% $459.11 Fee Schedule 145.00% $104.68 Fee Schedule 60.00% $173.25 Percent of Billed Charges "HC FISH,DIGEORGE QUEST" 300 CPT 88271 90 Outpatient $222.95 $27.63 $354.49 $222.95 $116.68 $116.68 Fee Schedule $116.68 $116.68 Fee Schedule $186.78 $177.14 Fee Schedule 74.74% $166.63 Percent of Billed Charges 68.24% $152.14 Percent of Billed Charges 65.00% $144.92 Percent of Billed Charges 67.00% $149.38 Percent of Billed Charges 77.50% $172.79 Percent of Billed Charges 79.97% $178.29 Percent of Billed Charges 55.00% $122.62 Percent of Billed Charges 49.55% $110.47 Percent of Billed Charges 55.00% $122.62 Percent of Billed Charges 55.00% $122.62 Percent of Billed Charges 78.94% $176.00 Percent of Billed Charges 74.00% $164.98 Percent of Billed Charges 92.50% $206.23 Percent of Billed Charges 55.00% $122.62 Percent of Billed Charges 85.00% $189.51 Percent of Billed Charges 63.00% $140.46 Percent of Billed Charges 63.00% $140.46 Percent of Billed Charges 75.00% $167.21 Percent of Billed Charges 66.24% $147.68 Percent of Billed Charges 165.81% $35.52 Fee Schedule 166.07% $35.57 Fee Schedule 176.26% $37.75 Fee Schedule 129.00% $27.63 Fee Schedule 191.24% $40.96 Fee Schedule 159.00% $354.49 Fee Schedule 145.00% $31.06 Fee Schedule 60.00% $133.77 Percent of Billed Charges HC FITZGERALD FACTOR 300 CPT 85293 90 Outpatient $66.39 $24.42 $105.56 $66.39 $103.20 $66.39 Fee Schedule $103.20 $66.39 Fee Schedule $165.07 $66.39 Fee Schedule 74.74% $49.62 Percent of Billed Charges 68.24% $45.30 Percent of Billed Charges 65.00% $43.15 Percent of Billed Charges 67.00% $44.48 Percent of Billed Charges 77.50% $51.45 Percent of Billed Charges 79.97% $53.09 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 49.55% $32.90 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 78.94% $52.41 Percent of Billed Charges 74.00% $49.13 Percent of Billed Charges 92.50% $61.41 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 85.00% $56.43 Percent of Billed Charges 63.00% $41.83 Percent of Billed Charges 63.00% $41.83 Percent of Billed Charges 75.00% $49.79 Percent of Billed Charges 66.24% $43.98 Percent of Billed Charges 165.81% $31.39 Fee Schedule 166.07% $31.44 Fee Schedule 176.26% $33.37 Fee Schedule 129.00% $24.42 Fee Schedule 191.24% $36.20 Fee Schedule 159.00% $105.56 Fee Schedule 145.00% $27.45 Fee Schedule 60.00% $39.83 Percent of Billed Charges HC FLECAINIDE LABCORP 300 CPT 80299 90 Outpatient $15.00 $7.43 $35.65 $15.00 $74.64 $15.00 Fee Schedule $74.64 $15.00 Fee Schedule $162.54 $15.00 Fee Schedule 74.74% $11.21 Percent of Billed Charges 68.24% $10.24 Percent of Billed Charges 65.00% $9.75 Percent of Billed Charges 67.00% $10.05 Percent of Billed Charges 77.50% $11.63 Percent of Billed Charges 79.97% $12.00 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 49.55% $7.43 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 78.94% $11.84 Percent of Billed Charges 74.00% $11.10 Percent of Billed Charges 92.50% $13.88 Percent of Billed Charges 55.00% $8.25 Percent of Billed Charges 85.00% $12.75 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 63.00% $9.45 Percent of Billed Charges 75.00% $11.25 Percent of Billed Charges 66.24% $9.94 Percent of Billed Charges 165.81% $15.00 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $23.85 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $9.00 Percent of Billed Charges HC FLETCHER(PREKALLIKREIN) 300 CPT 85292 90 Outpatient $66.39 $24.42 $105.56 $66.39 $103.20 $66.39 Fee Schedule $103.20 $66.39 Fee Schedule $165.07 $66.39 Fee Schedule 74.74% $49.62 Percent of Billed Charges 68.24% $45.30 Percent of Billed Charges 65.00% $43.15 Percent of Billed Charges 67.00% $44.48 Percent of Billed Charges 77.50% $51.45 Percent of Billed Charges 79.97% $53.09 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 49.55% $32.90 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 78.94% $52.41 Percent of Billed Charges 74.00% $49.13 Percent of Billed Charges 92.50% $61.41 Percent of Billed Charges 55.00% $36.51 Percent of Billed Charges 85.00% $56.43 Percent of Billed Charges 63.00% $41.83 Percent of Billed Charges 63.00% $41.83 Percent of Billed Charges 75.00% $49.79 Percent of Billed Charges 66.24% $43.98 Percent of Billed Charges 165.81% $31.39 Fee Schedule 166.07% $31.44 Fee Schedule 176.26% $33.37 Fee Schedule 129.00% $24.42 Fee Schedule 191.24% $36.20 Fee Schedule 159.00% $105.56 Fee Schedule 145.00% $27.45 Fee Schedule 60.00% $39.83 Percent of Billed Charges HC FLOW CYT INTRO 2-8 MARKERS UW 300 CPT 88187 90 Outpatient $136.53 $59.40 $217.08 $136.53 $292.16 $136.53 Fee Schedule $292.16 $136.53 Fee Schedule 56.78% $77.52 Percent of Billed Charges 74.74% $102.04 Percent of Billed Charges 68.24% $93.17 Percent of Billed Charges 65.00% $88.74 Percent of Billed Charges 67.00% $91.48 Percent of Billed Charges 77.50% $105.81 Percent of Billed Charges 79.97% $109.18 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 49.55% $67.65 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 78.94% $107.78 Percent of Billed Charges 74.00% $101.03 Percent of Billed Charges 92.50% $126.29 Percent of Billed Charges 55.00% $75.09 Percent of Billed Charges 85.00% $116.05 Percent of Billed Charges 63.00% $86.01 Percent of Billed Charges 63.00% $86.01 Percent of Billed Charges 75.00% $102.40 Percent of Billed Charges 66.24% $90.44 Percent of Billed Charges 165.81% $76.36 Fee Schedule 166.07% $76.48 Fee Schedule 176.26% $81.17 Fee Schedule 129.00% $59.40 Fee Schedule 191.24% $88.07 Fee Schedule 159.00% $217.08 Fee Schedule 145.00% $66.77 Fee Schedule 60.00% $81.92 Percent of Billed Charges HC FLUCONAZOLE ARUP 300 CPT 80299 90 Outpatient $60.25 $24.05 $95.80 $60.25 $74.64 $60.25 Fee Schedule $74.64 $60.25 Fee Schedule $162.54 $60.25 Fee Schedule 74.74% $45.03 Percent of Billed Charges 68.24% $41.11 Percent of Billed Charges 65.00% $39.16 Percent of Billed Charges 67.00% $40.37 Percent of Billed Charges 77.50% $46.69 Percent of Billed Charges 79.97% $48.18 Percent of Billed Charges 55.00% $33.14 Percent of Billed Charges 49.55% $29.85 Percent of Billed Charges 55.00% $33.14 Percent of Billed Charges 55.00% $33.14 Percent of Billed Charges 78.94% $47.56 Percent of Billed Charges 74.00% $44.59 Percent of Billed Charges 92.50% $55.73 Percent of Billed Charges 55.00% $33.14 Percent of Billed Charges 85.00% $51.21 Percent of Billed Charges 63.00% $37.96 Percent of Billed Charges 63.00% $37.96 Percent of Billed Charges 75.00% $45.19 Percent of Billed Charges 66.24% $39.91 Percent of Billed Charges 165.81% $30.91 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $95.80 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $36.15 Percent of Billed Charges HC FLUCYTOSINE 300 CPT 80299 90 Outpatient $106.88 $24.05 $169.94 $106.88 $74.64 $74.64 Fee Schedule $74.64 $74.64 Fee Schedule $162.54 $106.88 Fee Schedule 74.74% $79.88 Percent of Billed Charges 68.24% $72.93 Percent of Billed Charges 65.00% $69.47 Percent of Billed Charges 67.00% $71.61 Percent of Billed Charges 77.50% $82.83 Percent of Billed Charges 79.97% $85.47 Percent of Billed Charges 55.00% $58.78 Percent of Billed Charges 49.55% $52.96 Percent of Billed Charges 55.00% $58.78 Percent of Billed Charges 55.00% $58.78 Percent of Billed Charges 78.94% $84.37 Percent of Billed Charges 74.00% $79.09 Percent of Billed Charges 92.50% $98.86 Percent of Billed Charges 55.00% $58.78 Percent of Billed Charges 85.00% $90.85 Percent of Billed Charges 63.00% $67.33 Percent of Billed Charges 63.00% $67.33 Percent of Billed Charges 75.00% $80.16 Percent of Billed Charges 66.24% $70.80 Percent of Billed Charges 165.81% $30.91 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $169.94 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $64.13 Percent of Billed Charges HC FOLATE RBC LABCORP 300 CPT 82747 90 Outpatient $8.00 $3.96 $33.75 $8.00 $94.36 $8.00 Fee Schedule $94.36 $8.00 Fee Schedule $153.91 $8.00 Fee Schedule 74.74% $5.98 Percent of Billed Charges 68.24% $5.46 Percent of Billed Charges 65.00% $5.20 Percent of Billed Charges 67.00% $5.36 Percent of Billed Charges 77.50% $6.20 Percent of Billed Charges 79.97% $6.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 49.55% $3.96 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 78.94% $6.32 Percent of Billed Charges 74.00% $5.92 Percent of Billed Charges 92.50% $7.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 85.00% $6.80 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 75.00% $6.00 Percent of Billed Charges 66.24% $5.30 Percent of Billed Charges 165.81% $8.00 Fee Schedule 166.07% $29.31 Fee Schedule 176.26% $31.11 Fee Schedule 129.00% $22.77 Fee Schedule 191.24% $33.75 Fee Schedule 159.00% $12.72 Fee Schedule 145.00% $25.59 Fee Schedule 60.00% $4.80 Percent of Billed Charges HC FOLATES LABCORP 300 CPT 82746 90 Outpatient $3.00 $1.49 $28.11 $3.00 $80.12 $3.00 Fee Schedule $80.12 $3.00 Fee Schedule $128.18 $3.00 Fee Schedule 74.74% $2.24 Percent of Billed Charges 68.24% $2.05 Percent of Billed Charges 65.00% $1.95 Percent of Billed Charges 67.00% $2.01 Percent of Billed Charges 77.50% $2.33 Percent of Billed Charges 79.97% $2.40 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 49.55% $1.49 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 78.94% $2.37 Percent of Billed Charges 74.00% $2.22 Percent of Billed Charges 92.50% $2.78 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 85.00% $2.55 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 75.00% $2.25 Percent of Billed Charges 66.24% $1.99 Percent of Billed Charges 165.81% $3.00 Fee Schedule 166.07% $24.41 Fee Schedule 176.26% $25.91 Fee Schedule 129.00% $18.96 Fee Schedule 191.24% $28.11 Fee Schedule 159.00% $4.77 Fee Schedule 145.00% $21.32 Fee Schedule 60.00% $1.80 Percent of Billed Charges HC FOOD ALLERGY PROFILE QUEST 300 CPT 86003 90 Outpatient $96.45 $6.73 $153.36 $96.45 $28.44 $28.44 Fee Schedule $28.44 $28.44 Fee Schedule $45.52 $43.17 Fee Schedule 74.74% $72.09 Percent of Billed Charges 68.24% $65.82 Percent of Billed Charges 65.00% $62.69 Percent of Billed Charges 67.00% $64.62 Percent of Billed Charges 77.50% $74.75 Percent of Billed Charges 79.97% $77.13 Percent of Billed Charges 55.00% $53.05 Percent of Billed Charges 49.55% $47.79 Percent of Billed Charges 55.00% $53.05 Percent of Billed Charges 55.00% $53.05 Percent of Billed Charges 78.94% $76.14 Percent of Billed Charges 74.00% $71.37 Percent of Billed Charges 92.50% $89.22 Percent of Billed Charges 55.00% $53.05 Percent of Billed Charges 85.00% $81.98 Percent of Billed Charges 63.00% $60.76 Percent of Billed Charges 63.00% $60.76 Percent of Billed Charges 75.00% $72.34 Percent of Billed Charges 66.24% $63.89 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $153.36 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $57.87 Percent of Billed Charges HC FOOD ALLERGY PROFILE LABCORP 300 CPT 86003 90 Outpatient $48.00 $6.73 $76.32 $48.00 $28.44 $28.44 Fee Schedule $28.44 $28.44 Fee Schedule $45.52 $43.17 Fee Schedule 74.74% $35.88 Percent of Billed Charges 68.24% $32.76 Percent of Billed Charges 65.00% $31.20 Percent of Billed Charges 67.00% $32.16 Percent of Billed Charges 77.50% $37.20 Percent of Billed Charges 79.97% $38.39 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 49.55% $23.78 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 78.94% $37.89 Percent of Billed Charges 74.00% $35.52 Percent of Billed Charges 92.50% $44.40 Percent of Billed Charges 55.00% $26.40 Percent of Billed Charges 85.00% $40.80 Percent of Billed Charges 63.00% $30.24 Percent of Billed Charges 63.00% $30.24 Percent of Billed Charges 75.00% $36.00 Percent of Billed Charges 66.24% $31.80 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $76.32 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $28.80 Percent of Billed Charges HC FRAGILE X PCR LABCORP 300 CPT 81243 90 Outpatient $375.00 $73.58 $596.25 $375.00 $228.16 $228.16 Fee Schedule $228.16 $228.16 Fee Schedule $497.39 $375.00 Fee Schedule 74.74% $280.28 Percent of Billed Charges 68.24% $255.90 Percent of Billed Charges 65.00% $243.75 Percent of Billed Charges 67.00% $251.25 Percent of Billed Charges 77.50% $290.63 Percent of Billed Charges 79.97% $299.89 Percent of Billed Charges 55.00% $206.25 Percent of Billed Charges 49.55% $185.81 Percent of Billed Charges 55.00% $206.25 Percent of Billed Charges 55.00% $206.25 Percent of Billed Charges 78.94% $296.03 Percent of Billed Charges 74.00% $277.50 Percent of Billed Charges 92.50% $346.88 Percent of Billed Charges 55.00% $206.25 Percent of Billed Charges 85.00% $318.75 Percent of Billed Charges 63.00% $236.25 Percent of Billed Charges 63.00% $236.25 Percent of Billed Charges 75.00% $281.25 Percent of Billed Charges 66.24% $248.40 Percent of Billed Charges 165.81% $94.58 Fee Schedule 166.07% $94.73 Fee Schedule 176.26% $100.54 Fee Schedule 129.00% $73.58 Fee Schedule 191.24% $109.08 Fee Schedule 159.00% $596.25 Fee Schedule 145.00% $82.71 Fee Schedule 60.00% $225.00 Percent of Billed Charges HC FRATAXIN MAYO 300 CPT 83520 90 Outpatient $117.80 $22.28 $187.30 $117.80 $70.52 $70.52 Fee Schedule $70.52 $70.52 Fee Schedule $150.59 $117.80 Fee Schedule 74.74% $88.04 Percent of Billed Charges 68.24% $80.39 Percent of Billed Charges 65.00% $76.57 Percent of Billed Charges 67.00% $78.93 Percent of Billed Charges 77.50% $91.30 Percent of Billed Charges 79.97% $94.20 Percent of Billed Charges 55.00% $64.79 Percent of Billed Charges 49.55% $58.37 Percent of Billed Charges 55.00% $64.79 Percent of Billed Charges 55.00% $64.79 Percent of Billed Charges 78.94% $92.99 Percent of Billed Charges 74.00% $87.17 Percent of Billed Charges 92.50% $108.97 Percent of Billed Charges 55.00% $64.79 Percent of Billed Charges 85.00% $100.13 Percent of Billed Charges 63.00% $74.21 Percent of Billed Charges 63.00% $74.21 Percent of Billed Charges 75.00% $88.35 Percent of Billed Charges 66.24% $78.03 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $187.30 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $70.68 Percent of Billed Charges HC FRUCTOSAMINE LABCORP 300 CPT 82985 90 Outpatient $2.75 $1.36 $32.05 $2.75 $82.16 $2.75 Fee Schedule $82.16 $2.75 Fee Schedule $146.15 $2.75 Fee Schedule 74.74% $2.06 Percent of Billed Charges 68.24% $1.88 Percent of Billed Charges 65.00% $1.79 Percent of Billed Charges 67.00% $1.84 Percent of Billed Charges 77.50% $2.13 Percent of Billed Charges 79.97% $2.20 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 49.55% $1.36 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 78.94% $2.17 Percent of Billed Charges 74.00% $2.04 Percent of Billed Charges 92.50% $2.54 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 85.00% $2.34 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 75.00% $2.06 Percent of Billed Charges 66.24% $1.82 Percent of Billed Charges 165.81% $2.75 Fee Schedule 166.07% $27.83 Fee Schedule 176.26% $29.54 Fee Schedule 129.00% $21.62 Fee Schedule 191.24% $32.05 Fee Schedule 159.00% $4.37 Fee Schedule 145.00% $24.30 Fee Schedule 60.00% $1.65 Percent of Billed Charges HC FSH LABCORP 300 CPT 83001 90 Outpatient $5.00 $2.48 $35.53 $5.00 $101.24 $5.00 Fee Schedule $101.24 $5.00 Fee Schedule $162.02 $5.00 Fee Schedule 74.74% $3.74 Percent of Billed Charges 68.24% $3.41 Percent of Billed Charges 65.00% $3.25 Percent of Billed Charges 67.00% $3.35 Percent of Billed Charges 77.50% $3.88 Percent of Billed Charges 79.97% $4.00 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 49.55% $2.48 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 78.94% $3.95 Percent of Billed Charges 74.00% $3.70 Percent of Billed Charges 92.50% $4.63 Percent of Billed Charges 55.00% $2.75 Percent of Billed Charges 85.00% $4.25 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 63.00% $3.15 Percent of Billed Charges 75.00% $3.75 Percent of Billed Charges 66.24% $3.31 Percent of Billed Charges 165.81% $5.00 Fee Schedule 166.07% $30.86 Fee Schedule 176.26% $32.75 Fee Schedule 129.00% $23.97 Fee Schedule 191.24% $35.53 Fee Schedule 159.00% $7.95 Fee Schedule 145.00% $26.94 Fee Schedule 60.00% $3.00 Percent of Billed Charges HC FTA FLOURESCENT ABS ARUP 300 CPT 86592 90 Outpatient $10.88 $5.39 $17.30 $10.88 $23.28 $10.88 Fee Schedule $23.28 $10.88 Fee Schedule $37.23 $10.88 Fee Schedule 74.74% $8.13 Percent of Billed Charges 68.24% $7.42 Percent of Billed Charges 65.00% $7.07 Percent of Billed Charges 67.00% $7.29 Percent of Billed Charges 77.50% $8.43 Percent of Billed Charges 79.97% $8.70 Percent of Billed Charges 55.00% $5.98 Percent of Billed Charges 49.55% $5.39 Percent of Billed Charges 55.00% $5.98 Percent of Billed Charges 55.00% $5.98 Percent of Billed Charges 78.94% $8.59 Percent of Billed Charges 74.00% $8.05 Percent of Billed Charges 92.50% $10.06 Percent of Billed Charges 55.00% $5.98 Percent of Billed Charges 85.00% $9.25 Percent of Billed Charges 63.00% $6.85 Percent of Billed Charges 63.00% $6.85 Percent of Billed Charges 75.00% $8.16 Percent of Billed Charges 66.24% $7.21 Percent of Billed Charges 165.81% $7.08 Fee Schedule 166.07% $7.09 Fee Schedule 176.26% $7.53 Fee Schedule 129.00% $5.51 Fee Schedule 191.24% $8.17 Fee Schedule 159.00% $17.30 Fee Schedule 145.00% $6.19 Fee Schedule 60.00% $6.53 Percent of Billed Charges HC FUNGAL CULTURE LABCORP 300 CPT 87101 90 Outpatient $15.25 $7.56 $24.25 $15.25 $42.00 $15.25 Fee Schedule $42.00 $15.25 Fee Schedule $67.23 $15.25 Fee Schedule 74.74% $11.40 Percent of Billed Charges 68.24% $10.41 Percent of Billed Charges 65.00% $9.91 Percent of Billed Charges 67.00% $10.22 Percent of Billed Charges 77.50% $11.82 Percent of Billed Charges 79.97% $12.20 Percent of Billed Charges 55.00% $8.39 Percent of Billed Charges 49.55% $7.56 Percent of Billed Charges 55.00% $8.39 Percent of Billed Charges 55.00% $8.39 Percent of Billed Charges 78.94% $12.04 Percent of Billed Charges 74.00% $11.29 Percent of Billed Charges 92.50% $14.11 Percent of Billed Charges 55.00% $8.39 Percent of Billed Charges 85.00% $12.96 Percent of Billed Charges 63.00% $9.61 Percent of Billed Charges 63.00% $9.61 Percent of Billed Charges 75.00% $11.44 Percent of Billed Charges 66.24% $10.10 Percent of Billed Charges 165.81% $12.78 Fee Schedule 166.07% $12.80 Fee Schedule 176.26% $13.59 Fee Schedule 129.00% $9.95 Fee Schedule 191.24% $14.74 Fee Schedule 159.00% $24.25 Fee Schedule 145.00% $11.18 Fee Schedule 60.00% $9.15 Percent of Billed Charges HC FUNGAL PCR UW MOLECULAR LAB 300 CPT 87801 90 Outpatient $560.07 $69.92 $890.51 $560.07 $382.48 $382.48 Fee Schedule $382.48 $382.48 Fee Schedule $612.14 $450.28 Fee Schedule 74.74% $418.60 Percent of Billed Charges 68.24% $382.19 Percent of Billed Charges 65.00% $364.05 Percent of Billed Charges 67.00% $375.25 Percent of Billed Charges 77.50% $434.05 Percent of Billed Charges 79.97% $447.89 Percent of Billed Charges 55.00% $308.04 Percent of Billed Charges 49.55% $277.51 Percent of Billed Charges 55.00% $308.04 Percent of Billed Charges 55.00% $308.04 Percent of Billed Charges 78.94% $442.12 Percent of Billed Charges 74.00% $414.45 Percent of Billed Charges 92.50% $518.06 Percent of Billed Charges 55.00% $308.04 Percent of Billed Charges 85.00% $476.06 Percent of Billed Charges 63.00% $352.84 Percent of Billed Charges 63.00% $352.84 Percent of Billed Charges 75.00% $420.05 Percent of Billed Charges 66.24% $370.99 Percent of Billed Charges 165.81% $89.87 Fee Schedule 166.07% $90.01 Fee Schedule 176.26% $95.53 Fee Schedule 129.00% $69.92 Fee Schedule 191.24% $103.65 Fee Schedule 159.00% $890.51 Fee Schedule 145.00% $78.59 Fee Schedule 60.00% $336.04 Percent of Billed Charges HC FUNGAL STAIN LABCORP 300 CPT 87206 90 Outpatient $13.25 $6.57 $21.07 $13.25 $29.32 $13.25 Fee Schedule $29.32 $13.25 Fee Schedule $47.00 $13.25 Fee Schedule 74.74% $9.90 Percent of Billed Charges 68.24% $9.04 Percent of Billed Charges 65.00% $8.61 Percent of Billed Charges 67.00% $8.88 Percent of Billed Charges 77.50% $10.27 Percent of Billed Charges 79.97% $10.60 Percent of Billed Charges 55.00% $7.29 Percent of Billed Charges 49.55% $6.57 Percent of Billed Charges 55.00% $7.29 Percent of Billed Charges 55.00% $7.29 Percent of Billed Charges 78.94% $10.46 Percent of Billed Charges 74.00% $9.81 Percent of Billed Charges 92.50% $12.26 Percent of Billed Charges 55.00% $7.29 Percent of Billed Charges 85.00% $11.26 Percent of Billed Charges 63.00% $8.35 Percent of Billed Charges 63.00% $8.35 Percent of Billed Charges 75.00% $9.94 Percent of Billed Charges 66.24% $8.78 Percent of Billed Charges 165.81% $8.94 Fee Schedule 166.07% $8.95 Fee Schedule 176.26% $9.50 Fee Schedule 129.00% $6.95 Fee Schedule 191.24% $10.31 Fee Schedule 159.00% $21.07 Fee Schedule 145.00% $7.82 Fee Schedule 60.00% $7.95 Percent of Billed Charges HC FUNGITELL VIRACOR 300 CPT 87449 90 Outpatient $125.05 $15.45 $198.83 $125.05 $65.32 $65.32 Fee Schedule $65.32 $65.32 Fee Schedule $104.47 $99.07 Fee Schedule 74.74% $93.46 Percent of Billed Charges 68.24% $85.33 Percent of Billed Charges 65.00% $81.28 Percent of Billed Charges 67.00% $83.78 Percent of Billed Charges 77.50% $96.91 Percent of Billed Charges 79.97% $100.00 Percent of Billed Charges 55.00% $68.78 Percent of Billed Charges 49.55% $61.96 Percent of Billed Charges 55.00% $68.78 Percent of Billed Charges 55.00% $68.78 Percent of Billed Charges 78.94% $98.71 Percent of Billed Charges 74.00% $92.54 Percent of Billed Charges 92.50% $115.67 Percent of Billed Charges 55.00% $68.78 Percent of Billed Charges 85.00% $106.29 Percent of Billed Charges 63.00% $78.78 Percent of Billed Charges 63.00% $78.78 Percent of Billed Charges 75.00% $93.79 Percent of Billed Charges 66.24% $82.83 Percent of Billed Charges 165.81% $19.86 Fee Schedule 166.07% $19.90 Fee Schedule 176.26% $21.12 Fee Schedule 129.00% $15.45 Fee Schedule 191.24% $22.91 Fee Schedule 159.00% $198.83 Fee Schedule 145.00% $17.37 Fee Schedule 60.00% $75.03 Percent of Billed Charges HC FUSARIUM MONILIFORME IGE QUEST 300 CPT 86003 90 Outpatient $10.07 $4.99 $16.01 $10.07 $28.44 $10.07 Fee Schedule $28.44 $10.07 Fee Schedule $45.52 $10.07 Fee Schedule 74.74% $7.53 Percent of Billed Charges 68.24% $6.87 Percent of Billed Charges 65.00% $6.55 Percent of Billed Charges 67.00% $6.75 Percent of Billed Charges 77.50% $7.80 Percent of Billed Charges 79.97% $8.05 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 49.55% $4.99 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 78.94% $7.95 Percent of Billed Charges 74.00% $7.45 Percent of Billed Charges 92.50% $9.31 Percent of Billed Charges 55.00% $5.54 Percent of Billed Charges 85.00% $8.56 Percent of Billed Charges 63.00% $6.34 Percent of Billed Charges 63.00% $6.34 Percent of Billed Charges 75.00% $7.55 Percent of Billed Charges 66.24% $6.67 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $16.01 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $6.04 Percent of Billed Charges HC G6PD LABCORP 300 CPT 82955 90 Outpatient $4.40 $2.18 $18.55 $4.40 $52.84 $4.40 Fee Schedule $52.84 $4.40 Fee Schedule $84.58 $4.40 Fee Schedule 74.74% $3.29 Percent of Billed Charges 68.24% $3.00 Percent of Billed Charges 65.00% $2.86 Percent of Billed Charges 67.00% $2.95 Percent of Billed Charges 77.50% $3.41 Percent of Billed Charges 79.97% $3.52 Percent of Billed Charges 55.00% $2.42 Percent of Billed Charges 49.55% $2.18 Percent of Billed Charges 55.00% $2.42 Percent of Billed Charges 55.00% $2.42 Percent of Billed Charges 78.94% $3.47 Percent of Billed Charges 74.00% $3.26 Percent of Billed Charges 92.50% $4.07 Percent of Billed Charges 55.00% $2.42 Percent of Billed Charges 85.00% $3.74 Percent of Billed Charges 63.00% $2.77 Percent of Billed Charges 63.00% $2.77 Percent of Billed Charges 75.00% $3.30 Percent of Billed Charges 66.24% $2.91 Percent of Billed Charges 165.81% $4.40 Fee Schedule 166.07% $16.11 Fee Schedule 176.26% $17.10 Fee Schedule 129.00% $12.51 Fee Schedule 191.24% $18.55 Fee Schedule 159.00% $7.00 Fee Schedule 145.00% $14.07 Fee Schedule 60.00% $2.64 Percent of Billed Charges HC GABAPENTIN AR 300 CPT 80299 90 Outpatient $18.55 $9.19 $35.65 $18.55 $74.64 $18.55 Fee Schedule $74.64 $18.55 Fee Schedule $162.54 $18.55 Fee Schedule 74.74% $13.86 Percent of Billed Charges 68.24% $12.66 Percent of Billed Charges 65.00% $12.06 Percent of Billed Charges 67.00% $12.43 Percent of Billed Charges 77.50% $14.38 Percent of Billed Charges 79.97% $14.83 Percent of Billed Charges 55.00% $10.20 Percent of Billed Charges 49.55% $9.19 Percent of Billed Charges 55.00% $10.20 Percent of Billed Charges 55.00% $10.20 Percent of Billed Charges 78.94% $14.64 Percent of Billed Charges 74.00% $13.73 Percent of Billed Charges 92.50% $17.16 Percent of Billed Charges 55.00% $10.20 Percent of Billed Charges 85.00% $15.77 Percent of Billed Charges 63.00% $11.69 Percent of Billed Charges 63.00% $11.69 Percent of Billed Charges 75.00% $13.91 Percent of Billed Charges 66.24% $12.29 Percent of Billed Charges 165.81% $18.55 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $29.49 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $11.13 Percent of Billed Charges HC GAD ANTIBODY LABCORP 300 CPT 86341 90 Outpatient $11.00 $5.45 $45.08 $11.00 $107.80 $11.00 Fee Schedule $107.80 $11.00 Fee Schedule $205.53 $11.00 Fee Schedule 74.74% $8.22 Percent of Billed Charges 68.24% $7.51 Percent of Billed Charges 65.00% $7.15 Percent of Billed Charges 67.00% $7.37 Percent of Billed Charges 77.50% $8.53 Percent of Billed Charges 79.97% $8.80 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 49.55% $5.45 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 78.94% $8.68 Percent of Billed Charges 74.00% $8.14 Percent of Billed Charges 92.50% $10.18 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 85.00% $9.35 Percent of Billed Charges 63.00% $6.93 Percent of Billed Charges 63.00% $6.93 Percent of Billed Charges 75.00% $8.25 Percent of Billed Charges 66.24% $7.29 Percent of Billed Charges 165.81% $11.00 Fee Schedule 166.07% $39.14 Fee Schedule 176.26% $41.54 Fee Schedule 129.00% $30.41 Fee Schedule 191.24% $45.08 Fee Schedule 159.00% $17.49 Fee Schedule 145.00% $34.18 Fee Schedule 60.00% $6.60 Percent of Billed Charges HC GAL 1 PHOS URIDYLTRANS ARUP 300 CPT 82775 90 Outpatient $122.78 $27.18 $195.22 $122.78 $114.80 $114.80 Fee Schedule $114.80 $114.80 Fee Schedule $183.73 $122.78 Fee Schedule 74.74% $91.77 Percent of Billed Charges 68.24% $83.79 Percent of Billed Charges 65.00% $79.81 Percent of Billed Charges 67.00% $82.26 Percent of Billed Charges 77.50% $95.15 Percent of Billed Charges 79.97% $98.19 Percent of Billed Charges 55.00% $67.53 Percent of Billed Charges 49.55% $60.84 Percent of Billed Charges 55.00% $67.53 Percent of Billed Charges 55.00% $67.53 Percent of Billed Charges 78.94% $96.92 Percent of Billed Charges 74.00% $90.86 Percent of Billed Charges 92.50% $113.57 Percent of Billed Charges 55.00% $67.53 Percent of Billed Charges 85.00% $104.36 Percent of Billed Charges 63.00% $77.35 Percent of Billed Charges 63.00% $77.35 Percent of Billed Charges 75.00% $92.09 Percent of Billed Charges 66.24% $81.33 Percent of Billed Charges 165.81% $34.94 Fee Schedule 166.07% $34.99 Fee Schedule 176.26% $37.14 Fee Schedule 129.00% $27.18 Fee Schedule 191.24% $40.29 Fee Schedule 159.00% $195.22 Fee Schedule 145.00% $30.55 Fee Schedule 60.00% $73.67 Percent of Billed Charges HC GAL-1-P/ERYTHROCYTE CHLA 300 CPT 84311 90 Outpatient $128.79 $10.45 $204.78 $128.79 $38.08 $38.08 Fee Schedule $38.08 $38.08 Fee Schedule $70.63 $66.99 Fee Schedule 74.74% $96.26 Percent of Billed Charges 68.24% $87.89 Percent of Billed Charges 65.00% $83.71 Percent of Billed Charges 67.00% $86.29 Percent of Billed Charges 77.50% $99.81 Percent of Billed Charges 79.97% $102.99 Percent of Billed Charges 55.00% $70.83 Percent of Billed Charges 49.55% $63.82 Percent of Billed Charges 55.00% $70.83 Percent of Billed Charges 55.00% $70.83 Percent of Billed Charges 78.94% $101.67 Percent of Billed Charges 74.00% $95.30 Percent of Billed Charges 92.50% $119.13 Percent of Billed Charges 55.00% $70.83 Percent of Billed Charges 85.00% $109.47 Percent of Billed Charges 63.00% $81.14 Percent of Billed Charges 63.00% $81.14 Percent of Billed Charges 75.00% $96.59 Percent of Billed Charges 66.24% $85.31 Percent of Billed Charges 165.81% $13.43 Fee Schedule 166.07% $13.45 Fee Schedule 176.26% $14.28 Fee Schedule 129.00% $10.45 Fee Schedule 191.24% $15.49 Fee Schedule 159.00% $204.78 Fee Schedule 145.00% $11.75 Fee Schedule 60.00% $77.27 Percent of Billed Charges HC GALACTITOL PHIL 300 CPT 82542 90 Outpatient $192.37 $31.08 $305.87 $192.37 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $210.06 $181.05 Fee Schedule 74.74% $143.78 Percent of Billed Charges 68.24% $131.27 Percent of Billed Charges 65.00% $125.04 Percent of Billed Charges 67.00% $128.89 Percent of Billed Charges 77.50% $149.09 Percent of Billed Charges 79.97% $153.84 Percent of Billed Charges 55.00% $105.80 Percent of Billed Charges 49.55% $95.32 Percent of Billed Charges 55.00% $105.80 Percent of Billed Charges 55.00% $105.80 Percent of Billed Charges 78.94% $151.86 Percent of Billed Charges 74.00% $142.35 Percent of Billed Charges 92.50% $177.94 Percent of Billed Charges 55.00% $105.80 Percent of Billed Charges 85.00% $163.51 Percent of Billed Charges 63.00% $121.19 Percent of Billed Charges 63.00% $121.19 Percent of Billed Charges 75.00% $144.28 Percent of Billed Charges 66.24% $127.43 Percent of Billed Charges 165.81% $39.94 Fee Schedule 166.07% $40.01 Fee Schedule 176.26% $42.46 Fee Schedule 129.00% $31.08 Fee Schedule 191.24% $46.07 Fee Schedule 159.00% $305.87 Fee Schedule 145.00% $34.93 Fee Schedule 60.00% $115.42 Percent of Billed Charges HC GAMMA GLOBIN GENE SEQ MAY 300 CPT 81479 90 Outpatient $659.00 $- " $1,047.81 " $659.00 50.00% $329.50 Percent of Billed Charges 50.00% $329.50 Percent of Billed Charges 56.78% $374.18 Percent of Billed Charges 74.74% $492.54 Percent of Billed Charges 68.24% $449.70 Percent of Billed Charges 65.00% $428.35 Percent of Billed Charges 67.00% $441.53 Percent of Billed Charges 77.50% $510.73 Percent of Billed Charges 79.97% $527.00 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 49.55% $326.53 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 78.94% $520.21 Percent of Billed Charges 74.00% $487.66 Percent of Billed Charges 92.50% $609.58 Percent of Billed Charges 55.00% $362.45 Percent of Billed Charges 85.00% $560.15 Percent of Billed Charges 63.00% $415.17 Percent of Billed Charges 63.00% $415.17 Percent of Billed Charges 75.00% $494.25 Percent of Billed Charges 66.24% $436.52 Percent of Billed Charges 35.00% $230.65 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,047.81 " Fee Schedule 145.00% $- Fee Schedule 60.00% $395.40 Percent of Billed Charges HC GANCICLOVIR LEVEL MAYO 300 CPT 80299 90 Outpatient $206.00 $24.05 $327.54 $206.00 $74.64 $74.64 Fee Schedule $74.64 $74.64 Fee Schedule $162.54 $154.15 Fee Schedule 74.74% $153.96 Percent of Billed Charges 68.24% $140.57 Percent of Billed Charges 65.00% $133.90 Percent of Billed Charges 67.00% $138.02 Percent of Billed Charges 77.50% $159.65 Percent of Billed Charges 79.97% $164.74 Percent of Billed Charges 55.00% $113.30 Percent of Billed Charges 49.55% $102.07 Percent of Billed Charges 55.00% $113.30 Percent of Billed Charges 55.00% $113.30 Percent of Billed Charges 78.94% $162.62 Percent of Billed Charges 74.00% $152.44 Percent of Billed Charges 92.50% $190.55 Percent of Billed Charges 55.00% $113.30 Percent of Billed Charges 85.00% $175.10 Percent of Billed Charges 63.00% $129.78 Percent of Billed Charges 63.00% $129.78 Percent of Billed Charges 75.00% $154.50 Percent of Billed Charges 66.24% $136.45 Percent of Billed Charges 165.81% $30.91 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $327.54 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $123.60 Percent of Billed Charges HC GANGLIOSIDE ASIAL GM1 IG 300 CPT 83520 90 Outpatient $68.91 $22.28 $109.57 $68.91 $70.52 $68.91 Fee Schedule $70.52 $68.91 Fee Schedule $150.59 $68.91 Fee Schedule 74.74% $51.50 Percent of Billed Charges 68.24% $47.02 Percent of Billed Charges 65.00% $44.79 Percent of Billed Charges 67.00% $46.17 Percent of Billed Charges 77.50% $53.41 Percent of Billed Charges 79.97% $55.11 Percent of Billed Charges 55.00% $37.90 Percent of Billed Charges 49.55% $34.14 Percent of Billed Charges 55.00% $37.90 Percent of Billed Charges 55.00% $37.90 Percent of Billed Charges 78.94% $54.40 Percent of Billed Charges 74.00% $50.99 Percent of Billed Charges 92.50% $63.74 Percent of Billed Charges 55.00% $37.90 Percent of Billed Charges 85.00% $58.57 Percent of Billed Charges 63.00% $43.41 Percent of Billed Charges 63.00% $43.41 Percent of Billed Charges 75.00% $51.68 Percent of Billed Charges 66.24% $45.65 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $109.57 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $41.35 Percent of Billed Charges HC GANGLIOSIDE ASIALO GM1 IG 300 CPT 83520 90 Outpatient $56.75 $22.28 $90.23 $56.75 $70.52 $56.75 Fee Schedule $70.52 $56.75 Fee Schedule $150.59 $56.75 Fee Schedule 74.74% $42.41 Percent of Billed Charges 68.24% $38.73 Percent of Billed Charges 65.00% $36.89 Percent of Billed Charges 67.00% $38.02 Percent of Billed Charges 77.50% $43.98 Percent of Billed Charges 79.97% $45.38 Percent of Billed Charges 55.00% $31.21 Percent of Billed Charges 49.55% $28.12 Percent of Billed Charges 55.00% $31.21 Percent of Billed Charges 55.00% $31.21 Percent of Billed Charges 78.94% $44.80 Percent of Billed Charges 74.00% $42.00 Percent of Billed Charges 92.50% $52.49 Percent of Billed Charges 55.00% $31.21 Percent of Billed Charges 85.00% $48.24 Percent of Billed Charges 63.00% $35.75 Percent of Billed Charges 63.00% $35.75 Percent of Billed Charges 75.00% $42.56 Percent of Billed Charges 66.24% $37.59 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $90.23 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $34.05 Percent of Billed Charges HC GASTRIN LABCORP 300 CPT 82941 90 Outpatient $5.25 $2.60 $33.72 $5.25 $96.08 $5.25 Fee Schedule $96.08 $5.25 Fee Schedule $153.73 $5.25 Fee Schedule 74.74% $3.92 Percent of Billed Charges 68.24% $3.58 Percent of Billed Charges 65.00% $3.41 Percent of Billed Charges 67.00% $3.52 Percent of Billed Charges 77.50% $4.07 Percent of Billed Charges 79.97% $4.20 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 49.55% $2.60 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 78.94% $4.14 Percent of Billed Charges 74.00% $3.89 Percent of Billed Charges 92.50% $4.86 Percent of Billed Charges 55.00% $2.89 Percent of Billed Charges 85.00% $4.46 Percent of Billed Charges 63.00% $3.31 Percent of Billed Charges 63.00% $3.31 Percent of Billed Charges 75.00% $3.94 Percent of Billed Charges 66.24% $3.48 Percent of Billed Charges 165.81% $5.25 Fee Schedule 166.07% $29.28 Fee Schedule 176.26% $31.07 Fee Schedule 129.00% $22.74 Fee Schedule 191.24% $33.72 Fee Schedule 159.00% $8.35 Fee Schedule 145.00% $25.56 Fee Schedule 60.00% $3.15 Percent of Billed Charges HC GAUCHER EGL - 82164 300 CPT 82164 90 Outpatient $230.00 $18.83 $365.70 $230.00 $79.56 $79.56 Fee Schedule $79.56 $79.56 Fee Schedule $127.31 $120.74 Fee Schedule 74.74% $171.90 Percent of Billed Charges 68.24% $156.95 Percent of Billed Charges 65.00% $149.50 Percent of Billed Charges 67.00% $154.10 Percent of Billed Charges 77.50% $178.25 Percent of Billed Charges 79.97% $183.93 Percent of Billed Charges 55.00% $126.50 Percent of Billed Charges 49.55% $113.97 Percent of Billed Charges 55.00% $126.50 Percent of Billed Charges 55.00% $126.50 Percent of Billed Charges 78.94% $181.56 Percent of Billed Charges 74.00% $170.20 Percent of Billed Charges 92.50% $212.75 Percent of Billed Charges 55.00% $126.50 Percent of Billed Charges 85.00% $195.50 Percent of Billed Charges 63.00% $144.90 Percent of Billed Charges 63.00% $144.90 Percent of Billed Charges 75.00% $172.50 Percent of Billed Charges 66.24% $152.35 Percent of Billed Charges 165.81% $24.21 Fee Schedule 166.07% $24.25 Fee Schedule 176.26% $25.73 Fee Schedule 129.00% $18.83 Fee Schedule 191.24% $27.92 Fee Schedule 159.00% $365.70 Fee Schedule 145.00% $21.17 Fee Schedule 60.00% $138.00 Percent of Billed Charges HC GAUCHER EGL - 82657 300 CPT 82657 90 Outpatient $296.00 $28.60 $470.64 $296.00 $98.40 $98.40 Fee Schedule $98.40 $98.40 Fee Schedule $193.32 $183.35 Fee Schedule 74.74% $221.23 Percent of Billed Charges 68.24% $201.99 Percent of Billed Charges 65.00% $192.40 Percent of Billed Charges 67.00% $198.32 Percent of Billed Charges 77.50% $229.40 Percent of Billed Charges 79.97% $236.71 Percent of Billed Charges 55.00% $162.80 Percent of Billed Charges 49.55% $146.67 Percent of Billed Charges 55.00% $162.80 Percent of Billed Charges 55.00% $162.80 Percent of Billed Charges 78.94% $233.66 Percent of Billed Charges 74.00% $219.04 Percent of Billed Charges 92.50% $273.80 Percent of Billed Charges 55.00% $162.80 Percent of Billed Charges 85.00% $251.60 Percent of Billed Charges 63.00% $186.48 Percent of Billed Charges 63.00% $186.48 Percent of Billed Charges 75.00% $222.00 Percent of Billed Charges 66.24% $196.07 Percent of Billed Charges 165.81% $36.76 Fee Schedule 166.07% $36.82 Fee Schedule 176.26% $39.08 Fee Schedule 129.00% $28.60 Fee Schedule 191.24% $42.40 Fee Schedule 159.00% $470.64 Fee Schedule 145.00% $32.15 Fee Schedule 60.00% $177.60 Percent of Billed Charges HC GD1A AB QUEST 300 CPT 83520 90 Outpatient $121.62 $22.28 $193.38 $121.62 $70.52 $70.52 Fee Schedule $70.52 $70.52 Fee Schedule $150.59 $121.62 Fee Schedule 74.74% $90.90 Percent of Billed Charges 68.24% $82.99 Percent of Billed Charges 65.00% $79.05 Percent of Billed Charges 67.00% $81.49 Percent of Billed Charges 77.50% $94.26 Percent of Billed Charges 79.97% $97.26 Percent of Billed Charges 55.00% $66.89 Percent of Billed Charges 49.55% $60.26 Percent of Billed Charges 55.00% $66.89 Percent of Billed Charges 55.00% $66.89 Percent of Billed Charges 78.94% $96.01 Percent of Billed Charges 74.00% $90.00 Percent of Billed Charges 92.50% $112.50 Percent of Billed Charges 55.00% $66.89 Percent of Billed Charges 85.00% $103.38 Percent of Billed Charges 63.00% $76.62 Percent of Billed Charges 63.00% $76.62 Percent of Billed Charges 75.00% $91.22 Percent of Billed Charges 66.24% $80.56 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $193.38 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $72.97 Percent of Billed Charges HC GIARDIA AB BY IFA 300 CPT 86674 90 Outpatient $40.25 $18.99 $64.00 $40.25 $80.20 $40.25 Fee Schedule $80.20 $40.25 Fee Schedule $128.36 $40.25 Fee Schedule 74.74% $30.08 Percent of Billed Charges 68.24% $27.47 Percent of Billed Charges 65.00% $26.16 Percent of Billed Charges 67.00% $26.97 Percent of Billed Charges 77.50% $31.19 Percent of Billed Charges 79.97% $32.19 Percent of Billed Charges 55.00% $22.14 Percent of Billed Charges 49.55% $19.94 Percent of Billed Charges 55.00% $22.14 Percent of Billed Charges 55.00% $22.14 Percent of Billed Charges 78.94% $31.77 Percent of Billed Charges 74.00% $29.79 Percent of Billed Charges 92.50% $37.23 Percent of Billed Charges 55.00% $22.14 Percent of Billed Charges 85.00% $34.21 Percent of Billed Charges 63.00% $25.36 Percent of Billed Charges 63.00% $25.36 Percent of Billed Charges 75.00% $30.19 Percent of Billed Charges 66.24% $26.66 Percent of Billed Charges 165.81% $24.41 Fee Schedule 166.07% $24.45 Fee Schedule 176.26% $25.95 Fee Schedule 129.00% $18.99 Fee Schedule 191.24% $28.15 Fee Schedule 159.00% $64.00 Fee Schedule 145.00% $21.34 Fee Schedule 60.00% $24.15 Percent of Billed Charges HC GLIADIN IGA/IGG LABCORP 300 CPT 83516 90 Outpatient $14.00 $6.94 $22.26 $14.00 $62.84 $14.00 Fee Schedule $62.84 $14.00 Fee Schedule $100.54 $14.00 Fee Schedule 74.74% $10.46 Percent of Billed Charges 68.24% $9.55 Percent of Billed Charges 65.00% $9.10 Percent of Billed Charges 67.00% $9.38 Percent of Billed Charges 77.50% $10.85 Percent of Billed Charges 79.97% $11.20 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 49.55% $6.94 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 78.94% $11.05 Percent of Billed Charges 74.00% $10.36 Percent of Billed Charges 92.50% $12.95 Percent of Billed Charges 55.00% $7.70 Percent of Billed Charges 85.00% $11.90 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 63.00% $8.82 Percent of Billed Charges 75.00% $10.50 Percent of Billed Charges 66.24% $9.27 Percent of Billed Charges 165.81% $14.00 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $22.26 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $8.40 Percent of Billed Charges HC GLOMERULAR BASEMENT AB ARUP 300 CPT 83516 90 Outpatient $26.75 $13.25 $42.53 $26.75 $62.84 $26.75 Fee Schedule $62.84 $26.75 Fee Schedule $100.54 $26.75 Fee Schedule 74.74% $19.99 Percent of Billed Charges 68.24% $18.25 Percent of Billed Charges 65.00% $17.39 Percent of Billed Charges 67.00% $17.92 Percent of Billed Charges 77.50% $20.73 Percent of Billed Charges 79.97% $21.39 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 49.55% $13.25 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 78.94% $21.12 Percent of Billed Charges 74.00% $19.80 Percent of Billed Charges 92.50% $24.74 Percent of Billed Charges 55.00% $14.71 Percent of Billed Charges 85.00% $22.74 Percent of Billed Charges 63.00% $16.85 Percent of Billed Charges 63.00% $16.85 Percent of Billed Charges 75.00% $20.06 Percent of Billed Charges 66.24% $17.72 Percent of Billed Charges 165.81% $19.12 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $42.53 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $16.05 Percent of Billed Charges HC GLOMERULAR FILT RATE LABCORP 300 CPT 82565 90 Outpatient $2.75 $1.36 $9.79 $2.75 $27.92 $2.75 Fee Schedule $27.92 $2.75 Fee Schedule $44.65 $2.75 Fee Schedule 74.74% $2.06 Percent of Billed Charges 68.24% $1.88 Percent of Billed Charges 65.00% $1.79 Percent of Billed Charges 67.00% $1.84 Percent of Billed Charges 77.50% $2.13 Percent of Billed Charges 79.97% $2.20 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 49.55% $1.36 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 78.94% $2.17 Percent of Billed Charges 74.00% $2.04 Percent of Billed Charges 92.50% $2.54 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 85.00% $2.34 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 75.00% $2.06 Percent of Billed Charges 66.24% $1.82 Percent of Billed Charges 165.81% $2.75 Fee Schedule 166.07% $8.50 Fee Schedule 176.26% $9.02 Fee Schedule 129.00% $6.60 Fee Schedule 191.24% $9.79 Fee Schedule 159.00% $4.37 Fee Schedule 145.00% $7.42 Fee Schedule 60.00% $1.65 Percent of Billed Charges HC GLUCOSE POCT 300 CPT 82947 Outpatient $80.00 $5.07 $127.20 $80.00 $21.40 $21.40 Fee Schedule $21.40 $21.40 Fee Schedule $34.27 $32.50 Fee Schedule 74.74% $59.79 Percent of Billed Charges 68.24% $54.59 Percent of Billed Charges 65.00% $52.00 Percent of Billed Charges 67.00% $53.60 Percent of Billed Charges 77.50% $62.00 Percent of Billed Charges 79.97% $63.98 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 49.55% $39.64 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 78.94% $63.15 Percent of Billed Charges 74.00% $59.20 Percent of Billed Charges 92.50% $74.00 Percent of Billed Charges 55.00% $44.00 Percent of Billed Charges 85.00% $68.00 Percent of Billed Charges 63.00% $50.40 Percent of Billed Charges 63.00% $50.40 Percent of Billed Charges 75.00% $60.00 Percent of Billed Charges 66.24% $52.99 Percent of Billed Charges 165.81% $6.52 Fee Schedule 166.07% $6.53 Fee Schedule 176.26% $6.93 Fee Schedule 129.00% $5.07 Fee Schedule 191.24% $7.52 Fee Schedule 159.00% $127.20 Fee Schedule 145.00% $5.70 Fee Schedule 60.00% $48.00 Percent of Billed Charges "HC GLUCOSE,URINE" 300 CPT 82945 90 Outpatient $15.70 $5.07 $24.96 $15.70 $21.40 $15.70 Fee Schedule $21.40 $15.70 Fee Schedule $34.27 $15.70 Fee Schedule 74.74% $11.73 Percent of Billed Charges 68.24% $10.71 Percent of Billed Charges 65.00% $10.21 Percent of Billed Charges 67.00% $10.52 Percent of Billed Charges 77.50% $12.17 Percent of Billed Charges 79.97% $12.56 Percent of Billed Charges 55.00% $8.64 Percent of Billed Charges 49.55% $7.78 Percent of Billed Charges 55.00% $8.64 Percent of Billed Charges 55.00% $8.64 Percent of Billed Charges 78.94% $12.39 Percent of Billed Charges 74.00% $11.62 Percent of Billed Charges 92.50% $14.52 Percent of Billed Charges 55.00% $8.64 Percent of Billed Charges 85.00% $13.35 Percent of Billed Charges 63.00% $9.89 Percent of Billed Charges 63.00% $9.89 Percent of Billed Charges 75.00% $11.78 Percent of Billed Charges 66.24% $10.40 Percent of Billed Charges 165.81% $6.52 Fee Schedule 166.07% $6.53 Fee Schedule 176.26% $6.93 Fee Schedule 129.00% $5.07 Fee Schedule 191.24% $7.52 Fee Schedule 159.00% $24.96 Fee Schedule 145.00% $5.70 Fee Schedule 60.00% $9.42 Percent of Billed Charges HC GLUCOSE/BODY FLUID ARUP 300 CPT 82945 90 Outpatient $7.35 $3.64 $11.69 $7.35 $21.40 $7.35 Fee Schedule $21.40 $7.35 Fee Schedule $34.27 $7.35 Fee Schedule 74.74% $5.49 Percent of Billed Charges 68.24% $5.02 Percent of Billed Charges 65.00% $4.78 Percent of Billed Charges 67.00% $4.92 Percent of Billed Charges 77.50% $5.70 Percent of Billed Charges 79.97% $5.88 Percent of Billed Charges 55.00% $4.04 Percent of Billed Charges 49.55% $3.64 Percent of Billed Charges 55.00% $4.04 Percent of Billed Charges 55.00% $4.04 Percent of Billed Charges 78.94% $5.80 Percent of Billed Charges 74.00% $5.44 Percent of Billed Charges 92.50% $6.80 Percent of Billed Charges 55.00% $4.04 Percent of Billed Charges 85.00% $6.25 Percent of Billed Charges 63.00% $4.63 Percent of Billed Charges 63.00% $4.63 Percent of Billed Charges 75.00% $5.51 Percent of Billed Charges 66.24% $4.87 Percent of Billed Charges 165.81% $6.52 Fee Schedule 166.07% $6.53 Fee Schedule 176.26% $6.93 Fee Schedule 129.00% $5.07 Fee Schedule 191.24% $7.52 Fee Schedule 159.00% $11.69 Fee Schedule 145.00% $5.70 Fee Schedule 60.00% $4.41 Percent of Billed Charges HC GLUTARIC ACID TYPE I DENVERGEN 300 CPT 81406 90 Outpatient $700.00 $- " $1,113.00 " $700.00 " $1,131.52 " $700.00 Fee Schedule " $1,131.52 " $700.00 Fee Schedule " $2,466.71 " $700.00 Fee Schedule 74.74% $523.18 Percent of Billed Charges 68.24% $477.68 Percent of Billed Charges 65.00% $455.00 Percent of Billed Charges 67.00% $469.00 Percent of Billed Charges 77.50% $542.50 Percent of Billed Charges 79.97% $559.79 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 49.55% $346.85 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 78.94% $552.58 Percent of Billed Charges 74.00% $518.00 Percent of Billed Charges 92.50% $647.50 Percent of Billed Charges 55.00% $385.00 Percent of Billed Charges 85.00% $595.00 Percent of Billed Charges 63.00% $441.00 Percent of Billed Charges 63.00% $441.00 Percent of Billed Charges 75.00% $525.00 Percent of Billed Charges 66.24% $463.68 Percent of Billed Charges 35.00% $245.00 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,113.00 " Fee Schedule 145.00% $- Fee Schedule 60.00% $420.00 Percent of Billed Charges HC GQ1B AB QUEST 300 CPT 83520 90 Outpatient $78.07 $22.28 $124.13 $78.07 $70.52 $70.52 Fee Schedule $70.52 $70.52 Fee Schedule $150.59 $78.07 Fee Schedule 74.74% $58.35 Percent of Billed Charges 68.24% $53.27 Percent of Billed Charges 65.00% $50.75 Percent of Billed Charges 67.00% $52.31 Percent of Billed Charges 77.50% $60.50 Percent of Billed Charges 79.97% $62.43 Percent of Billed Charges 55.00% $42.94 Percent of Billed Charges 49.55% $38.68 Percent of Billed Charges 55.00% $42.94 Percent of Billed Charges 55.00% $42.94 Percent of Billed Charges 78.94% $61.63 Percent of Billed Charges 74.00% $57.77 Percent of Billed Charges 92.50% $72.21 Percent of Billed Charges 55.00% $42.94 Percent of Billed Charges 85.00% $66.36 Percent of Billed Charges 63.00% $49.18 Percent of Billed Charges 63.00% $49.18 Percent of Billed Charges 75.00% $58.55 Percent of Billed Charges 66.24% $51.71 Percent of Billed Charges 165.81% $28.64 Fee Schedule 166.07% $28.68 Fee Schedule 176.26% $30.44 Fee Schedule 129.00% $22.28 Fee Schedule 191.24% $33.03 Fee Schedule 159.00% $124.13 Fee Schedule 145.00% $25.04 Fee Schedule 60.00% $46.84 Percent of Billed Charges HC GROWTH HORMONE LABCORP 300 CPT 83003 90 Outpatient $2.75 $1.36 $31.88 $2.75 $90.88 $2.75 Fee Schedule $90.88 $2.75 Fee Schedule $145.36 $2.75 Fee Schedule 74.74% $2.06 Percent of Billed Charges 68.24% $1.88 Percent of Billed Charges 65.00% $1.79 Percent of Billed Charges 67.00% $1.84 Percent of Billed Charges 77.50% $2.13 Percent of Billed Charges 79.97% $2.20 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 49.55% $1.36 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 78.94% $2.17 Percent of Billed Charges 74.00% $2.04 Percent of Billed Charges 92.50% $2.54 Percent of Billed Charges 55.00% $1.51 Percent of Billed Charges 85.00% $2.34 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 63.00% $1.73 Percent of Billed Charges 75.00% $2.06 Percent of Billed Charges 66.24% $1.82 Percent of Billed Charges 165.81% $2.75 Fee Schedule 166.07% $27.68 Fee Schedule 176.26% $29.38 Fee Schedule 129.00% $21.50 Fee Schedule 191.24% $31.88 Fee Schedule 159.00% $4.37 Fee Schedule 145.00% $24.17 Fee Schedule 60.00% $1.65 Percent of Billed Charges HC GROWTH HORMONE AB 300 CPT 86277 90 Outpatient $77.00 $20.30 $122.43 $77.00 $85.76 $77.00 Fee Schedule $85.76 $77.00 Fee Schedule $137.25 $77.00 Fee Schedule 74.74% $57.55 Percent of Billed Charges 68.24% $52.54 Percent of Billed Charges 65.00% $50.05 Percent of Billed Charges 67.00% $51.59 Percent of Billed Charges 77.50% $59.68 Percent of Billed Charges 79.97% $61.58 Percent of Billed Charges 55.00% $42.35 Percent of Billed Charges 49.55% $38.15 Percent of Billed Charges 55.00% $42.35 Percent of Billed Charges 55.00% $42.35 Percent of Billed Charges 78.94% $60.78 Percent of Billed Charges 74.00% $56.98 Percent of Billed Charges 92.50% $71.23 Percent of Billed Charges 55.00% $42.35 Percent of Billed Charges 85.00% $65.45 Percent of Billed Charges 63.00% $48.51 Percent of Billed Charges 63.00% $48.51 Percent of Billed Charges 75.00% $57.75 Percent of Billed Charges 66.24% $51.00 Percent of Billed Charges 165.81% $26.10 Fee Schedule 166.07% $26.14 Fee Schedule 176.26% $27.74 Fee Schedule 129.00% $20.30 Fee Schedule 191.24% $30.10 Fee Schedule 159.00% $122.43 Fee Schedule 145.00% $22.82 Fee Schedule 60.00% $46.20 Percent of Billed Charges HC H INFLUENZAE B IGG LABCORP 300 CPT 86317 90 Outpatient $94.50 $19.34 $150.26 $94.50 $81.68 $81.68 Fee Schedule $81.68 $81.68 Fee Schedule $130.71 $94.50 Fee Schedule 74.74% $70.63 Percent of Billed Charges 68.24% $64.49 Percent of Billed Charges 65.00% $61.43 Percent of Billed Charges 67.00% $63.32 Percent of Billed Charges 77.50% $73.24 Percent of Billed Charges 79.97% $75.57 Percent of Billed Charges 55.00% $51.98 Percent of Billed Charges 49.55% $46.82 Percent of Billed Charges 55.00% $51.98 Percent of Billed Charges 55.00% $51.98 Percent of Billed Charges 78.94% $74.60 Percent of Billed Charges 74.00% $69.93 Percent of Billed Charges 92.50% $87.41 Percent of Billed Charges 55.00% $51.98 Percent of Billed Charges 85.00% $80.33 Percent of Billed Charges 63.00% $59.54 Percent of Billed Charges 63.00% $59.54 Percent of Billed Charges 75.00% $70.88 Percent of Billed Charges 66.24% $62.60 Percent of Billed Charges 165.81% $24.85 Fee Schedule 166.07% $24.89 Fee Schedule 176.26% $26.42 Fee Schedule 129.00% $19.34 Fee Schedule 191.24% $28.67 Fee Schedule 159.00% $150.26 Fee Schedule 145.00% $21.74 Fee Schedule 60.00% $56.70 Percent of Billed Charges HC H PYLORI CULTURE MAYO 300 CPT 87081 90 Outpatient $68.50 $8.55 $108.92 $68.50 $36.12 $36.12 Fee Schedule $36.12 $36.12 Fee Schedule $57.81 $54.83 Fee Schedule 74.74% $51.20 Percent of Billed Charges 68.24% $46.74 Percent of Billed Charges 65.00% $44.53 Percent of Billed Charges 67.00% $45.90 Percent of Billed Charges 77.50% $53.09 Percent of Billed Charges 79.97% $54.78 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 49.55% $33.94 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 78.94% $54.07 Percent of Billed Charges 74.00% $50.69 Percent of Billed Charges 92.50% $63.36 Percent of Billed Charges 55.00% $37.68 Percent of Billed Charges 85.00% $58.23 Percent of Billed Charges 63.00% $43.16 Percent of Billed Charges 63.00% $43.16 Percent of Billed Charges 75.00% $51.38 Percent of Billed Charges 66.24% $45.37 Percent of Billed Charges 165.81% $10.99 Fee Schedule 166.07% $11.01 Fee Schedule 176.26% $11.69 Fee Schedule 129.00% $8.55 Fee Schedule 191.24% $12.68 Fee Schedule 159.00% $108.92 Fee Schedule 145.00% $9.61 Fee Schedule 60.00% $41.10 Percent of Billed Charges HC H PYLORI IGA LABCORP 300 CPT 86677 90 Outpatient $4.50 $2.23 $32.22 $4.50 $79.08 $4.50 Fee Schedule $79.08 $4.50 Fee Schedule $146.93 $4.50 Fee Schedule 74.74% $3.36 Percent of Billed Charges 68.24% $3.07 Percent of Billed Charges 65.00% $2.93 Percent of Billed Charges 67.00% $3.02 Percent of Billed Charges 77.50% $3.49 Percent of Billed Charges 79.97% $3.60 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 49.55% $2.23 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 78.94% $3.55 Percent of Billed Charges 74.00% $3.33 Percent of Billed Charges 92.50% $4.16 Percent of Billed Charges 55.00% $2.48 Percent of Billed Charges 85.00% $3.83 Percent of Billed Charges 63.00% $2.84 Percent of Billed Charges 63.00% $2.84 Percent of Billed Charges 75.00% $3.38 Percent of Billed Charges 66.24% $2.98 Percent of Billed Charges 165.81% $4.50 Fee Schedule 166.07% $27.98 Fee Schedule 176.26% $29.70 Fee Schedule 129.00% $21.74 Fee Schedule 191.24% $32.22 Fee Schedule 159.00% $7.16 Fee Schedule 145.00% $24.43 Fee Schedule 60.00% $2.70 Percent of Billed Charges HC H PYLORI IGG LABCORP 300 CPT 86677 90 Outpatient $3.50 $1.73 $32.22 $3.50 $79.08 $3.50 Fee Schedule $79.08 $3.50 Fee Schedule $146.93 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $27.98 Fee Schedule 176.26% $29.70 Fee Schedule 129.00% $21.74 Fee Schedule 191.24% $32.22 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $24.43 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC H PYLORI IGM LABCORP 300 CPT 86677 90 Outpatient $3.00 $1.49 $32.22 $3.00 $79.08 $3.00 Fee Schedule $79.08 $3.00 Fee Schedule $146.93 $3.00 Fee Schedule 74.74% $2.24 Percent of Billed Charges 68.24% $2.05 Percent of Billed Charges 65.00% $1.95 Percent of Billed Charges 67.00% $2.01 Percent of Billed Charges 77.50% $2.33 Percent of Billed Charges 79.97% $2.40 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 49.55% $1.49 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 78.94% $2.37 Percent of Billed Charges 74.00% $2.22 Percent of Billed Charges 92.50% $2.78 Percent of Billed Charges 55.00% $1.65 Percent of Billed Charges 85.00% $2.55 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 63.00% $1.89 Percent of Billed Charges 75.00% $2.25 Percent of Billed Charges 66.24% $1.99 Percent of Billed Charges 165.81% $3.00 Fee Schedule 166.07% $27.98 Fee Schedule 176.26% $29.70 Fee Schedule 129.00% $21.74 Fee Schedule 191.24% $32.22 Fee Schedule 159.00% $4.77 Fee Schedule 145.00% $24.43 Fee Schedule 60.00% $1.80 Percent of Billed Charges HC H PYLORI STOOL AG LABCORP 300 CPT 87338 90 Outpatient $33.00 $16.35 $52.47 $33.00 $78.36 $33.00 Fee Schedule $78.36 $33.00 Fee Schedule $125.39 $33.00 Fee Schedule 74.74% $24.66 Percent of Billed Charges 68.24% $22.52 Percent of Billed Charges 65.00% $21.45 Percent of Billed Charges 67.00% $22.11 Percent of Billed Charges 77.50% $25.58 Percent of Billed Charges 79.97% $26.39 Percent of Billed Charges 55.00% $18.15 Percent of Billed Charges 49.55% $16.35 Percent of Billed Charges 55.00% $18.15 Percent of Billed Charges 55.00% $18.15 Percent of Billed Charges 78.94% $26.05 Percent of Billed Charges 74.00% $24.42 Percent of Billed Charges 92.50% $30.53 Percent of Billed Charges 55.00% $18.15 Percent of Billed Charges 85.00% $28.05 Percent of Billed Charges 63.00% $20.79 Percent of Billed Charges 63.00% $20.79 Percent of Billed Charges 75.00% $24.75 Percent of Billed Charges 66.24% $21.86 Percent of Billed Charges 165.81% $23.84 Fee Schedule 166.07% $23.88 Fee Schedule 176.26% $25.35 Fee Schedule 129.00% $18.55 Fee Schedule 191.24% $27.50 Fee Schedule 159.00% $52.47 Fee Schedule 145.00% $20.85 Fee Schedule 60.00% $19.80 Percent of Billed Charges HC H PYLORI UREA BREATH LABCORP 300 CPT 83013 90 Outpatient $107.97 $53.50 $171.67 $107.97 $367.00 $107.97 Fee Schedule $367.00 $107.97 Fee Schedule $587.38 $107.97 Fee Schedule 74.74% $80.70 Percent of Billed Charges 68.24% $73.68 Percent of Billed Charges 65.00% $70.18 Percent of Billed Charges 67.00% $72.34 Percent of Billed Charges 77.50% $83.68 Percent of Billed Charges 79.97% $86.34 Percent of Billed Charges 55.00% $59.38 Percent of Billed Charges 49.55% $53.50 Percent of Billed Charges 55.00% $59.38 Percent of Billed Charges 55.00% $59.38 Percent of Billed Charges 78.94% $85.23 Percent of Billed Charges 74.00% $79.90 Percent of Billed Charges 92.50% $99.87 Percent of Billed Charges 55.00% $59.38 Percent of Billed Charges 85.00% $91.77 Percent of Billed Charges 63.00% $68.02 Percent of Billed Charges 63.00% $68.02 Percent of Billed Charges 75.00% $80.98 Percent of Billed Charges 66.24% $71.52 Percent of Billed Charges 165.81% $107.97 Fee Schedule 166.07% $111.86 Fee Schedule 176.26% $118.73 Fee Schedule 129.00% $86.89 Fee Schedule 191.24% $128.82 Fee Schedule 159.00% $171.67 Fee Schedule 145.00% $97.67 Fee Schedule 60.00% $64.78 Percent of Billed Charges HC HANTAVIRUS ABS QUEST 300 CPT 86790 90 Outpatient $60.00 $16.62 $95.40 $60.00 $70.20 $60.00 Fee Schedule $70.20 $60.00 Fee Schedule $112.31 $60.00 Fee Schedule 74.74% $44.84 Percent of Billed Charges 68.24% $40.94 Percent of Billed Charges 65.00% $39.00 Percent of Billed Charges 67.00% $40.20 Percent of Billed Charges 77.50% $46.50 Percent of Billed Charges 79.97% $47.98 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 49.55% $29.73 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 78.94% $47.36 Percent of Billed Charges 74.00% $44.40 Percent of Billed Charges 92.50% $55.50 Percent of Billed Charges 55.00% $33.00 Percent of Billed Charges 85.00% $51.00 Percent of Billed Charges 63.00% $37.80 Percent of Billed Charges 63.00% $37.80 Percent of Billed Charges 75.00% $45.00 Percent of Billed Charges 66.24% $39.74 Percent of Billed Charges 165.81% $21.36 Fee Schedule 166.07% $21.39 Fee Schedule 176.26% $22.70 Fee Schedule 129.00% $16.62 Fee Schedule 191.24% $24.63 Fee Schedule 159.00% $95.40 Fee Schedule 145.00% $18.68 Fee Schedule 60.00% $36.00 Percent of Billed Charges HC HAPTOGLOBIN LABCORP 300 CPT 83010 90 Outpatient $3.55 $1.76 $24.06 $3.55 $68.52 $3.55 Fee Schedule $68.52 $3.55 Fee Schedule $109.70 $3.55 Fee Schedule 74.74% $2.65 Percent of Billed Charges 68.24% $2.42 Percent of Billed Charges 65.00% $2.31 Percent of Billed Charges 67.00% $2.38 Percent of Billed Charges 77.50% $2.75 Percent of Billed Charges 79.97% $2.84 Percent of Billed Charges 55.00% $1.95 Percent of Billed Charges 49.55% $1.76 Percent of Billed Charges 55.00% $1.95 Percent of Billed Charges 55.00% $1.95 Percent of Billed Charges 78.94% $2.80 Percent of Billed Charges 74.00% $2.63 Percent of Billed Charges 92.50% $3.28 Percent of Billed Charges 55.00% $1.95 Percent of Billed Charges 85.00% $3.02 Percent of Billed Charges 63.00% $2.24 Percent of Billed Charges 63.00% $2.24 Percent of Billed Charges 75.00% $2.66 Percent of Billed Charges 66.24% $2.35 Percent of Billed Charges 165.81% $3.55 Fee Schedule 166.07% $20.89 Fee Schedule 176.26% $22.17 Fee Schedule 129.00% $16.23 Fee Schedule 191.24% $24.06 Fee Schedule 159.00% $5.64 Fee Schedule 145.00% $18.24 Fee Schedule 60.00% $2.13 Percent of Billed Charges HC HAZELNUT COMPONENT QUEST 300 CPT 86008 90 Outpatient $39.31 $19.48 $62.50 $39.31 $88.56 $39.31 Fee Schedule $88.56 $39.31 Fee Schedule $156.35 $39.31 Fee Schedule 74.74% $29.38 Percent of Billed Charges 68.24% $26.83 Percent of Billed Charges 65.00% $25.55 Percent of Billed Charges 67.00% $26.34 Percent of Billed Charges 77.50% $30.47 Percent of Billed Charges 79.97% $31.44 Percent of Billed Charges 55.00% $21.62 Percent of Billed Charges 49.55% $19.48 Percent of Billed Charges 55.00% $21.62 Percent of Billed Charges 55.00% $21.62 Percent of Billed Charges 78.94% $31.03 Percent of Billed Charges 74.00% $29.09 Percent of Billed Charges 92.50% $36.36 Percent of Billed Charges 55.00% $21.62 Percent of Billed Charges 85.00% $33.41 Percent of Billed Charges 63.00% $24.77 Percent of Billed Charges 63.00% $24.77 Percent of Billed Charges 75.00% $29.48 Percent of Billed Charges 66.24% $26.04 Percent of Billed Charges 165.81% $29.73 Fee Schedule 166.07% $29.78 Fee Schedule 176.26% $31.60 Fee Schedule 129.00% $23.13 Fee Schedule 191.24% $34.29 Fee Schedule 159.00% $62.50 Fee Schedule 145.00% $26.00 Fee Schedule 60.00% $23.59 Percent of Billed Charges HC HAZELNUT IgE - LABCORP 300 CPT 86003 90 Outpatient $24.25 $6.73 $38.56 $24.25 $28.44 $24.25 Fee Schedule $28.44 $24.25 Fee Schedule $45.52 $24.25 Fee Schedule 74.74% $18.12 Percent of Billed Charges 68.24% $16.55 Percent of Billed Charges 65.00% $15.76 Percent of Billed Charges 67.00% $16.25 Percent of Billed Charges 77.50% $18.79 Percent of Billed Charges 79.97% $19.39 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 49.55% $12.02 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 78.94% $19.14 Percent of Billed Charges 74.00% $17.95 Percent of Billed Charges 92.50% $22.43 Percent of Billed Charges 55.00% $13.34 Percent of Billed Charges 85.00% $20.61 Percent of Billed Charges 63.00% $15.28 Percent of Billed Charges 63.00% $15.28 Percent of Billed Charges 75.00% $18.19 Percent of Billed Charges 66.24% $16.06 Percent of Billed Charges 165.81% $8.66 Fee Schedule 166.07% $8.67 Fee Schedule 176.26% $9.20 Fee Schedule 129.00% $6.73 Fee Schedule 191.24% $9.98 Fee Schedule 159.00% $38.56 Fee Schedule 145.00% $7.57 Fee Schedule 60.00% $14.55 Percent of Billed Charges "HC HC CMV PCR, QUANT, VIRACOR" 300 CPT 87799 90 Outpatient $177.29 $55.26 $281.89 $177.29 $233.40 $177.29 Fee Schedule $233.40 $177.29 Fee Schedule $373.56 $177.29 Fee Schedule 74.74% $132.51 Percent of Billed Charges 68.24% $120.98 Percent of Billed Charges 65.00% $115.24 Percent of Billed Charges 67.00% $118.78 Percent of Billed Charges 77.50% $137.40 Percent of Billed Charges 79.97% $141.78 Percent of Billed Charges 55.00% $97.51 Percent of Billed Charges 49.55% $87.85 Percent of Billed Charges 55.00% $97.51 Percent of Billed Charges 55.00% $97.51 Percent of Billed Charges 78.94% $139.95 Percent of Billed Charges 74.00% $131.19 Percent of Billed Charges 92.50% $163.99 Percent of Billed Charges 55.00% $97.51 Percent of Billed Charges 85.00% $150.70 Percent of Billed Charges 63.00% $111.69 Percent of Billed Charges 63.00% $111.69 Percent of Billed Charges 75.00% $132.97 Percent of Billed Charges 66.24% $117.44 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $281.89 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $106.37 Percent of Billed Charges HC HCG W/ GESTATIONAL TBL QUEST 300 CPT 84702 90 Outpatient $130.18 $19.41 $206.99 $130.18 $82.04 $82.04 Fee Schedule $82.04 $82.04 Fee Schedule $131.24 $124.46 Fee Schedule 74.74% $97.30 Percent of Billed Charges 68.24% $88.83 Percent of Billed Charges 65.00% $84.62 Percent of Billed Charges 67.00% $87.22 Percent of Billed Charges 77.50% $100.89 Percent of Billed Charges 79.97% $104.10 Percent of Billed Charges 55.00% $71.60 Percent of Billed Charges 49.55% $64.50 Percent of Billed Charges 55.00% $71.60 Percent of Billed Charges 55.00% $71.60 Percent of Billed Charges 78.94% $102.76 Percent of Billed Charges 74.00% $96.33 Percent of Billed Charges 92.50% $120.42 Percent of Billed Charges 55.00% $71.60 Percent of Billed Charges 85.00% $110.65 Percent of Billed Charges 63.00% $82.01 Percent of Billed Charges 63.00% $82.01 Percent of Billed Charges 75.00% $97.64 Percent of Billed Charges 66.24% $86.23 Percent of Billed Charges 165.81% $24.95 Fee Schedule 166.07% $24.99 Fee Schedule 176.26% $26.53 Fee Schedule 129.00% $19.41 Fee Schedule 191.24% $28.78 Fee Schedule 159.00% $206.99 Fee Schedule 145.00% $21.82 Fee Schedule 60.00% $78.11 Percent of Billed Charges HC HCV RNA QUANT LABCORP 300 CPT 87522 90 Outpatient $110.00 $54.51 $174.90 $110.00 $233.40 $110.00 Fee Schedule $233.40 $110.00 Fee Schedule $373.56 $110.00 Fee Schedule 74.74% $82.21 Percent of Billed Charges 68.24% $75.06 Percent of Billed Charges 65.00% $71.50 Percent of Billed Charges 67.00% $73.70 Percent of Billed Charges 77.50% $85.25 Percent of Billed Charges 79.97% $87.97 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 49.55% $54.51 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 78.94% $86.83 Percent of Billed Charges 74.00% $81.40 Percent of Billed Charges 92.50% $101.75 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 85.00% $93.50 Percent of Billed Charges 63.00% $69.30 Percent of Billed Charges 63.00% $69.30 Percent of Billed Charges 75.00% $82.50 Percent of Billed Charges 66.24% $72.86 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $174.90 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $66.00 Percent of Billed Charges HC HDL CHOLESTEROL SUBCLASS QUES 300 CPT 83701 90 Outpatient $31.48 $15.60 $64.75 $31.48 $135.28 $31.48 Fee Schedule $135.28 $31.48 Fee Schedule $295.26 $31.48 Fee Schedule 74.74% $23.53 Percent of Billed Charges 68.24% $21.48 Percent of Billed Charges 65.00% $20.46 Percent of Billed Charges 67.00% $21.09 Percent of Billed Charges 77.50% $24.40 Percent of Billed Charges 79.97% $25.17 Percent of Billed Charges 55.00% $17.31 Percent of Billed Charges 49.55% $15.60 Percent of Billed Charges 55.00% $17.31 Percent of Billed Charges 55.00% $17.31 Percent of Billed Charges 78.94% $24.85 Percent of Billed Charges 74.00% $23.30 Percent of Billed Charges 92.50% $29.12 Percent of Billed Charges 55.00% $17.31 Percent of Billed Charges 85.00% $26.76 Percent of Billed Charges 63.00% $19.83 Percent of Billed Charges 63.00% $19.83 Percent of Billed Charges 75.00% $23.61 Percent of Billed Charges 66.24% $20.85 Percent of Billed Charges 165.81% $31.48 Fee Schedule 166.07% $56.23 Fee Schedule 176.26% $59.68 Fee Schedule 129.00% $43.68 Fee Schedule 191.24% $64.75 Fee Schedule 159.00% $50.05 Fee Schedule 145.00% $49.10 Fee Schedule 60.00% $18.89 Percent of Billed Charges "HC HE4, OVARIAN CANCER MONIT" 300 CPT 86305 90 Outpatient $256.00 $26.84 $407.04 $256.00 $113.40 $113.40 Fee Schedule $113.40 $113.40 Fee Schedule $181.46 $172.10 Fee Schedule 74.74% $191.33 Percent of Billed Charges 68.24% $174.69 Percent of Billed Charges 65.00% $166.40 Percent of Billed Charges 67.00% $171.52 Percent of Billed Charges 77.50% $198.40 Percent of Billed Charges 79.97% $204.72 Percent of Billed Charges 55.00% $140.80 Percent of Billed Charges 49.55% $126.85 Percent of Billed Charges 55.00% $140.80 Percent of Billed Charges 55.00% $140.80 Percent of Billed Charges 78.94% $202.09 Percent of Billed Charges 74.00% $189.44 Percent of Billed Charges 92.50% $236.80 Percent of Billed Charges 55.00% $140.80 Percent of Billed Charges 85.00% $217.60 Percent of Billed Charges 63.00% $161.28 Percent of Billed Charges 63.00% $161.28 Percent of Billed Charges 75.00% $192.00 Percent of Billed Charges 66.24% $169.57 Percent of Billed Charges 165.81% $34.51 Fee Schedule 166.07% $34.56 Fee Schedule 176.26% $36.68 Fee Schedule 129.00% $26.84 Fee Schedule 191.24% $39.80 Fee Schedule 159.00% $407.04 Fee Schedule 145.00% $30.17 Fee Schedule 60.00% $153.60 Percent of Billed Charges "HC HEMOGLOBIN, URINE ARUP" 300 CPT 83069 90 Outpatient $17.40 $5.10 $27.67 $17.40 $21.52 $17.40 Fee Schedule $21.52 $17.40 Fee Schedule $34.44 $17.40 Fee Schedule 74.74% $13.00 Percent of Billed Charges 68.24% $11.87 Percent of Billed Charges 65.00% $11.31 Percent of Billed Charges 67.00% $11.66 Percent of Billed Charges 77.50% $13.49 Percent of Billed Charges 79.97% $13.91 Percent of Billed Charges 55.00% $9.57 Percent of Billed Charges 49.55% $8.62 Percent of Billed Charges 55.00% $9.57 Percent of Billed Charges 55.00% $9.57 Percent of Billed Charges 78.94% $13.74 Percent of Billed Charges 74.00% $12.88 Percent of Billed Charges 92.50% $16.10 Percent of Billed Charges 55.00% $9.57 Percent of Billed Charges 85.00% $14.79 Percent of Billed Charges 63.00% $10.96 Percent of Billed Charges 63.00% $10.96 Percent of Billed Charges 75.00% $13.05 Percent of Billed Charges 66.24% $11.53 Percent of Billed Charges 165.81% $6.55 Fee Schedule 166.07% $6.56 Fee Schedule 176.26% $6.96 Fee Schedule 129.00% $5.10 Fee Schedule 191.24% $7.55 Fee Schedule 159.00% $27.67 Fee Schedule 145.00% $5.73 Fee Schedule 60.00% $10.44 Percent of Billed Charges HC HEMP MAYO 300 CPT 81479 90 Outpatient $662.90 $- " $1,054.01 " $662.90 50.00% $331.45 Percent of Billed Charges 50.00% $331.45 Percent of Billed Charges 56.78% $376.39 Percent of Billed Charges 74.74% $495.45 Percent of Billed Charges 68.24% $452.36 Percent of Billed Charges 65.00% $430.89 Percent of Billed Charges 67.00% $444.14 Percent of Billed Charges 77.50% $513.75 Percent of Billed Charges 79.97% $530.12 Percent of Billed Charges 55.00% $364.60 Percent of Billed Charges 49.55% $328.47 Percent of Billed Charges 55.00% $364.60 Percent of Billed Charges 55.00% $364.60 Percent of Billed Charges 78.94% $523.29 Percent of Billed Charges 74.00% $490.55 Percent of Billed Charges 92.50% $613.18 Percent of Billed Charges 55.00% $364.60 Percent of Billed Charges 85.00% $563.47 Percent of Billed Charges 63.00% $417.63 Percent of Billed Charges 63.00% $417.63 Percent of Billed Charges 75.00% $497.18 Percent of Billed Charges 66.24% $439.10 Percent of Billed Charges 35.00% $232.02 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $1,054.01 " Fee Schedule 145.00% $- Fee Schedule 60.00% $397.74 Percent of Billed Charges HC HEP B PCR LABCORP 300 CPT 87517 90 Outpatient $150.00 $55.26 $238.50 $150.00 $233.40 $150.00 Fee Schedule $233.40 $150.00 Fee Schedule $373.56 $150.00 Fee Schedule 74.74% $112.11 Percent of Billed Charges 68.24% $102.36 Percent of Billed Charges 65.00% $97.50 Percent of Billed Charges 67.00% $100.50 Percent of Billed Charges 77.50% $116.25 Percent of Billed Charges 79.97% $119.96 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 49.55% $74.33 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 78.94% $118.41 Percent of Billed Charges 74.00% $111.00 Percent of Billed Charges 92.50% $138.75 Percent of Billed Charges 55.00% $82.50 Percent of Billed Charges 85.00% $127.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 63.00% $94.50 Percent of Billed Charges 75.00% $112.50 Percent of Billed Charges 66.24% $99.36 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $238.50 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $90.00 Percent of Billed Charges HC HEP B SURF AB QNT LABCORP 300 CPT 86317 90 Outpatient $7.00 $3.47 $28.67 $7.00 $81.68 $7.00 Fee Schedule $81.68 $7.00 Fee Schedule $130.71 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $24.89 Fee Schedule 176.26% $26.42 Fee Schedule 129.00% $19.34 Fee Schedule 191.24% $28.67 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $21.74 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC HEP B SURF AB QUAL LABCORP 300 CPT 86706 90 Outpatient $6.50 $3.22 $20.54 $6.50 $58.52 $6.50 Fee Schedule $58.52 $6.50 Fee Schedule $93.65 $6.50 Fee Schedule 74.74% $4.86 Percent of Billed Charges 68.24% $4.44 Percent of Billed Charges 65.00% $4.23 Percent of Billed Charges 67.00% $4.36 Percent of Billed Charges 77.50% $5.04 Percent of Billed Charges 79.97% $5.20 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 49.55% $3.22 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 78.94% $5.13 Percent of Billed Charges 74.00% $4.81 Percent of Billed Charges 92.50% $6.01 Percent of Billed Charges 55.00% $3.58 Percent of Billed Charges 85.00% $5.53 Percent of Billed Charges 63.00% $4.10 Percent of Billed Charges 63.00% $4.10 Percent of Billed Charges 75.00% $4.88 Percent of Billed Charges 66.24% $4.31 Percent of Billed Charges 165.81% $6.50 Fee Schedule 166.07% $17.84 Fee Schedule 176.26% $18.93 Fee Schedule 129.00% $13.85 Fee Schedule 191.24% $20.54 Fee Schedule 159.00% $10.34 Fee Schedule 145.00% $15.57 Fee Schedule 60.00% $3.90 Percent of Billed Charges HC HEP C QUAL RNA PCR LABCORP 300 CPT 87521 90 Outpatient $116.75 $45.27 $185.63 $116.75 $191.20 $116.75 Fee Schedule $191.20 $116.75 Fee Schedule $305.98 $116.75 Fee Schedule 74.74% $87.26 Percent of Billed Charges 68.24% $79.67 Percent of Billed Charges 65.00% $75.89 Percent of Billed Charges 67.00% $78.22 Percent of Billed Charges 77.50% $90.48 Percent of Billed Charges 79.97% $93.36 Percent of Billed Charges 55.00% $64.21 Percent of Billed Charges 49.55% $57.85 Percent of Billed Charges 55.00% $64.21 Percent of Billed Charges 55.00% $64.21 Percent of Billed Charges 78.94% $92.16 Percent of Billed Charges 74.00% $86.40 Percent of Billed Charges 92.50% $107.99 Percent of Billed Charges 55.00% $64.21 Percent of Billed Charges 85.00% $99.24 Percent of Billed Charges 63.00% $73.55 Percent of Billed Charges 63.00% $73.55 Percent of Billed Charges 75.00% $87.56 Percent of Billed Charges 66.24% $77.34 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $185.63 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $70.05 Percent of Billed Charges HC HEP C RNA PCR LABCORP 300 CPT 87522 90 Outpatient $110.00 $54.51 $174.90 $110.00 $233.40 $110.00 Fee Schedule $233.40 $110.00 Fee Schedule $373.56 $110.00 Fee Schedule 74.74% $82.21 Percent of Billed Charges 68.24% $75.06 Percent of Billed Charges 65.00% $71.50 Percent of Billed Charges 67.00% $73.70 Percent of Billed Charges 77.50% $85.25 Percent of Billed Charges 79.97% $87.97 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 49.55% $54.51 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 78.94% $86.83 Percent of Billed Charges 74.00% $81.40 Percent of Billed Charges 92.50% $101.75 Percent of Billed Charges 55.00% $60.50 Percent of Billed Charges 85.00% $93.50 Percent of Billed Charges 63.00% $69.30 Percent of Billed Charges 63.00% $69.30 Percent of Billed Charges 75.00% $82.50 Percent of Billed Charges 66.24% $72.86 Percent of Billed Charges 165.81% $71.03 Fee Schedule 166.07% $71.14 Fee Schedule 176.26% $75.51 Fee Schedule 129.00% $55.26 Fee Schedule 191.24% $81.93 Fee Schedule 159.00% $174.90 Fee Schedule 145.00% $62.12 Fee Schedule 60.00% $66.00 Percent of Billed Charges "HC HEP C RNA, GENOTYPE ARUP" 300 CPT 87902 90 Outpatient $102.00 $50.54 $492.35 $102.00 " $1,402.76 " $102.00 Fee Schedule " $1,402.76 " $102.00 Fee Schedule " $2,244.96 " $102.00 Fee Schedule 74.74% $76.23 Percent of Billed Charges 68.24% $69.60 Percent of Billed Charges 65.00% $66.30 Percent of Billed Charges 67.00% $68.34 Percent of Billed Charges 77.50% $79.05 Percent of Billed Charges 79.97% $81.57 Percent of Billed Charges 55.00% $56.10 Percent of Billed Charges 49.55% $50.54 Percent of Billed Charges 55.00% $56.10 Percent of Billed Charges 55.00% $56.10 Percent of Billed Charges 78.94% $80.52 Percent of Billed Charges 74.00% $75.48 Percent of Billed Charges 92.50% $94.35 Percent of Billed Charges 55.00% $56.10 Percent of Billed Charges 85.00% $86.70 Percent of Billed Charges 63.00% $64.26 Percent of Billed Charges 63.00% $64.26 Percent of Billed Charges 75.00% $76.50 Percent of Billed Charges 66.24% $67.56 Percent of Billed Charges 165.81% $102.00 Fee Schedule 166.07% $427.55 Fee Schedule 176.26% $453.78 Fee Schedule 129.00% $332.11 Fee Schedule 191.24% $492.35 Fee Schedule 159.00% $162.18 Fee Schedule 145.00% $373.30 Fee Schedule 60.00% $61.20 Percent of Billed Charges HC HEPARIN INDUCED PLT AB LABCORP 300 CPT 86022 90 Outpatient $55.00 $23.70 $87.45 $55.00 $100.08 $55.00 Fee Schedule $100.08 $55.00 Fee Schedule $160.19 $55.00 Fee Schedule 74.74% $41.11 Percent of Billed Charges 68.24% $37.53 Percent of Billed Charges 65.00% $35.75 Percent of Billed Charges 67.00% $36.85 Percent of Billed Charges 77.50% $42.63 Percent of Billed Charges 79.97% $43.98 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 49.55% $27.25 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 78.94% $43.42 Percent of Billed Charges 74.00% $40.70 Percent of Billed Charges 92.50% $50.88 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 85.00% $46.75 Percent of Billed Charges 63.00% $34.65 Percent of Billed Charges 63.00% $34.65 Percent of Billed Charges 75.00% $41.25 Percent of Billed Charges 66.24% $36.43 Percent of Billed Charges 165.81% $30.46 Fee Schedule 166.07% $30.51 Fee Schedule 176.26% $32.38 Fee Schedule 129.00% $23.70 Fee Schedule 191.24% $35.13 Fee Schedule 159.00% $87.45 Fee Schedule 145.00% $26.64 Fee Schedule 60.00% $33.00 Percent of Billed Charges HC HEPATITIS A AB LABCORP 300 CPT 86708 90 Outpatient $7.00 $3.47 $23.69 $7.00 $67.48 $7.00 Fee Schedule $67.48 $7.00 Fee Schedule $108.04 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $20.58 Fee Schedule 176.26% $21.84 Fee Schedule 129.00% $15.98 Fee Schedule 191.24% $23.69 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $17.97 Fee Schedule 60.00% $4.20 Percent of Billed Charges "HC HEPATITIS A AB,IGM LABCORP" 300 CPT 86709 90 Outpatient $6.75 $3.34 $21.53 $6.75 $61.32 $6.75 Fee Schedule $61.32 $6.75 Fee Schedule $98.19 $6.75 Fee Schedule 74.74% $5.04 Percent of Billed Charges 68.24% $4.61 Percent of Billed Charges 65.00% $4.39 Percent of Billed Charges 67.00% $4.52 Percent of Billed Charges 77.50% $5.23 Percent of Billed Charges 79.97% $5.40 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 49.55% $3.34 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 78.94% $5.33 Percent of Billed Charges 74.00% $5.00 Percent of Billed Charges 92.50% $6.24 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 85.00% $5.74 Percent of Billed Charges 63.00% $4.25 Percent of Billed Charges 63.00% $4.25 Percent of Billed Charges 75.00% $5.06 Percent of Billed Charges 66.24% $4.47 Percent of Billed Charges 165.81% $6.75 Fee Schedule 166.07% $18.70 Fee Schedule 176.26% $19.85 Fee Schedule 129.00% $14.53 Fee Schedule 191.24% $21.53 Fee Schedule 159.00% $10.73 Fee Schedule 145.00% $16.33 Fee Schedule 60.00% $4.05 Percent of Billed Charges "HC HEPATITIS B COR AB,IGM LABCORP" 300 CPT 86705 90 Outpatient $6.75 $3.34 $22.51 $6.75 $64.16 $6.75 Fee Schedule $64.16 $6.75 Fee Schedule $102.63 $6.75 Fee Schedule 74.74% $5.04 Percent of Billed Charges 68.24% $4.61 Percent of Billed Charges 65.00% $4.39 Percent of Billed Charges 67.00% $4.52 Percent of Billed Charges 77.50% $5.23 Percent of Billed Charges 79.97% $5.40 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 49.55% $3.34 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 78.94% $5.33 Percent of Billed Charges 74.00% $5.00 Percent of Billed Charges 92.50% $6.24 Percent of Billed Charges 55.00% $3.71 Percent of Billed Charges 85.00% $5.74 Percent of Billed Charges 63.00% $4.25 Percent of Billed Charges 63.00% $4.25 Percent of Billed Charges 75.00% $5.06 Percent of Billed Charges 66.24% $4.47 Percent of Billed Charges 165.81% $6.75 Fee Schedule 166.07% $19.55 Fee Schedule 176.26% $20.75 Fee Schedule 129.00% $15.18 Fee Schedule 191.24% $22.51 Fee Schedule 159.00% $10.73 Fee Schedule 145.00% $17.07 Fee Schedule 60.00% $4.05 Percent of Billed Charges HC HEPATITIS B CORE AB LABCORP 300 CPT 86704 90 Outpatient $7.00 $3.47 $23.04 $7.00 $65.64 $7.00 Fee Schedule $65.64 $7.00 Fee Schedule $105.08 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $20.01 Fee Schedule 176.26% $21.24 Fee Schedule 129.00% $15.54 Fee Schedule 191.24% $23.04 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $17.47 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC HEPATITIS B SURF AG LABCORP 300 CPT 87340 90 Outpatient $4.80 $2.38 $19.76 $4.80 $56.28 $4.80 Fee Schedule $56.28 $4.80 Fee Schedule $90.08 $4.80 Fee Schedule 74.74% $3.59 Percent of Billed Charges 68.24% $3.28 Percent of Billed Charges 65.00% $3.12 Percent of Billed Charges 67.00% $3.22 Percent of Billed Charges 77.50% $3.72 Percent of Billed Charges 79.97% $3.84 Percent of Billed Charges 55.00% $2.64 Percent of Billed Charges 49.55% $2.38 Percent of Billed Charges 55.00% $2.64 Percent of Billed Charges 55.00% $2.64 Percent of Billed Charges 78.94% $3.79 Percent of Billed Charges 74.00% $3.55 Percent of Billed Charges 92.50% $4.44 Percent of Billed Charges 55.00% $2.64 Percent of Billed Charges 85.00% $4.08 Percent of Billed Charges 63.00% $3.02 Percent of Billed Charges 63.00% $3.02 Percent of Billed Charges 75.00% $3.60 Percent of Billed Charges 66.24% $3.18 Percent of Billed Charges 165.81% $4.80 Fee Schedule 166.07% $17.16 Fee Schedule 176.26% $18.21 Fee Schedule 129.00% $13.33 Fee Schedule 191.24% $19.76 Fee Schedule 159.00% $7.63 Fee Schedule 145.00% $14.98 Fee Schedule 60.00% $2.88 Percent of Billed Charges HC HEPATITIS BE AB LABCORP 300 CPT 86707 90 Outpatient $7.00 $3.47 $22.13 $7.00 $63.04 $7.00 Fee Schedule $63.04 $7.00 Fee Schedule $100.89 $7.00 Fee Schedule 74.74% $5.23 Percent of Billed Charges 68.24% $4.78 Percent of Billed Charges 65.00% $4.55 Percent of Billed Charges 67.00% $4.69 Percent of Billed Charges 77.50% $5.43 Percent of Billed Charges 79.97% $5.60 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 49.55% $3.47 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 78.94% $5.53 Percent of Billed Charges 74.00% $5.18 Percent of Billed Charges 92.50% $6.48 Percent of Billed Charges 55.00% $3.85 Percent of Billed Charges 85.00% $5.95 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 63.00% $4.41 Percent of Billed Charges 75.00% $5.25 Percent of Billed Charges 66.24% $4.64 Percent of Billed Charges 165.81% $7.00 Fee Schedule 166.07% $19.21 Fee Schedule 176.26% $20.39 Fee Schedule 129.00% $14.93 Fee Schedule 191.24% $22.13 Fee Schedule 159.00% $11.13 Fee Schedule 145.00% $16.78 Fee Schedule 60.00% $4.20 Percent of Billed Charges HC HEPATITIS BE AG LABCORP 300 CPT 87350 90 Outpatient $5.50 $2.73 $22.05 $5.50 $62.80 $5.50 Fee Schedule $62.80 $5.50 Fee Schedule $100.54 $5.50 Fee Schedule 74.74% $4.11 Percent of Billed Charges 68.24% $3.75 Percent of Billed Charges 65.00% $3.58 Percent of Billed Charges 67.00% $3.69 Percent of Billed Charges 77.50% $4.26 Percent of Billed Charges 79.97% $4.40 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 49.55% $2.73 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 78.94% $4.34 Percent of Billed Charges 74.00% $4.07 Percent of Billed Charges 92.50% $5.09 Percent of Billed Charges 55.00% $3.03 Percent of Billed Charges 85.00% $4.68 Percent of Billed Charges 63.00% $3.47 Percent of Billed Charges 63.00% $3.47 Percent of Billed Charges 75.00% $4.13 Percent of Billed Charges 66.24% $3.64 Percent of Billed Charges 165.81% $5.50 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $8.75 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $3.30 Percent of Billed Charges HC HEPATITIS C AB LABCORP 300 CPT 86803 90 Outpatient $8.00 $3.96 $27.29 $8.00 $77.76 $8.00 Fee Schedule $77.76 $8.00 Fee Schedule $124.43 $8.00 Fee Schedule 74.74% $5.98 Percent of Billed Charges 68.24% $5.46 Percent of Billed Charges 65.00% $5.20 Percent of Billed Charges 67.00% $5.36 Percent of Billed Charges 77.50% $6.20 Percent of Billed Charges 79.97% $6.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 49.55% $3.96 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 78.94% $6.32 Percent of Billed Charges 74.00% $5.92 Percent of Billed Charges 92.50% $7.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 85.00% $6.80 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 75.00% $6.00 Percent of Billed Charges 66.24% $5.30 Percent of Billed Charges 165.81% $8.00 Fee Schedule 166.07% $23.70 Fee Schedule 176.26% $25.15 Fee Schedule 129.00% $18.41 Fee Schedule 191.24% $27.29 Fee Schedule 159.00% $12.72 Fee Schedule 145.00% $20.69 Fee Schedule 60.00% $4.80 Percent of Billed Charges HC HEPATITIS E AB ARUP 300 CPT 86790 90 Outpatient $42.53 $16.62 $67.62 $42.53 $70.20 $42.53 Fee Schedule $70.20 $42.53 Fee Schedule $112.31 $42.53 Fee Schedule 74.74% $31.79 Percent of Billed Charges 68.24% $29.02 Percent of Billed Charges 65.00% $27.64 Percent of Billed Charges 67.00% $28.50 Percent of Billed Charges 77.50% $32.96 Percent of Billed Charges 79.97% $34.01 Percent of Billed Charges 55.00% $23.39 Percent of Billed Charges 49.55% $21.07 Percent of Billed Charges 55.00% $23.39 Percent of Billed Charges 55.00% $23.39 Percent of Billed Charges 78.94% $33.57 Percent of Billed Charges 74.00% $31.47 Percent of Billed Charges 92.50% $39.34 Percent of Billed Charges 55.00% $23.39 Percent of Billed Charges 85.00% $36.15 Percent of Billed Charges 63.00% $26.79 Percent of Billed Charges 63.00% $26.79 Percent of Billed Charges 75.00% $31.90 Percent of Billed Charges 66.24% $28.17 Percent of Billed Charges 165.81% $21.36 Fee Schedule 166.07% $21.39 Fee Schedule 176.26% $22.70 Fee Schedule 129.00% $16.62 Fee Schedule 191.24% $24.63 Fee Schedule 159.00% $67.62 Fee Schedule 145.00% $18.68 Fee Schedule 60.00% $25.52 Percent of Billed Charges HC HEPATITIS PANEL (4) LABCORP 300 CPT 80074 90 Outpatient $26.30 $13.03 $91.09 $26.30 $259.56 $26.30 Fee Schedule $259.56 $26.30 Fee Schedule $415.33 $26.30 Fee Schedule 74.74% $19.66 Percent of Billed Charges 68.24% $17.95 Percent of Billed Charges 65.00% $17.10 Percent of Billed Charges 67.00% $17.62 Percent of Billed Charges 77.50% $20.38 Percent of Billed Charges 79.97% $21.03 Percent of Billed Charges 55.00% $14.47 Percent of Billed Charges 49.55% $13.03 Percent of Billed Charges 55.00% $14.47 Percent of Billed Charges 55.00% $14.47 Percent of Billed Charges 78.94% $20.76 Percent of Billed Charges 74.00% $19.46 Percent of Billed Charges 92.50% $24.33 Percent of Billed Charges 55.00% $14.47 Percent of Billed Charges 85.00% $22.36 Percent of Billed Charges 63.00% $16.57 Percent of Billed Charges 63.00% $16.57 Percent of Billed Charges 75.00% $19.73 Percent of Billed Charges 66.24% $17.42 Percent of Billed Charges 165.81% $26.30 Fee Schedule 166.07% $79.10 Fee Schedule 176.26% $83.95 Fee Schedule 129.00% $61.44 Fee Schedule 191.24% $91.09 Fee Schedule 159.00% $41.82 Fee Schedule 145.00% $69.06 Fee Schedule 60.00% $15.78 Percent of Billed Charges HC HEREDITARY HEMOCHROMAT LABCORP 300 CPT 81256 90 Outpatient $85.74 $42.48 $136.33 $85.74 $356.16 $85.74 Fee Schedule $356.16 $85.74 Fee Schedule $569.94 $85.74 Fee Schedule 74.74% $64.08 Percent of Billed Charges 68.24% $58.51 Percent of Billed Charges 65.00% $55.73 Percent of Billed Charges 67.00% $57.45 Percent of Billed Charges 77.50% $66.45 Percent of Billed Charges 79.97% $68.57 Percent of Billed Charges 55.00% $47.16 Percent of Billed Charges 49.55% $42.48 Percent of Billed Charges 55.00% $47.16 Percent of Billed Charges 55.00% $47.16 Percent of Billed Charges 78.94% $67.68 Percent of Billed Charges 74.00% $63.45 Percent of Billed Charges 92.50% $79.31 Percent of Billed Charges 55.00% $47.16 Percent of Billed Charges 85.00% $72.88 Percent of Billed Charges 63.00% $54.02 Percent of Billed Charges 63.00% $54.02 Percent of Billed Charges 75.00% $64.31 Percent of Billed Charges 66.24% $56.79 Percent of Billed Charges 165.81% $85.74 Fee Schedule 166.07% $108.54 Fee Schedule 176.26% $115.20 Fee Schedule 129.00% $84.31 Fee Schedule 191.24% $124.99 Fee Schedule 159.00% $136.33 Fee Schedule 145.00% $94.77 Fee Schedule 60.00% $51.44 Percent of Billed Charges HC HERPES SIMPLEX VIRUS 1-PCR ARUP 300 CPT 87529 90 Outpatient $109.69 $45.27 $174.41 $109.69 $191.20 $109.69 Fee Schedule $191.20 $109.69 Fee Schedule $305.98 $109.69 Fee Schedule 74.74% $81.98 Percent of Billed Charges 68.24% $74.85 Percent of Billed Charges 65.00% $71.30 Percent of Billed Charges 67.00% $73.49 Percent of Billed Charges 77.50% $85.01 Percent of Billed Charges 79.97% $87.72 Percent of Billed Charges 55.00% $60.33 Percent of Billed Charges 49.55% $54.35 Percent of Billed Charges 55.00% $60.33 Percent of Billed Charges 55.00% $60.33 Percent of Billed Charges 78.94% $86.59 Percent of Billed Charges 74.00% $81.17 Percent of Billed Charges 92.50% $101.46 Percent of Billed Charges 55.00% $60.33 Percent of Billed Charges 85.00% $93.24 Percent of Billed Charges 63.00% $69.10 Percent of Billed Charges 63.00% $69.10 Percent of Billed Charges 75.00% $82.27 Percent of Billed Charges 66.24% $72.66 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $174.41 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $65.81 Percent of Billed Charges "HC HETEROPHILE ANTIBODIES,SCREEN - MONONUCLEOSIS SCREEN" 300 CPT 86308 Outpatient $151.00 $6.68 $240.09 $151.00 $28.20 $28.20 Fee Schedule $28.20 $28.20 Fee Schedule $45.17 $42.84 Fee Schedule 74.74% $112.86 Percent of Billed Charges 68.24% $103.04 Percent of Billed Charges 65.00% $98.15 Percent of Billed Charges 67.00% $101.17 Percent of Billed Charges 77.50% $117.03 Percent of Billed Charges 79.97% $120.75 Percent of Billed Charges 55.00% $83.05 Percent of Billed Charges 49.55% $74.82 Percent of Billed Charges 55.00% $83.05 Percent of Billed Charges 55.00% $83.05 Percent of Billed Charges 78.94% $119.20 Percent of Billed Charges 74.00% $111.74 Percent of Billed Charges 92.50% $139.68 Percent of Billed Charges 55.00% $83.05 Percent of Billed Charges 85.00% $128.35 Percent of Billed Charges 63.00% $95.13 Percent of Billed Charges 63.00% $95.13 Percent of Billed Charges 75.00% $113.25 Percent of Billed Charges 66.24% $100.02 Percent of Billed Charges 165.81% $8.59 Fee Schedule 166.07% $8.60 Fee Schedule 176.26% $9.13 Fee Schedule 129.00% $6.68 Fee Schedule 191.24% $9.91 Fee Schedule 159.00% $240.09 Fee Schedule 145.00% $7.51 Fee Schedule 60.00% $90.60 Percent of Billed Charges HC HGB ELECTROPHORESIS LABCORP 300 CPT 83021 90 Outpatient $11.00 $5.45 $34.54 $11.00 $98.40 $11.00 Fee Schedule $98.40 $11.00 Fee Schedule $157.48 $11.00 Fee Schedule 74.74% $8.22 Percent of Billed Charges 68.24% $7.51 Percent of Billed Charges 65.00% $7.15 Percent of Billed Charges 67.00% $7.37 Percent of Billed Charges 77.50% $8.53 Percent of Billed Charges 79.97% $8.80 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 49.55% $5.45 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 78.94% $8.68 Percent of Billed Charges 74.00% $8.14 Percent of Billed Charges 92.50% $10.18 Percent of Billed Charges 55.00% $6.05 Percent of Billed Charges 85.00% $9.35 Percent of Billed Charges 63.00% $6.93 Percent of Billed Charges 63.00% $6.93 Percent of Billed Charges 75.00% $8.25 Percent of Billed Charges 66.24% $7.29 Percent of Billed Charges 165.81% $11.00 Fee Schedule 166.07% $29.99 Fee Schedule 176.26% $31.83 Fee Schedule 129.00% $23.30 Fee Schedule 191.24% $34.54 Fee Schedule 159.00% $17.49 Fee Schedule 145.00% $26.19 Fee Schedule 60.00% $6.60 Percent of Billed Charges HC HGB QUANT AND FRACT STAN 300 CPT 83020 90 Outpatient $57.00 $16.60 $90.63 $57.00 $70.12 $57.00 Fee Schedule $70.12 $57.00 Fee Schedule $112.23 $57.00 Fee Schedule 74.74% $42.60 Percent of Billed Charges 68.24% $38.90 Percent of Billed Charges 65.00% $37.05 Percent of Billed Charges 67.00% $38.19 Percent of Billed Charges 77.50% $44.18 Percent of Billed Charges 79.97% $45.58 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 49.55% $28.24 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 78.94% $45.00 Percent of Billed Charges 74.00% $42.18 Percent of Billed Charges 92.50% $52.73 Percent of Billed Charges 55.00% $31.35 Percent of Billed Charges 85.00% $48.45 Percent of Billed Charges 63.00% $35.91 Percent of Billed Charges 63.00% $35.91 Percent of Billed Charges 75.00% $42.75 Percent of Billed Charges 66.24% $37.76 Percent of Billed Charges 165.81% $21.34 Fee Schedule 166.07% $21.37 Fee Schedule 176.26% $22.68 Fee Schedule 129.00% $16.60 Fee Schedule 191.24% $24.61 Fee Schedule 159.00% $90.63 Fee Schedule 145.00% $18.66 Fee Schedule 60.00% $34.20 Percent of Billed Charges HC HGB S ARUP 300 CPT 83021 90 Outpatient $28.80 $14.27 $45.79 $28.80 $98.40 $28.80 Fee Schedule $98.40 $28.80 Fee Schedule $157.48 $28.80 Fee Schedule 74.74% $21.53 Percent of Billed Charges 68.24% $19.65 Percent of Billed Charges 65.00% $18.72 Percent of Billed Charges 67.00% $19.30 Percent of Billed Charges 77.50% $22.32 Percent of Billed Charges 79.97% $23.03 Percent of Billed Charges 55.00% $15.84 Percent of Billed Charges 49.55% $14.27 Percent of Billed Charges 55.00% $15.84 Percent of Billed Charges 55.00% $15.84 Percent of Billed Charges 78.94% $22.73 Percent of Billed Charges 74.00% $21.31 Percent of Billed Charges 92.50% $26.64 Percent of Billed Charges 55.00% $15.84 Percent of Billed Charges 85.00% $24.48 Percent of Billed Charges 63.00% $18.14 Percent of Billed Charges 63.00% $18.14 Percent of Billed Charges 75.00% $21.60 Percent of Billed Charges 66.24% $19.08 Percent of Billed Charges 165.81% $28.80 Fee Schedule 166.07% $29.99 Fee Schedule 176.26% $31.83 Fee Schedule 129.00% $23.30 Fee Schedule 191.24% $34.54 Fee Schedule 159.00% $45.79 Fee Schedule 145.00% $26.19 Fee Schedule 60.00% $17.28 Percent of Billed Charges HC HGB VARIANT A2 & F MAYO 300 CPT 83020 90 Outpatient $55.00 $16.60 $87.45 $55.00 $70.12 $55.00 Fee Schedule $70.12 $55.00 Fee Schedule $112.23 $55.00 Fee Schedule 74.74% $41.11 Percent of Billed Charges 68.24% $37.53 Percent of Billed Charges 65.00% $35.75 Percent of Billed Charges 67.00% $36.85 Percent of Billed Charges 77.50% $42.63 Percent of Billed Charges 79.97% $43.98 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 49.55% $27.25 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 78.94% $43.42 Percent of Billed Charges 74.00% $40.70 Percent of Billed Charges 92.50% $50.88 Percent of Billed Charges 55.00% $30.25 Percent of Billed Charges 85.00% $46.75 Percent of Billed Charges 63.00% $34.65 Percent of Billed Charges 63.00% $34.65 Percent of Billed Charges 75.00% $41.25 Percent of Billed Charges 66.24% $36.43 Percent of Billed Charges 165.81% $21.34 Fee Schedule 166.07% $21.37 Fee Schedule 176.26% $22.68 Fee Schedule 129.00% $16.60 Fee Schedule 191.24% $24.61 Fee Schedule 159.00% $87.45 Fee Schedule 145.00% $18.66 Fee Schedule 60.00% $33.00 Percent of Billed Charges HC HGBA1C W/ GLYCOMARK LABCORP 300 CPT 83036 90 Outpatient $62.88 $12.53 $99.98 $62.88 $52.88 $52.88 Fee Schedule $52.88 $52.88 Fee Schedule $84.67 $62.88 Fee Schedule 74.74% $47.00 Percent of Billed Charges 68.24% $42.91 Percent of Billed Charges 65.00% $40.87 Percent of Billed Charges 67.00% $42.13 Percent of Billed Charges 77.50% $48.73 Percent of Billed Charges 79.97% $50.29 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 49.55% $31.16 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 78.94% $49.64 Percent of Billed Charges 74.00% $46.53 Percent of Billed Charges 92.50% $58.16 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 85.00% $53.45 Percent of Billed Charges 63.00% $39.61 Percent of Billed Charges 63.00% $39.61 Percent of Billed Charges 75.00% $47.16 Percent of Billed Charges 66.24% $41.65 Percent of Billed Charges 165.81% $16.10 Fee Schedule 166.07% $16.13 Fee Schedule 176.26% $17.11 Fee Schedule 129.00% $12.53 Fee Schedule 191.24% $18.57 Fee Schedule 159.00% $99.98 Fee Schedule 145.00% $14.08 Fee Schedule 60.00% $37.73 Percent of Billed Charges HC HGBA1C W/ GLYCOMARK LABCORP 300 CPT 84378 90 Outpatient $62.87 $14.87 $99.96 $62.87 $62.80 $62.80 Fee Schedule $62.80 $62.80 Fee Schedule $100.54 $62.87 Fee Schedule 74.74% $46.99 Percent of Billed Charges 68.24% $42.90 Percent of Billed Charges 65.00% $40.87 Percent of Billed Charges 67.00% $42.12 Percent of Billed Charges 77.50% $48.72 Percent of Billed Charges 79.97% $50.28 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 49.55% $31.15 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 78.94% $49.63 Percent of Billed Charges 74.00% $46.52 Percent of Billed Charges 92.50% $58.15 Percent of Billed Charges 55.00% $34.58 Percent of Billed Charges 85.00% $53.44 Percent of Billed Charges 63.00% $39.61 Percent of Billed Charges 63.00% $39.61 Percent of Billed Charges 75.00% $47.15 Percent of Billed Charges 66.24% $41.65 Percent of Billed Charges 165.81% $19.12 Fee Schedule 166.07% $19.15 Fee Schedule 176.26% $20.32 Fee Schedule 129.00% $14.87 Fee Schedule 191.24% $22.05 Fee Schedule 159.00% $99.96 Fee Schedule 145.00% $16.72 Fee Schedule 60.00% $37.72 Percent of Billed Charges HC H H V-6 IGG LABCORP 300 CPT 86790 90 Outpatient $18.30 $9.07 $29.10 $18.30 $70.20 $18.30 Fee Schedule $70.20 $18.30 Fee Schedule $112.31 $18.30 Fee Schedule 74.74% $13.68 Percent of Billed Charges 68.24% $12.49 Percent of Billed Charges 65.00% $11.90 Percent of Billed Charges 67.00% $12.26 Percent of Billed Charges 77.50% $14.18 Percent of Billed Charges 79.97% $14.63 Percent of Billed Charges 55.00% $10.07 Percent of Billed Charges 49.55% $9.07 Percent of Billed Charges 55.00% $10.07 Percent of Billed Charges 55.00% $10.07 Percent of Billed Charges 78.94% $14.45 Percent of Billed Charges 74.00% $13.54 Percent of Billed Charges 92.50% $16.93 Percent of Billed Charges 55.00% $10.07 Percent of Billed Charges 85.00% $15.56 Percent of Billed Charges 63.00% $11.53 Percent of Billed Charges 63.00% $11.53 Percent of Billed Charges 75.00% $13.73 Percent of Billed Charges 66.24% $12.12 Percent of Billed Charges 165.81% $18.30 Fee Schedule 166.07% $21.39 Fee Schedule 176.26% $22.70 Fee Schedule 129.00% $16.62 Fee Schedule 191.24% $24.63 Fee Schedule 159.00% $29.10 Fee Schedule 145.00% $18.68 Fee Schedule 60.00% $10.98 Percent of Billed Charges HC H H V-6 IGM ARUP 300 CPT 86790 90 Outpatient $127.63 $16.62 $202.93 $127.63 $70.20 $70.20 Fee Schedule $70.20 $70.20 Fee Schedule $112.31 $106.52 Fee Schedule 74.74% $95.39 Percent of Billed Charges 68.24% $87.09 Percent of Billed Charges 65.00% $82.96 Percent of Billed Charges 67.00% $85.51 Percent of Billed Charges 77.50% $98.91 Percent of Billed Charges 79.97% $102.07 Percent of Billed Charges 55.00% $70.20 Percent of Billed Charges 49.55% $63.24 Percent of Billed Charges 55.00% $70.20 Percent of Billed Charges 55.00% $70.20 Percent of Billed Charges 78.94% $100.75 Percent of Billed Charges 74.00% $94.45 Percent of Billed Charges 92.50% $118.06 Percent of Billed Charges 55.00% $70.20 Percent of Billed Charges 85.00% $108.49 Percent of Billed Charges 63.00% $80.41 Percent of Billed Charges 63.00% $80.41 Percent of Billed Charges 75.00% $95.72 Percent of Billed Charges 66.24% $84.54 Percent of Billed Charges 165.81% $21.36 Fee Schedule 166.07% $21.39 Fee Schedule 176.26% $22.70 Fee Schedule 129.00% $16.62 Fee Schedule 191.24% $24.63 Fee Schedule 159.00% $202.93 Fee Schedule 145.00% $18.68 Fee Schedule 60.00% $76.58 Percent of Billed Charges "HC H H V-6 QUANT, DNA PCR LABCORP" 300 CPT 87533 90 Outpatient $200.00 $53.87 $318.00 $200.00 $227.52 $200.00 Fee Schedule $227.52 $200.00 Fee Schedule $364.15 $200.00 Fee Schedule 74.74% $149.48 Percent of Billed Charges 68.24% $136.48 Percent of Billed Charges 65.00% $130.00 Percent of Billed Charges 67.00% $134.00 Percent of Billed Charges 77.50% $155.00 Percent of Billed Charges 79.97% $159.94 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 49.55% $99.10 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 78.94% $157.88 Percent of Billed Charges 74.00% $148.00 Percent of Billed Charges 92.50% $185.00 Percent of Billed Charges 55.00% $110.00 Percent of Billed Charges 85.00% $170.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 63.00% $126.00 Percent of Billed Charges 75.00% $150.00 Percent of Billed Charges 66.24% $132.48 Percent of Billed Charges 165.81% $69.24 Fee Schedule 166.07% $69.35 Fee Schedule 176.26% $73.61 Fee Schedule 129.00% $53.87 Fee Schedule 191.24% $79.86 Fee Schedule 159.00% $318.00 Fee Schedule 145.00% $60.55 Fee Schedule 60.00% $120.00 Percent of Billed Charges "HC H H V-6, DNA PCR QL LABCORP" 300 CPT 87532 90 Outpatient $115.00 $45.27 $182.85 $115.00 $191.20 $115.00 Fee Schedule $191.20 $115.00 Fee Schedule $305.98 $115.00 Fee Schedule 74.74% $85.95 Percent of Billed Charges 68.24% $78.48 Percent of Billed Charges 65.00% $74.75 Percent of Billed Charges 67.00% $77.05 Percent of Billed Charges 77.50% $89.13 Percent of Billed Charges 79.97% $91.97 Percent of Billed Charges 55.00% $63.25 Percent of Billed Charges 49.55% $56.98 Percent of Billed Charges 55.00% $63.25 Percent of Billed Charges 55.00% $63.25 Percent of Billed Charges 78.94% $90.78 Percent of Billed Charges 74.00% $85.10 Percent of Billed Charges 92.50% $106.38 Percent of Billed Charges 55.00% $63.25 Percent of Billed Charges 85.00% $97.75 Percent of Billed Charges 63.00% $72.45 Percent of Billed Charges 63.00% $72.45 Percent of Billed Charges 75.00% $86.25 Percent of Billed Charges 66.24% $76.18 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $182.85 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $69.00 Percent of Billed Charges HC HISTOPLASMA ABS BY CF&ID ARUP 300 CPT 86698 90 Outpatient $33.11 $16.41 $52.64 $33.11 $68.08 $33.11 Fee Schedule $68.08 $33.11 Fee Schedule $120.25 $33.11 Fee Schedule 74.74% $24.75 Percent of Billed Charges 68.24% $22.59 Percent of Billed Charges 65.00% $21.52 Percent of Billed Charges 67.00% $22.18 Percent of Billed Charges 77.50% $25.66 Percent of Billed Charges 79.97% $26.48 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 49.55% $16.41 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 78.94% $26.14 Percent of Billed Charges 74.00% $24.50 Percent of Billed Charges 92.50% $30.63 Percent of Billed Charges 55.00% $18.21 Percent of Billed Charges 85.00% $28.14 Percent of Billed Charges 63.00% $20.86 Percent of Billed Charges 63.00% $20.86 Percent of Billed Charges 75.00% $24.83 Percent of Billed Charges 66.24% $21.93 Percent of Billed Charges 165.81% $22.87 Fee Schedule 166.07% $22.90 Fee Schedule 176.26% $24.31 Fee Schedule 129.00% $17.79 Fee Schedule 191.24% $26.37 Fee Schedule 159.00% $52.64 Fee Schedule 145.00% $20.00 Fee Schedule 60.00% $19.87 Percent of Billed Charges HC HISTOPLASMA AG ARUP 300 CPT 87385 90 Outpatient $68.63 $17.09 $109.12 $68.63 $65.32 $65.32 Fee Schedule $65.32 $65.32 Fee Schedule $115.54 $68.63 Fee Schedule 74.74% $51.29 Percent of Billed Charges 68.24% $46.83 Percent of Billed Charges 65.00% $44.61 Percent of Billed Charges 67.00% $45.98 Percent of Billed Charges 77.50% $53.19 Percent of Billed Charges 79.97% $54.88 Percent of Billed Charges 55.00% $37.75 Percent of Billed Charges 49.55% $34.01 Percent of Billed Charges 55.00% $37.75 Percent of Billed Charges 55.00% $37.75 Percent of Billed Charges 78.94% $54.18 Percent of Billed Charges 74.00% $50.79 Percent of Billed Charges 92.50% $63.48 Percent of Billed Charges 55.00% $37.75 Percent of Billed Charges 85.00% $58.34 Percent of Billed Charges 63.00% $43.24 Percent of Billed Charges 63.00% $43.24 Percent of Billed Charges 75.00% $51.47 Percent of Billed Charges 66.24% $45.46 Percent of Billed Charges 165.81% $21.97 Fee Schedule 166.07% $22.00 Fee Schedule 176.26% $23.35 Fee Schedule 129.00% $17.09 Fee Schedule 191.24% $25.34 Fee Schedule 159.00% $109.12 Fee Schedule 145.00% $19.21 Fee Schedule 60.00% $41.18 Percent of Billed Charges HC HISTOPLASMA AG URINE ARUP 300 CPT 87385 90 Outpatient $73.50 $17.09 $116.87 $73.50 $65.32 $65.32 Fee Schedule $65.32 $65.32 Fee Schedule $115.54 $73.50 Fee Schedule 74.74% $54.93 Percent of Billed Charges 68.24% $50.16 Percent of Billed Charges 65.00% $47.78 Percent of Billed Charges 67.00% $49.25 Percent of Billed Charges 77.50% $56.96 Percent of Billed Charges 79.97% $58.78 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 49.55% $36.42 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 78.94% $58.02 Percent of Billed Charges 74.00% $54.39 Percent of Billed Charges 92.50% $67.99 Percent of Billed Charges 55.00% $40.43 Percent of Billed Charges 85.00% $62.48 Percent of Billed Charges 63.00% $46.31 Percent of Billed Charges 63.00% $46.31 Percent of Billed Charges 75.00% $55.13 Percent of Billed Charges 66.24% $48.69 Percent of Billed Charges 165.81% $21.97 Fee Schedule 166.07% $22.00 Fee Schedule 176.26% $23.35 Fee Schedule 129.00% $17.09 Fee Schedule 191.24% $25.34 Fee Schedule 159.00% $116.87 Fee Schedule 145.00% $19.21 Fee Schedule 60.00% $44.10 Percent of Billed Charges HC HIV-1 DNA BY PCR QUAL ARUP 300 CPT 87535 90 Outpatient $114.50 $45.27 $182.06 $114.50 $191.20 $114.50 Fee Schedule $191.20 $114.50 Fee Schedule $305.98 $114.50 Fee Schedule 74.74% $85.58 Percent of Billed Charges 68.24% $78.13 Percent of Billed Charges 65.00% $74.43 Percent of Billed Charges 67.00% $76.72 Percent of Billed Charges 77.50% $88.74 Percent of Billed Charges 79.97% $91.57 Percent of Billed Charges 55.00% $62.98 Percent of Billed Charges 49.55% $56.73 Percent of Billed Charges 55.00% $62.98 Percent of Billed Charges 55.00% $62.98 Percent of Billed Charges 78.94% $90.39 Percent of Billed Charges 74.00% $84.73 Percent of Billed Charges 92.50% $105.91 Percent of Billed Charges 55.00% $62.98 Percent of Billed Charges 85.00% $97.33 Percent of Billed Charges 63.00% $72.14 Percent of Billed Charges 63.00% $72.14 Percent of Billed Charges 75.00% $85.88 Percent of Billed Charges 66.24% $75.84 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $182.06 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $68.70 Percent of Billed Charges HC HIV-1/2 AB DIFFERENTIATIN ARUP 300 CPT 86701 90 Outpatient $49.19 $11.47 $78.21 $49.19 $48.44 $48.44 Fee Schedule $48.44 $48.44 Fee Schedule $77.52 $49.19 Fee Schedule 74.74% $36.76 Percent of Billed Charges 68.24% $33.57 Percent of Billed Charges 65.00% $31.97 Percent of Billed Charges 67.00% $32.96 Percent of Billed Charges 77.50% $38.12 Percent of Billed Charges 79.97% $39.34 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 49.55% $24.37 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 78.94% $38.83 Percent of Billed Charges 74.00% $36.40 Percent of Billed Charges 92.50% $45.50 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 85.00% $41.81 Percent of Billed Charges 63.00% $30.99 Percent of Billed Charges 63.00% $30.99 Percent of Billed Charges 75.00% $36.89 Percent of Billed Charges 66.24% $32.58 Percent of Billed Charges 165.81% $14.74 Fee Schedule 166.07% $14.76 Fee Schedule 176.26% $15.67 Fee Schedule 129.00% $11.47 Fee Schedule 191.24% $17.00 Fee Schedule 159.00% $78.21 Fee Schedule 145.00% $12.89 Fee Schedule 60.00% $29.51 Percent of Billed Charges HC HIV-1/2 AB DIFFERENTIATIN ARUP 300 CPT 86702 90 Outpatient $49.19 $17.44 $78.21 $49.19 $73.64 $49.19 Fee Schedule $73.64 $49.19 Fee Schedule $117.89 $49.19 Fee Schedule 74.74% $36.76 Percent of Billed Charges 68.24% $33.57 Percent of Billed Charges 65.00% $31.97 Percent of Billed Charges 67.00% $32.96 Percent of Billed Charges 77.50% $38.12 Percent of Billed Charges 79.97% $39.34 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 49.55% $24.37 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 78.94% $38.83 Percent of Billed Charges 74.00% $36.40 Percent of Billed Charges 92.50% $45.50 Percent of Billed Charges 55.00% $27.05 Percent of Billed Charges 85.00% $41.81 Percent of Billed Charges 63.00% $30.99 Percent of Billed Charges 63.00% $30.99 Percent of Billed Charges 75.00% $36.89 Percent of Billed Charges 66.24% $32.58 Percent of Billed Charges 165.81% $22.42 Fee Schedule 166.07% $22.45 Fee Schedule 176.26% $23.83 Fee Schedule 129.00% $17.44 Fee Schedule 191.24% $25.86 Fee Schedule 159.00% $78.21 Fee Schedule 145.00% $19.60 Fee Schedule 60.00% $29.51 Percent of Billed Charges HC HLA AB CITY OF HOPE 300 CPT 86832 90 Outpatient $139.00 $18.51 $221.01 $139.00 $691.32 $139.00 Fee Schedule $691.32 $139.00 Fee Schedule " $2,823.10 " $139.00 Fee Schedule 74.74% $103.89 Percent of Billed Charges 68.24% $94.85 Percent of Billed Charges 65.00% $90.35 Percent of Billed Charges 67.00% $93.13 Percent of Billed Charges 77.50% $107.73 Percent of Billed Charges 79.97% $111.16 Percent of Billed Charges 55.00% $76.45 Percent of Billed Charges 49.55% $68.87 Percent of Billed Charges 55.00% $76.45 Percent of Billed Charges 55.00% $76.45 Percent of Billed Charges 78.94% $109.73 Percent of Billed Charges 74.00% $102.86 Percent of Billed Charges 92.50% $128.58 Percent of Billed Charges 55.00% $76.45 Percent of Billed Charges 85.00% $118.15 Percent of Billed Charges 63.00% $87.57 Percent of Billed Charges 63.00% $87.57 Percent of Billed Charges 75.00% $104.25 Percent of Billed Charges 66.24% $92.07 Percent of Billed Charges 165.81% $23.79 Fee Schedule 166.07% $23.83 Fee Schedule 176.26% $25.29 Fee Schedule 129.00% $18.51 Fee Schedule 191.24% $27.44 Fee Schedule 159.00% $221.01 Fee Schedule 145.00% $20.81 Fee Schedule 60.00% $83.40 Percent of Billed Charges HC HLA AB CITY OF HOPE 300 CPT 86833 90 Outpatient $197.00 $18.51 $313.23 $197.00 $628.48 $197.00 Fee Schedule $628.48 $197.00 Fee Schedule " $2,840.98 " $197.00 Fee Schedule 74.74% $147.24 Percent of Billed Charges 68.24% $134.43 Percent of Billed Charges 65.00% $128.05 Percent of Billed Charges 67.00% $131.99 Percent of Billed Charges 77.50% $152.68 Percent of Billed Charges 79.97% $157.54 Percent of Billed Charges 55.00% $108.35 Percent of Billed Charges 49.55% $97.61 Percent of Billed Charges 55.00% $108.35 Percent of Billed Charges 55.00% $108.35 Percent of Billed Charges 78.94% $155.51 Percent of Billed Charges 74.00% $145.78 Percent of Billed Charges 92.50% $182.23 Percent of Billed Charges 55.00% $108.35 Percent of Billed Charges 85.00% $167.45 Percent of Billed Charges 63.00% $124.11 Percent of Billed Charges 63.00% $124.11 Percent of Billed Charges 75.00% $147.75 Percent of Billed Charges 66.24% $130.49 Percent of Billed Charges 165.81% $23.79 Fee Schedule 166.07% $23.83 Fee Schedule 176.26% $25.29 Fee Schedule 129.00% $18.51 Fee Schedule 191.24% $27.44 Fee Schedule 159.00% $313.23 Fee Schedule 145.00% $20.81 Fee Schedule 60.00% $118.20 Percent of Billed Charges HC HLA AB STANFORD BLD CTR 86832 300 CPT 86832 90 Outpatient $629.00 $18.51 " $1,000.11 " $629.00 $691.32 $629.00 Fee Schedule $691.32 $629.00 Fee Schedule " $2,823.10 " $629.00 Fee Schedule 74.74% $470.11 Percent of Billed Charges 68.24% $429.23 Percent of Billed Charges 65.00% $408.85 Percent of Billed Charges 67.00% $421.43 Percent of Billed Charges 77.50% $487.48 Percent of Billed Charges 79.97% $503.01 Percent of Billed Charges 55.00% $345.95 Percent of Billed Charges 49.55% $311.67 Percent of Billed Charges 55.00% $345.95 Percent of Billed Charges 55.00% $345.95 Percent of Billed Charges 78.94% $496.53 Percent of Billed Charges 74.00% $465.46 Percent of Billed Charges 92.50% $581.83 Percent of Billed Charges 55.00% $345.95 Percent of Billed Charges 85.00% $534.65 Percent of Billed Charges 63.00% $396.27 Percent of Billed Charges 63.00% $396.27 Percent of Billed Charges 75.00% $471.75 Percent of Billed Charges 66.24% $416.65 Percent of Billed Charges 165.81% $23.79 Fee Schedule 166.07% $23.83 Fee Schedule 176.26% $25.29 Fee Schedule 129.00% $18.51 Fee Schedule 191.24% $27.44 Fee Schedule 159.00% " $1,000.11 " Fee Schedule 145.00% $20.81 Fee Schedule 60.00% $377.40 Percent of Billed Charges HC HLA AB STANFORD BLD CTR 86833 300 CPT 86833 90 Outpatient $514.00 $18.51 $817.26 $514.00 $628.48 $514.00 Fee Schedule $628.48 $514.00 Fee Schedule " $2,840.98 " $514.00 Fee Schedule 74.74% $384.16 Percent of Billed Charges 68.24% $350.75 Percent of Billed Charges 65.00% $334.10 Percent of Billed Charges 67.00% $344.38 Percent of Billed Charges 77.50% $398.35 Percent of Billed Charges 79.97% $411.05 Percent of Billed Charges 55.00% $282.70 Percent of Billed Charges 49.55% $254.69 Percent of Billed Charges 55.00% $282.70 Percent of Billed Charges 55.00% $282.70 Percent of Billed Charges 78.94% $405.75 Percent of Billed Charges 74.00% $380.36 Percent of Billed Charges 92.50% $475.45 Percent of Billed Charges 55.00% $282.70 Percent of Billed Charges 85.00% $436.90 Percent of Billed Charges 63.00% $323.82 Percent of Billed Charges 63.00% $323.82 Percent of Billed Charges 75.00% $385.50 Percent of Billed Charges 66.24% $340.47 Percent of Billed Charges 165.81% $23.79 Fee Schedule 166.07% $23.83 Fee Schedule 176.26% $25.29 Fee Schedule 129.00% $18.51 Fee Schedule 191.24% $27.44 Fee Schedule 159.00% $817.26 Fee Schedule 145.00% $20.81 Fee Schedule 60.00% $308.40 Percent of Billed Charges HC HLA AB STANFORD BLD CTR 99001 300 CPT 99001 90 Outpatient $138.00 $- $219.42 $138.00 $27.20 $27.20 Fee Schedule $27.20 $27.20 Fee Schedule 56.78% $78.36 Percent of Billed Charges 74.74% $103.14 Percent of Billed Charges 68.24% $94.17 Percent of Billed Charges 65.00% $89.70 Percent of Billed Charges 67.00% $92.46 Percent of Billed Charges 77.50% $106.95 Percent of Billed Charges 79.97% $110.36 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 49.55% $68.38 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 78.94% $108.94 Percent of Billed Charges 74.00% $102.12 Percent of Billed Charges 92.50% $127.65 Percent of Billed Charges 55.00% $75.90 Percent of Billed Charges 85.00% $117.30 Percent of Billed Charges 63.00% $86.94 Percent of Billed Charges 63.00% $86.94 Percent of Billed Charges 75.00% $103.50 Percent of Billed Charges 66.24% $91.41 Percent of Billed Charges 35.00% $48.30 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% $219.42 Fee Schedule 145.00% $- Fee Schedule 60.00% $82.80 Percent of Billed Charges HC HLA B27 LABCORP 300 CPT 81374 90 Outpatient $30.00 $14.87 $142.15 $30.00 $396.40 $30.00 Fee Schedule $396.40 $30.00 Fee Schedule $648.16 $30.00 Fee Schedule 74.74% $22.42 Percent of Billed Charges 68.24% $20.47 Percent of Billed Charges 65.00% $19.50 Percent of Billed Charges 67.00% $20.10 Percent of Billed Charges 77.50% $23.25 Percent of Billed Charges 79.97% $23.99 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 49.55% $14.87 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 78.94% $23.68 Percent of Billed Charges 74.00% $22.20 Percent of Billed Charges 92.50% $27.75 Percent of Billed Charges 55.00% $16.50 Percent of Billed Charges 85.00% $25.50 Percent of Billed Charges 63.00% $18.90 Percent of Billed Charges 63.00% $18.90 Percent of Billed Charges 75.00% $22.50 Percent of Billed Charges 66.24% $19.87 Percent of Billed Charges 165.81% $30.00 Fee Schedule 166.07% $123.44 Fee Schedule 176.26% $131.01 Fee Schedule 129.00% $95.89 Fee Schedule 191.24% $142.15 Fee Schedule 159.00% $47.70 Fee Schedule 145.00% $107.78 Fee Schedule 60.00% $18.00 Percent of Billed Charges HC HLA B51 DNA TYPING WISCONSIN 300 CPT 81374 90 Outpatient $212.00 $95.89 $337.08 $212.00 $396.40 $212.00 Fee Schedule $396.40 $212.00 Fee Schedule $648.16 $193.00 Fee Schedule 74.74% $158.45 Percent of Billed Charges 68.24% $144.67 Percent of Billed Charges 65.00% $137.80 Percent of Billed Charges 67.00% $142.04 Percent of Billed Charges 77.50% $164.30 Percent of Billed Charges 79.97% $169.54 Percent of Billed Charges 55.00% $116.60 Percent of Billed Charges 49.55% $105.05 Percent of Billed Charges 55.00% $116.60 Percent of Billed Charges 55.00% $116.60 Percent of Billed Charges 78.94% $167.35 Percent of Billed Charges 74.00% $156.88 Percent of Billed Charges 92.50% $196.10 Percent of Billed Charges 55.00% $116.60 Percent of Billed Charges 85.00% $180.20 Percent of Billed Charges 63.00% $133.56 Percent of Billed Charges 63.00% $133.56 Percent of Billed Charges 75.00% $159.00 Percent of Billed Charges 66.24% $140.43 Percent of Billed Charges 165.81% $123.25 Fee Schedule 166.07% $123.44 Fee Schedule 176.26% $131.01 Fee Schedule 129.00% $95.89 Fee Schedule 191.24% $142.15 Fee Schedule 159.00% $337.08 Fee Schedule 145.00% $107.78 Fee Schedule 60.00% $127.20 Percent of Billed Charges HC HLA PANEL CINCINNATI CHIL MOPATH PROCEDURE LEVEL 5 300 CPT 81404 90 Outpatient " $1,992.00 " $- " $3,167.28 " " $1,992.00 " " $1,099.32 " " $1,099.32 " Fee Schedule " $1,099.32 " " $1,099.32 " Fee Schedule " $2,396.52 " " $1,992.00 " Fee Schedule 74.74% " $1,488.82 " Percent of Billed Charges 68.24% " $1,359.34 " Percent of Billed Charges 65.00% " $1,294.80 " Percent of Billed Charges 67.00% " $1,334.64 " Percent of Billed Charges 77.50% " $1,543.80 " Percent of Billed Charges 79.97% " $1,593.00 " Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 49.55% $987.04 Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 78.94% " $1,572.48 " Percent of Billed Charges 74.00% " $1,474.08 " Percent of Billed Charges 92.50% " $1,842.60 " Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 85.00% " $1,693.20 " Percent of Billed Charges 63.00% " $1,254.96 " Percent of Billed Charges 63.00% " $1,254.96 " Percent of Billed Charges 75.00% " $1,494.00 " Percent of Billed Charges 66.24% " $1,319.50 " Percent of Billed Charges 35.00% $697.20 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $3,167.28 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $1,195.20 " Percent of Billed Charges HC HLA PANEL CINCINNATI CHIL UNLISTED MOLECULAR PATHOLOGY 300 CPT 81479 90 Outpatient " $1,992.00 " $- " $3,167.28 " " $1,992.00 " 50.00% $996.00 Percent of Billed Charges 50.00% $996.00 Percent of Billed Charges 56.78% " $1,131.06 " Percent of Billed Charges 74.74% " $1,488.82 " Percent of Billed Charges 68.24% " $1,359.34 " Percent of Billed Charges 65.00% " $1,294.80 " Percent of Billed Charges 67.00% " $1,334.64 " Percent of Billed Charges 77.50% " $1,543.80 " Percent of Billed Charges 79.97% " $1,593.00 " Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 49.55% $987.04 Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 78.94% " $1,572.48 " Percent of Billed Charges 74.00% " $1,474.08 " Percent of Billed Charges 92.50% " $1,842.60 " Percent of Billed Charges 55.00% " $1,095.60 " Percent of Billed Charges 85.00% " $1,693.20 " Percent of Billed Charges 63.00% " $1,254.96 " Percent of Billed Charges 63.00% " $1,254.96 " Percent of Billed Charges 75.00% " $1,494.00 " Percent of Billed Charges 66.24% " $1,319.50 " Percent of Billed Charges 35.00% $697.20 Percent of Billed Charges 166.07% $- Fee Schedule 176.26% $- Fee Schedule 129.00% $- Fee Schedule 191.24% $- Fee Schedule 159.00% " $3,167.28 " Fee Schedule 145.00% $- Fee Schedule 60.00% " $1,195.20 " Percent of Billed Charges HC HOMOCYSTEINE LABCORP 300 CPT 83090 90 Outpatient $8.00 $3.96 $34.27 $8.00 $91.92 $8.00 Fee Schedule $91.92 $8.00 Fee Schedule $156.26 $8.00 Fee Schedule 74.74% $5.98 Percent of Billed Charges 68.24% $5.46 Percent of Billed Charges 65.00% $5.20 Percent of Billed Charges 67.00% $5.36 Percent of Billed Charges 77.50% $6.20 Percent of Billed Charges 79.97% $6.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 49.55% $3.96 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 78.94% $6.32 Percent of Billed Charges 74.00% $5.92 Percent of Billed Charges 92.50% $7.40 Percent of Billed Charges 55.00% $4.40 Percent of Billed Charges 85.00% $6.80 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 63.00% $5.04 Percent of Billed Charges 75.00% $6.00 Percent of Billed Charges 66.24% $5.30 Percent of Billed Charges 165.81% $8.00 Fee Schedule 166.07% $29.76 Fee Schedule 176.26% $31.59 Fee Schedule 129.00% $23.12 Fee Schedule 191.24% $34.27 Fee Schedule 159.00% $12.72 Fee Schedule 145.00% $25.98 Fee Schedule 60.00% $4.80 Percent of Billed Charges HC HOMOCYSTEINE STANFORD 300 CPT 83090 90 Outpatient $74.00 $23.12 $117.66 $74.00 $91.92 $74.00 Fee Schedule $91.92 $74.00 Fee Schedule $156.26 $74.00 Fee Schedule 74.74% $55.31 Percent of Billed Charges 68.24% $50.50 Percent of Billed Charges 65.00% $48.10 Percent of Billed Charges 67.00% $49.58 Percent of Billed Charges 77.50% $57.35 Percent of Billed Charges 79.97% $59.18 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 49.55% $36.67 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 78.94% $58.42 Percent of Billed Charges 74.00% $54.76 Percent of Billed Charges 92.50% $68.45 Percent of Billed Charges 55.00% $40.70 Percent of Billed Charges 85.00% $62.90 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 63.00% $46.62 Percent of Billed Charges 75.00% $55.50 Percent of Billed Charges 66.24% $49.02 Percent of Billed Charges 165.81% $29.71 Fee Schedule 166.07% $29.76 Fee Schedule 176.26% $31.59 Fee Schedule 129.00% $23.12 Fee Schedule 191.24% $34.27 Fee Schedule 159.00% $117.66 Fee Schedule 145.00% $25.98 Fee Schedule 60.00% $44.40 Percent of Billed Charges "HC HOMOCYSTEINE,TOTAL ARUP" 300 CPT 83090 90 Outpatient $20.48 $10.15 $34.27 $20.48 $91.92 $20.48 Fee Schedule $91.92 $20.48 Fee Schedule $156.26 $20.48 Fee Schedule 74.74% $15.31 Percent of Billed Charges 68.24% $13.98 Percent of Billed Charges 65.00% $13.31 Percent of Billed Charges 67.00% $13.72 Percent of Billed Charges 77.50% $15.87 Percent of Billed Charges 79.97% $16.38 Percent of Billed Charges 55.00% $11.26 Percent of Billed Charges 49.55% $10.15 Percent of Billed Charges 55.00% $11.26 Percent of Billed Charges 55.00% $11.26 Percent of Billed Charges 78.94% $16.17 Percent of Billed Charges 74.00% $15.16 Percent of Billed Charges 92.50% $18.94 Percent of Billed Charges 55.00% $11.26 Percent of Billed Charges 85.00% $17.41 Percent of Billed Charges 63.00% $12.90 Percent of Billed Charges 63.00% $12.90 Percent of Billed Charges 75.00% $15.36 Percent of Billed Charges 66.24% $13.57 Percent of Billed Charges 165.81% $20.48 Fee Schedule 166.07% $29.76 Fee Schedule 176.26% $31.59 Fee Schedule 129.00% $23.12 Fee Schedule 191.24% $34.27 Fee Schedule 159.00% $32.56 Fee Schedule 145.00% $25.98 Fee Schedule 60.00% $12.29 Percent of Billed Charges HC HSV 1 IGG LABCORP 300 CPT 86695 90 Outpatient $3.50 $1.73 $25.22 $3.50 $71.88 $3.50 Fee Schedule $71.88 $3.50 Fee Schedule $115.02 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC HSV 2 IGG LABCORP 300 CPT 86696 90 Outpatient $3.50 $1.73 $37.00 $3.50 $105.48 $3.50 Fee Schedule $105.48 $3.50 Fee Schedule $168.73 $3.50 Fee Schedule 74.74% $2.62 Percent of Billed Charges 68.24% $2.39 Percent of Billed Charges 65.00% $2.28 Percent of Billed Charges 67.00% $2.35 Percent of Billed Charges 77.50% $2.71 Percent of Billed Charges 79.97% $2.80 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 49.55% $1.73 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 78.94% $2.76 Percent of Billed Charges 74.00% $2.59 Percent of Billed Charges 92.50% $3.24 Percent of Billed Charges 55.00% $1.93 Percent of Billed Charges 85.00% $2.98 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 63.00% $2.21 Percent of Billed Charges 75.00% $2.63 Percent of Billed Charges 66.24% $2.32 Percent of Billed Charges 165.81% $3.50 Fee Schedule 166.07% $32.13 Fee Schedule 176.26% $34.11 Fee Schedule 129.00% $24.96 Fee Schedule 191.24% $37.00 Fee Schedule 159.00% $5.57 Fee Schedule 145.00% $28.06 Fee Schedule 60.00% $2.10 Percent of Billed Charges HC HSV CSF BY PCR 300 CPT 87529 Outpatient $533.00 $45.27 $847.47 $533.00 $191.20 $191.20 Fee Schedule $191.20 $191.20 Fee Schedule $305.98 $290.19 Fee Schedule 74.74% $398.36 Percent of Billed Charges 68.24% $363.72 Percent of Billed Charges 65.00% $346.45 Percent of Billed Charges 67.00% $357.11 Percent of Billed Charges 77.50% $413.08 Percent of Billed Charges 79.97% $426.24 Percent of Billed Charges 55.00% $293.15 Percent of Billed Charges 49.55% $264.10 Percent of Billed Charges 55.00% $293.15 Percent of Billed Charges 55.00% $293.15 Percent of Billed Charges 78.94% $420.75 Percent of Billed Charges 74.00% $394.42 Percent of Billed Charges 92.50% $493.03 Percent of Billed Charges 55.00% $293.15 Percent of Billed Charges 85.00% $453.05 Percent of Billed Charges 63.00% $335.79 Percent of Billed Charges 63.00% $335.79 Percent of Billed Charges 75.00% $399.75 Percent of Billed Charges 66.24% $353.06 Percent of Billed Charges 165.81% $58.18 Fee Schedule 166.07% $58.27 Fee Schedule 176.26% $61.85 Fee Schedule 129.00% $45.27 Fee Schedule 191.24% $67.11 Fee Schedule 159.00% $847.47 Fee Schedule 145.00% $50.88 Fee Schedule 60.00% $319.80 Percent of Billed Charges HC HSV-1 IGM LABCORP 300 CPT 86695 90 Outpatient $17.00 $8.42 $27.03 $17.00 $71.88 $17.00 Fee Schedule $71.88 $17.00 Fee Schedule $115.02 $17.00 Fee Schedule 74.74% $12.71 Percent of Billed Charges 68.24% $11.60 Percent of Billed Charges 65.00% $11.05 Percent of Billed Charges 67.00% $11.39 Percent of Billed Charges 77.50% $13.18 Percent of Billed Charges 79.97% $13.59 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 49.55% $8.42 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 78.94% $13.42 Percent of Billed Charges 74.00% $12.58 Percent of Billed Charges 92.50% $15.73 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 85.00% $14.45 Percent of Billed Charges 63.00% $10.71 Percent of Billed Charges 63.00% $10.71 Percent of Billed Charges 75.00% $12.75 Percent of Billed Charges 66.24% $11.26 Percent of Billed Charges 165.81% $17.00 Fee Schedule 166.07% $21.90 Fee Schedule 176.26% $23.25 Fee Schedule 129.00% $17.02 Fee Schedule 191.24% $25.22 Fee Schedule 159.00% $27.03 Fee Schedule 145.00% $19.13 Fee Schedule 60.00% $10.20 Percent of Billed Charges HC HSV-2 IGM LABCORP 300 CPT 86696 90 Outpatient $17.00 $8.42 $37.00 $17.00 $105.48 $17.00 Fee Schedule $105.48 $17.00 Fee Schedule $168.73 $17.00 Fee Schedule 74.74% $12.71 Percent of Billed Charges 68.24% $11.60 Percent of Billed Charges 65.00% $11.05 Percent of Billed Charges 67.00% $11.39 Percent of Billed Charges 77.50% $13.18 Percent of Billed Charges 79.97% $13.59 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 49.55% $8.42 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 78.94% $13.42 Percent of Billed Charges 74.00% $12.58 Percent of Billed Charges 92.50% $15.73 Percent of Billed Charges 55.00% $9.35 Percent of Billed Charges 85.00% $14.45 Percent of Billed Charges 63.00% $10.71 Percent of Billed Charges 63.00% $10.71 Percent of Billed Charges 75.00% $12.75 Percent of Billed Charges 66.24% $11.26 Percent of Billed Charges 165.81% $17.00 Fee Schedule 166.07% $32.13 Fee Schedule 176.26% $34.11 Fee Schedule 129.00% $24.96 Fee Schedule 191.24% $37.00 Fee Schedule 159.00% $27.03 Fee Schedule 145.00% $28.06 Fee Schedule 60.00% $10.20 Percent of Billed Charges "HC HTLV I/II ANTIBODIES,EIA ARUP" 300 CPT 86790 90 Outpatient $12.35 $6.12 $24.63 $12.35 $70.20 $12.35 Fee Schedule $70.20 $12.35 Fee Schedule $112.31 $12.35 Fee Schedule 74.74% $9.23 Percent of Billed Charges 68.24% $8.43 Percent of Billed Charges 65.00% $8.03 Percent of Billed Charges 67.00% $8.27 Percent of Billed Charges 77.50% $9.57 Percent of Billed Charges 79.97% $9.88 Percent of Billed Charges 55.00% $6.79 Percent of Billed Charges 49.55% $6.12 Percent of Billed Charges 55.00% $6.79 Percent of Billed Charges 55.00% $6.79 Percent of Billed Charges 78.94% $9.75 Percent of Billed Charges 74.00% $9.14 Percent of Billed Charges 92.50% $11.42 Percent of Billed Charges 55.00% $6.79 Percent of Billed Charges 85.00% $10.50 Percent of Billed Charges 63.00% $7.78 Percent of Billed Charges 63.00% $7.78 Percent of Billed Charges 75.00% $9.26 Percent of Billed Charges 66.24% $8.18 Percent of Billed Charges 165.81% $12.35 Fee Schedule 166.07% $21.39 Fee Schedule 176.26% $22.70 Fee Schedule 129.00% $16.62 Fee Schedule 191.24% $24.63 Fee Schedule 159.00% $19.64 Fee Schedule 145.00% $18.68 Fee Schedule 60.00% $7.41 Percent of Billed Charges HC HYDROXYCHLOROQUINE 300 CPT 80299 90 Outpatient $153.00 $24.05 $243.27 $153.00 $74.64 $74.64 Fee Schedule $74.64 $74.64 Fee Schedule $162.54 $153.00 Fee Schedule 74.74% $114.35 Percent of Billed Charges 68.24% $104.41 Percent of Billed Charges 65.00% $99.45 Percent of Billed Charges 67.00% $102.51 Percent of Billed Charges 77.50% $118.58 Percent of Billed Charges 79.97% $122.35 Percent of Billed Charges 55.00% $84.15 Percent of Billed Charges 49.55% $75.81 Percent of Billed Charges 55.00% $84.15 Percent of Billed Charges 55.00% $84.15 Percent of Billed Charges 78.94% $120.78 Percent of Billed Charges 74.00% $113.22 Percent of Billed Charges 92.50% $141.53 Percent of Billed Charges 55.00% $84.15 Percent of Billed Charges 85.00% $130.05 Percent of Billed Charges 63.00% $96.39 Percent of Billed Charges 63.00% $96.39 Percent of Billed Charges 75.00% $114.75 Percent of Billed Charges 66.24% $101.35 Percent of Billed Charges 165.81% $30.91 Fee Schedule 166.07% $30.96 Fee Schedule 176.26% $32.85 Fee Schedule 129.00% $24.05 Fee Schedule 191.24% $35.65 Fee Schedule 159.00% $243.27 Fee Schedule 145.00% $27.03 Fee Schedule 60.00% $91.80 Percent of Billed Charges HC HYDROXYLASE AB LABCORP 300 CPT 83519 90 Outpatient $53.75 $23.74 $85.46 $53.75 $73.60 $53.75 Fee Schedule $73.60 $53.75 Fee Schedule $160.45 $53.75 Fee Schedule 74.74% $40.17 Percent of Billed Charges 68.24% $36.68 Percent of Billed Charges 65.00% $34.94 Percent of Billed Charges 67.00% $36.01 Percent of Billed Charges 77.50% $41.66 Percent of Billed Charges 79.97% $42.98 Percent of Billed Charges 55.00% $29.56 Percent of Billed Charges 49.55% $26.63 Percent of Billed Charges 55.00% $29.56 Percent of Billed Charges 55.00% $29.56 Percent of Billed Charges 78.94% $42.43 Percent of Billed Charges 74.00% $39.78 Percent of Billed Charges 92.50% $49.72 Percent of Billed Charges 55.00% $29.56 Percent of Billed Charges 85.00% $45.69 Percent of Billed Charges 63.00% $33.86 Percent of Billed Charges 63.00% $33.86 Percent of Billed Charges 75.00% $40.31 Percent of Billed Charges 66.24% $35.60 Percent of Billed Charges 165.81% $30.51 Fee Schedule 166.07% $30.56 Fee Schedule 176.26% $32.43 Fee Schedule 129.00% $23.74 Fee Schedule 191.24% $35.19 Fee Schedule 159.00% $85.46 Fee Schedule 145.00% $26.68 Fee Schedule 60.00% $32.25 Percent of Billed Charges HC HYPERSENS PNEUMONITIS QUEST 300 CPT 86001 90 Outpatient $180.46 $10.09 $286.93 $180.46 $28.44 $28.44 Fee Schedule $28.44 $28.44 Fee Schedule $68.19 $64.67 Fee Schedule 74.74% $134.88 Percent of Billed Charges 68.24% $123.15 Percent of Billed Charges 65.00% $117.30 Percent of Billed Charges 67.00% $120.91 Percent of Billed Charges 77.50% $139.86 Percent of Billed Charges 79.97% $144.31 Percent of Billed Charges 55.00% $99.25 Percent of Billed Charges 49.55% $89.42 Percent of Billed Charges 55.00% $99.25 Percent of Billed Charges 55.00% $99.25 Percent of Billed Charges 78.94% $142.46 Percent of Billed Charges 74.00% $133.54 Percent of Billed Charges 92.50% $166.93 Percent of Billed Charges 55.00% $99.25 Percent of Billed Charges 85.00% $153.39 Percent of Billed Charges 63.00% $113.69 Percent of Billed Charges 63.00% $113.69 Percent of Billed Charges 75.00% $135.35 Percent of Billed Charges 66.24% $119.54 Percent of Billed Charges 165.81% $12.97 Fee Schedule 166.07% $12.99 Fee Schedule 176.26% $13.78 Fee Schedule 129.00% $10.09 Fee Schedule 191.24% $14.95 Fee Schedule 159.00% $286.93 Fee Schedule 145.00% $11.34 Fee Schedule 60.00% $108.28 Percent of Billed Charges HC HYPERSENS PNEUMONITIS QUEST 300 CPT 86606 90 Outpatient $63.00 $19.41 $100.17 $63.00 $82.04 $63.00 Fee Schedule $82.04 $63.00 Fee Schedule $131.24 $63.00 Fee Schedule 74.74% $47.09 Percent of Billed Charges 68.24% $42.99 Percent of Billed Charges 65.00% $40.95 Percent of Billed Charges 67.00% $42.21 Percent of Billed Charges 77.50% $48.83 Percent of Billed Charges 79.97% $50.38 Percent of Billed Charges 55.00% $34.65 Percent of Billed Charges 49.55% $31.22 Percent of Billed Charges 55.00% $34.65 Percent of Billed Charges 55.00% $34.65 Percent of Billed Charges 78.94% $49.73 Percent of Billed Charges 74.00% $46.62 Percent of Billed Charges 92.50% $58.28 Percent of Billed Charges 55.00% $34.65 Percent of Billed Charges 85.00% $53.55 Percent of Billed Charges 63.00