Jacqueline Evans
Andrew Frick
2020-12-31T19:18:25Z
2021-01-14T21:56:34Z
LMH
16.00
11835
28800
0
0
False
False
Shoppable Services at Licking Memorial Hospital |
Gross Charge |
Billing Code |
De-identified minimum negotiated charge |
De-identified maximum negotiated charge |
Aetna |
Anthem |
Anthem HIX - PPO |
Anthem HIX - HMO |
Central Benefits |
Cigna |
First Health Network (Coventry) |
Great West Healthcare (inc with Cigna) |
HealthSmart (inc DCA, Emerald, PHS) |
Humana ChoiceCare |
LM Direct |
LM Select |
Medical Benefits |
Medical Mutual of Ohio |
MultiPlan (Network Logo) |
Ohio Health Choice |
Ohio Health Group |
Ohio Preferred Network |
OSU Managed Care Systems |
Prudential |
Quality Care Partners (Ohio PPO) |
United Healthcare (Commercial) |
Aetna (Denison/Owens Corning) |
MedMutual Marketplace |
TriWest (Veterans Choice Program) |
VA CCN (VA Overflow - Optum) |
Aetna Medicare |
Anthem Senior Advantage |
Humana Gold Choice |
Humana Medicare PPO |
Humana Medicare HMO |
Medical Mutual Medicare Advantage |
Medigold |
Valor (Medicare D-SNP for SNF) |
Humana Military Tricare East |
Molina Marketplace |
Buckeye Health Plan |
Caresource |
Molina |
Paramount Advantage |
UHC Community Plan (Medicaid) |
Cenpatico (Buckeye Behavioral Health) Applicable to only Behavioral Health Services |
Psychotherapy, 30 min |
172 |
90832 |
77.400000000000006 |
206.24 |
154.80000000000001 |
138.46 |
114.896 |
110.596 |
168.56 |
154.80000000000001 |
166.84 |
154.80000000000001 |
163.4 |
166.84 |
123.83999999999999 |
120.39999999999999 |
168.56 |
151.36000000000001 |
166.84 |
165.12 |
154.80000000000001 |
168.56 |
154.80000000000001 |
158.24 |
154.80000000000001 |
146.19999999999999 |
146.19999999999999 |
77.400000000000006 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
126.322 |
206.24 |
186.08100000000002 |
182.53659999999999 |
182.53659999999999 |
186.08100000000002 |
184.30880000000002 |
186.08100000000002 |
Psychotherapy, 45 min |
184 |
90834 |
82.8 |
281.03249999999997 |
165.6 |
148.12 |
122.91200000000001 |
118.312 |
180.32 |
165.6 |
178.48 |
165.6 |
174.79999999999998 |
178.48 |
132.47999999999999 |
128.79999999999998 |
180.32 |
161.91999999999999 |
178.48 |
176.64 |
165.6 |
180.32 |
165.6 |
169.28 |
165.6 |
156.4 |
156.4 |
82.8 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
126.322 |
206.24 |
281.03249999999997 |
275.67949999999996 |
275.67949999999996 |
281.03249999999997 |
278.35599999999999 |
281.03249999999997 |
Psychotherapy, 60 min |
197 |
90837 |
88.65 |
281.03249999999997 |
177.3 |
158.58500000000001 |
131.596 |
126.67100000000001 |
193.06 |
177.3 |
191.09 |
177.3 |
187.14999999999998 |
191.09 |
141.84 |
137.89999999999998 |
193.06 |
173.36 |
191.09 |
189.12 |
177.3 |
193.06 |
177.3 |
181.24 |
177.3 |
167.45 |
167.45 |
88.65 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
126.322 |
206.24 |
281.03249999999997 |
275.67949999999996 |
275.67949999999996 |
281.03249999999997 |
278.35599999999999 |
281.03249999999997 |
Family psychotherapy, not including patient, 50 min |
N/A |
90846 |
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Family psychotherapy, including patient, 50 min |
212 |
90847 |
95.4 |
368.47650000000004 |
190.8 |
170.66 |
141.61600000000001 |
136.316 |
207.76 |
190.8 |
205.64 |
190.8 |
201.39999999999998 |
205.64 |
152.63999999999999 |
148.39999999999998 |
207.76 |
186.56 |
205.64 |
203.51999999999998 |
190.8 |
207.76 |
190.8 |
195.04000000000002 |
190.8 |
180.2 |
180.2 |
95.4 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
128.9 |
126.322 |
206.24 |
368.47650000000004 |
361.4579 |
361.4579 |
368.47650000000004 |
364.96719999999999 |
368.47650000000004 |
Group psychotherapy |
245 |
90853 |
70.775599999999997 |
240.1 |
220.5 |
197.22500000000002 |
163.66 |
157.535 |
240.1 |
220.5 |
237.65 |
220.5 |
232.75 |
237.65 |
176.4 |
171.5 |
240.1 |
215.6 |
237.65 |
235.2 |
220.5 |
240.1 |
220.5 |
225.4 |
220.5 |
208.25 |
208.25 |
110.25 |
72.22 |
72.22 |
72.22 |
72.22 |
72.22 |
72.22 |
72.22 |
72.22 |
72.22 |
72.22 |
70.775599999999997 |
115.55200000000001 |
179.80200000000002 |
176.37720000000002 |
176.37720000000002 |
179.80200000000002 |
178.08960000000002 |
179.80200000000002 |
New patient office or other outpatient visit, typically 30 min |
N/A |
99203 |
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New patient office of other outpatient visit, typically 45 min |
N/A |
99204 |
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New patient office of other outpatient visit, typically 60 min |
N/A |
99205 |
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Patient office consultation, typically 40 min |
N/A |
99243 |
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Patient office consultation, typically 60 min |
N/A |
99244 |
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Initial new patient preventive medicine evaluation (18-39 years) |
N/A |
99385 |
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Initial new patient preventive medicine evaluation (40-64 years) |
N/A |
99386 |
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Lab test: Basic metabolic panel |
193.05 |
80048 |
8.2908000000000008 |
189.18900000000002 |
173.745 |
155.40525000000002 |
128.95740000000001 |
124.13115000000001 |
189.18900000000002 |
173.745 |
187.2585 |
173.745 |
183.39750000000001 |
187.2585 |
138.99600000000001 |
135.13499999999999 |
189.18900000000002 |
169.88400000000001 |
187.2585 |
185.328 |
173.745 |
189.18900000000002 |
173.745 |
177.60600000000002 |
173.745 |
164.0925 |
164.0925 |
86.872500000000002 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.4600000000000009 |
8.2908000000000008 |
13.536000000000001 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Blood test, comprehensive group of blood chemicals |
269.39999999999998 |
80053 |
10.348800000000001 |
264.012 |
242.45999999999998 |
216.86699999999999 |
179.95919999999998 |
173.2242 |
264.012 |
242.45999999999998 |
261.31799999999998 |
242.45999999999998 |
255.92999999999998 |
261.31799999999998 |
193.96799999999999 |
188.57999999999998 |
264.012 |
237.07199999999997 |
261.31799999999998 |
258.62399999999997 |
242.45999999999998 |
264.012 |
242.45999999999998 |
247.84799999999998 |
242.45999999999998 |
228.98999999999998 |
228.98999999999998 |
121.22999999999999 |
10.56 |
10.56 |
10.56 |
10.56 |
10.56 |
10.56 |
10.56 |
10.56 |
10.56 |
10.56 |
10.348800000000001 |
16.896000000000001 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Obstetric blood test panel |
385.7 |
80055 |
46.8538 |
377.98599999999999 |
347.13 |
310.48849999999999 |
257.64760000000001 |
248.0051 |
377.98599999999999 |
347.13 |
374.12899999999996 |
347.13 |
366.41499999999996 |
374.12899999999996 |
277.70400000000001 |
269.98999999999995 |
377.98599999999999 |
339.416 |
374.12899999999996 |
370.27199999999999 |
347.13 |
377.98599999999999 |
347.13 |
354.84399999999999 |
347.13 |
327.84499999999997 |
327.84499999999997 |
173.565 |
47.81 |
47.81 |
47.81 |
47.81 |
47.81 |
47.81 |
47.81 |
47.81 |
47.81 |
47.81 |
46.8538 |
76.496000000000009 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Blood test, lipids (cholesterol and triglycerides) |
187.25 |
80061 |
13.122200000000001 |
183.505 |
168.52500000000001 |
150.73625000000001 |
125.08300000000001 |
120.40175000000001 |
183.505 |
168.52500000000001 |
181.63249999999999 |
168.52500000000001 |
177.88749999999999 |
181.63249999999999 |
134.82 |
131.07499999999999 |
183.505 |
164.78 |
181.63249999999999 |
179.76 |
168.52500000000001 |
183.505 |
168.52500000000001 |
172.27 |
168.52500000000001 |
159.16249999999999 |
159.16249999999999 |
84.262500000000003 |
13.39 |
13.39 |
13.39 |
13.39 |
13.39 |
13.39 |
13.39 |
13.39 |
13.39 |
13.39 |
13.122200000000001 |
21.424000000000003 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Kidney function panel test |
173.1 |
80069 |
8.5161999999999995 |
169.63800000000001 |
155.79 |
139.34550000000002 |
115.63080000000001 |
111.30329999999999 |
169.63800000000001 |
155.79 |
167.90699999999998 |
155.79 |
164.44499999999999 |
167.90699999999998 |
124.63199999999999 |
121.16999999999999 |
169.63800000000001 |
152.328 |
167.90699999999998 |
166.17599999999999 |
155.79 |
169.63800000000001 |
155.79 |
159.25200000000001 |
155.79 |
147.13499999999999 |
147.13499999999999 |
77.894999999999996 |
8.69 |
8.69 |
8.69 |
8.69 |
8.69 |
8.69 |
8.69 |
8.69 |
8.69 |
8.69 |
8.5161999999999995 |
13.904 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Liver function blood test panel |
257.5 |
80076 |
8.0066000000000006 |
252.35 |
231.75 |
207.28750000000002 |
172.01000000000002 |
165.57249999999999 |
252.35 |
231.75 |
249.77500000000001 |
231.75 |
244.625 |
249.77500000000001 |
185.4 |
180.25 |
252.35 |
226.6 |
249.77500000000001 |
247.2 |
231.75 |
252.35 |
231.75 |
236.9 |
231.75 |
218.875 |
218.875 |
115.875 |
8.17 |
8.17 |
8.17 |
8.17 |
8.17 |
8.17 |
8.17 |
8.17 |
8.17 |
8.17 |
8.0066000000000006 |
13.072000000000001 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Manual urinalysis test with examination using microscope |
102.9 |
81000 or 81001 |
3.9395999999999995 |
100.842 |
92.610000000000014 |
82.834500000000006 |
68.737200000000001 |
66.164700000000011 |
100.842 |
92.610000000000014 |
99.813000000000002 |
92.610000000000014 |
97.754999999999995 |
99.813000000000002 |
74.088000000000008 |
72.03 |
100.842 |
90.552000000000007 |
99.813000000000002 |
98.784000000000006 |
92.610000000000014 |
100.842 |
92.610000000000014 |
94.668000000000006 |
92.610000000000014 |
87.465000000000003 |
87.465000000000003 |
46.305000000000007 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
4.0199999999999996 |
3.9395999999999995 |
6.4319999999999995 |
16.768500000000003 |
16.449100000000001 |
16.449100000000001 |
16.768500000000003 |
16.608800000000002 |
|
Automated urinalysis test |
81.95 |
81002 or 81003 |
2.2050000000000001 |
80.311000000000007 |
73.75500000000001 |
65.969750000000005 |
54.742600000000003 |
52.693850000000005 |
80.311000000000007 |
73.75500000000001 |
79.491500000000002 |
73.75500000000001 |
77.852499999999992 |
79.491500000000002 |
59.003999999999998 |
57.364999999999995 |
80.311000000000007 |
72.116 |
79.491500000000002 |
78.671999999999997 |
73.75500000000001 |
80.311000000000007 |
73.75500000000001 |
75.394000000000005 |
73.75500000000001 |
69.657499999999999 |
69.657499999999999 |
36.877500000000005 |
2.25 |
2.25 |
2.25 |
2.25 |
2.25 |
2.25 |
2.25 |
2.25 |
2.25 |
2.25 |
2.2050000000000001 |
3.6 |
16.768500000000003 |
16.449100000000001 |
16.449100000000001 |
16.768500000000003 |
16.608800000000002 |
|
PSA (prostate specific antigen) |
535.95000000000005 |
84153-84154 |
18.022200000000002 |
525.23099999999999 |
482.35500000000008 |
431.43975000000006 |
358.01460000000003 |
344.61585000000002 |
525.23099999999999 |
482.35500000000008 |
519.87150000000008 |
482.35500000000008 |
509.15250000000003 |
519.87150000000008 |
385.88400000000001 |
375.16500000000002 |
525.23099999999999 |
471.63600000000002 |
519.87150000000008 |
514.51200000000006 |
482.35500000000008 |
525.23099999999999 |
482.35500000000008 |
493.07400000000007 |
482.35500000000008 |
455.5575 |
455.5575 |
241.17750000000004 |
18.39 |
18.39 |
18.39 |
18.39 |
18.39 |
18.39 |
18.39 |
18.39 |
18.39 |
18.39 |
18.022200000000002 |
29.424000000000003 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Blood test, thyroid stimulating hormone (TSH) |
241.5 |
84443 |
16.463999999999999 |
236.67 |
217.35 |
194.4075 |
161.322 |
155.28450000000001 |
236.67 |
217.35 |
234.255 |
217.35 |
229.42499999999998 |
234.255 |
173.88 |
169.04999999999998 |
236.67 |
212.52 |
234.255 |
231.84 |
217.35 |
236.67 |
217.35 |
222.18 |
217.35 |
205.27500000000001 |
205.27500000000001 |
108.675 |
16.8 |
16.8 |
16.8 |
16.8 |
16.8 |
16.8 |
16.8 |
16.8 |
16.8 |
16.8 |
16.463999999999999 |
26.880000000000003 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Complete blood cell count, with differential white blood cells, automated |
109.9 |
85025 |
7.6145999999999994 |
107.702 |
98.910000000000011 |
88.469500000000011 |
73.413200000000003 |
70.665700000000001 |
107.702 |
98.910000000000011 |
106.60300000000001 |
98.910000000000011 |
104.405 |
106.60300000000001 |
79.128 |
76.929999999999993 |
107.702 |
96.712000000000003 |
106.60300000000001 |
105.504 |
98.910000000000011 |
107.702 |
98.910000000000011 |
101.108 |
98.910000000000011 |
93.415000000000006 |
93.415000000000006 |
49.455000000000005 |
7.77 |
7.77 |
7.77 |
7.77 |
7.77 |
7.77 |
7.77 |
7.77 |
7.77 |
7.77 |
7.6145999999999994 |
12.432 |
22.344000000000001 |
21.918400000000002 |
21.918400000000002 |
22.344000000000001 |
22.131200000000003 |
|
Complete blood count, automated |
109.15 |
85027 |
6.3405999999999993 |
106.967 |
98.235000000000014 |
87.865750000000006 |
72.912200000000013 |
70.183450000000008 |
106.967 |
98.235000000000014 |
105.8755 |
98.235000000000014 |
103.6925 |
105.8755 |
78.588000000000008 |
76.405000000000001 |
106.967 |
96.052000000000007 |
105.8755 |
104.78400000000001 |
98.235000000000014 |
106.967 |
98.235000000000014 |
100.41800000000001 |
98.235000000000014 |
92.777500000000003 |
92.777500000000003 |
49.117500000000007 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.3405999999999993 |
10.352 |
22.344000000000001 |
21.918400000000002 |
21.918400000000002 |
22.344000000000001 |
22.131200000000003 |
|
Blood test, clotting time |
53.15 |
85610 |
4.2042000000000002 |
52.086999999999996 |
47.835000000000001 |
42.78575 |
35.504200000000004 |
34.175449999999998 |
52.086999999999996 |
47.835000000000001 |
51.555499999999995 |
47.835000000000001 |
50.4925 |
51.555499999999995 |
38.268000000000001 |
37.204999999999998 |
52.086999999999996 |
46.771999999999998 |
51.555499999999995 |
51.023999999999994 |
47.835000000000001 |
52.086999999999996 |
47.835000000000001 |
48.898000000000003 |
47.835000000000001 |
45.177499999999995 |
45.177499999999995 |
23.9175 |
4.29 |
4.29 |
4.29 |
4.29 |
4.29 |
4.29 |
4.29 |
4.29 |
4.29 |
4.29 |
4.2042000000000002 |
6.8640000000000008 |
22.921499999999998 |
22.4849 |
22.4849 |
22.921499999999998 |
22.703199999999999 |
|
Coagulation assessment blood test |
100.7 |
85730 |
5.8897999999999993 |
98.686000000000007 |
90.63000000000001 |
81.063500000000005 |
67.267600000000002 |
64.750100000000003 |
98.686000000000007 |
90.63000000000001 |
97.679000000000002 |
90.63000000000001 |
95.664999999999992 |
97.679000000000002 |
72.504000000000005 |
70.489999999999995 |
98.686000000000007 |
88.616 |
97.679000000000002 |
96.671999999999997 |
90.63000000000001 |
98.686000000000007 |
90.63000000000001 |
92.644000000000005 |
90.63000000000001 |
85.594999999999999 |
85.594999999999999 |
45.315000000000005 |
6.01 |
6.01 |
6.01 |
6.01 |
6.01 |
6.01 |
6.01 |
6.01 |
6.01 |
6.01 |
5.8897999999999993 |
9.6159999999999997 |
22.921499999999998 |
22.4849 |
22.4849 |
22.921499999999998 |
22.703199999999999 |
|
CT scan, head or brain, without contrast |
2205.9 |
70450 |
103.0078 |
2161.7820000000002 |
1985.3100000000002 |
1775.7495000000001 |
1473.5412000000001 |
1418.3937000000001 |
2161.7820000000002 |
1985.3100000000002 |
2139.723 |
1985.3100000000002 |
2095.605 |
2139.723 |
1588.248 |
1544.1299999999999 |
2161.7820000000002 |
1941.192 |
2139.723 |
2117.6640000000002 |
1985.3100000000002 |
2161.7820000000002 |
1985.3100000000002 |
2029.4280000000001 |
1985.3100000000002 |
1875.0150000000001 |
1875.0150000000001 |
992.65500000000009 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
X-Ray, lower back, minimum four views |
821.65 |
72110 |
103.0078 |
805.21699999999998 |
739.48500000000001 |
661.42825000000005 |
548.86220000000003 |
528.32095000000004 |
805.21699999999998 |
739.48500000000001 |
797.00049999999999 |
739.48500000000001 |
780.5675 |
797.00049999999999 |
591.58799999999997 |
575.15499999999997 |
805.21699999999998 |
723.05200000000002 |
797.00049999999999 |
788.78399999999999 |
739.48500000000001 |
805.21699999999998 |
739.48500000000001 |
755.91800000000001 |
739.48500000000001 |
698.40249999999992 |
698.40249999999992 |
369.74250000000001 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
MRI scan of lower spinal canal |
3298.5 |
72148 |
217.54039999999998 |
3232.5299999999997 |
2968.65 |
2655.2925 |
2203.3980000000001 |
2120.9355 |
3232.5299999999997 |
2968.65 |
3199.5450000000001 |
2968.65 |
3133.5749999999998 |
3199.5450000000001 |
2374.92 |
2308.9499999999998 |
3232.5299999999997 |
2902.68 |
3199.5450000000001 |
3166.56 |
2968.65 |
3232.5299999999997 |
2968.65 |
3034.6200000000003 |
2968.65 |
2803.7249999999999 |
2803.7249999999999 |
1484.325 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
392.47950000000003 |
385.00370000000004 |
385.00370000000004 |
392.47950000000003 |
388.74160000000006 |
MRI scan of leg joint |
3298.5 |
73721 |
217.54039999999998 |
3232.5299999999997 |
2968.65 |
2655.2925 |
2203.3980000000001 |
2120.9355 |
3232.5299999999997 |
2968.65 |
3199.5450000000001 |
2968.65 |
3133.5749999999998 |
3199.5450000000001 |
2374.92 |
2308.9499999999998 |
3232.5299999999997 |
2902.68 |
3199.5450000000001 |
3166.56 |
2968.65 |
3232.5299999999997 |
2968.65 |
3034.6200000000003 |
2968.65 |
2803.7249999999999 |
2803.7249999999999 |
1484.325 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
392.47950000000003 |
385.00370000000004 |
385.00370000000004 |
392.47950000000003 |
388.74160000000006 |
Ultrasound of abdomen |
2370.25 |
76700 |
103.0078 |
2322.8449999999998 |
2133.2249999999999 |
1908.0512500000002 |
1583.327 |
1524.0707500000001 |
2322.8449999999998 |
2133.2249999999999 |
2299.1424999999999 |
2133.2249999999999 |
2251.7374999999997 |
2299.1424999999999 |
1706.58 |
1659.175 |
2322.8449999999998 |
2085.8200000000002 |
2299.1424999999999 |
2275.44 |
2133.2249999999999 |
2322.8449999999998 |
2133.2249999999999 |
2180.63 |
2133.2249999999999 |
2014.7124999999999 |
2014.7124999999999 |
1066.6125 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
363.28950000000003 |
356.36970000000002 |
356.36970000000002 |
363.28950000000003 |
359.82960000000003 |
|
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus |
1076.05 |
76805 |
103.0078 |
1054.529 |
968.44499999999994 |
866.22024999999996 |
718.80140000000006 |
691.90014999999994 |
1054.529 |
968.44499999999994 |
1043.7684999999999 |
968.44499999999994 |
1022.2474999999999 |
1043.7684999999999 |
774.75599999999997 |
753.2349999999999 |
1054.529 |
946.92399999999998 |
1043.7684999999999 |
1033.0079999999998 |
968.44499999999994 |
1054.529 |
968.44499999999994 |
989.96600000000001 |
968.44499999999994 |
914.64249999999993 |
914.64249999999993 |
484.22249999999997 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
318.48599999999999 |
312.4196 |
312.4196 |
318.48599999999999 |
315.45280000000002 |
|
Ultrasound pelvis through vagina |
712.55 |
76830 |
103.0078 |
698.29899999999998 |
641.29499999999996 |
573.60275000000001 |
475.98340000000002 |
458.16964999999999 |
698.29899999999998 |
641.29499999999996 |
691.17349999999999 |
641.29499999999996 |
676.9224999999999 |
691.17349999999999 |
513.03599999999994 |
498.78499999999991 |
698.29899999999998 |
627.04399999999998 |
691.17349999999999 |
684.04799999999989 |
641.29499999999996 |
698.29899999999998 |
641.29499999999996 |
655.54599999999994 |
641.29499999999996 |
605.6674999999999 |
605.6674999999999 |
320.64749999999998 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Mammography of one breast |
368.05 |
77065 |
68.680400000000006 |
360.68900000000002 |
331.245 |
296.28025000000002 |
245.85740000000001 |
236.65615000000003 |
360.68900000000002 |
331.245 |
357.00850000000003 |
331.245 |
349.64749999999998 |
357.00850000000003 |
264.99599999999998 |
257.63499999999999 |
360.68900000000002 |
323.88400000000001 |
357.00850000000003 |
353.32799999999997 |
331.245 |
360.68900000000002 |
331.245 |
338.60600000000005 |
331.245 |
312.84250000000003 |
312.84250000000003 |
165.6225 |
83.53 |
83.53 |
83.53 |
83.53 |
83.53 |
83.53 |
83.53 |
83.53 |
83.53 |
83.53 |
81.859399999999994 |
133.648 |
70.01400000000001 |
68.680400000000006 |
68.680400000000006 |
70.01400000000001 |
69.347200000000015 |
|
Mammography of both breasts |
445.5 |
77066 |
68.680400000000006 |
436.59 |
400.95 |
358.6275 |
297.59399999999999 |
286.45650000000001 |
436.59 |
400.95 |
432.13499999999999 |
400.95 |
423.22499999999997 |
432.13499999999999 |
320.76 |
311.84999999999997 |
436.59 |
392.04 |
432.13499999999999 |
427.68 |
400.95 |
436.59 |
400.95 |
409.86 |
400.95 |
378.67500000000001 |
378.67500000000001 |
200.47499999999999 |
106.79 |
106.79 |
106.79 |
106.79 |
106.79 |
106.79 |
106.79 |
106.79 |
106.79 |
106.79 |
104.6542 |
170.86400000000003 |
70.01400000000001 |
68.680400000000006 |
68.680400000000006 |
70.01400000000001 |
69.347200000000015 |
|
Mammography, screening, bilateral |
312 |
77067 |
68.680400000000006 |
305.76 |
280.8 |
251.16000000000003 |
208.41600000000003 |
200.61600000000001 |
305.76 |
280.8 |
302.64 |
280.8 |
296.39999999999998 |
302.64 |
224.64 |
218.39999999999998 |
305.76 |
274.56 |
302.64 |
299.52 |
280.8 |
305.76 |
280.8 |
287.04000000000002 |
280.8 |
265.2 |
265.2 |
140.4 |
88.31 |
88.31 |
88.31 |
88.31 |
88.31 |
88.31 |
88.31 |
88.31 |
88.31 |
88.31 |
86.543800000000005 |
141.29600000000002 |
70.01400000000001 |
68.680400000000006 |
68.680400000000006 |
70.01400000000001 |
69.347200000000015 |
|
Electrocardiogram, routine, with interpretation and report |
N/A |
93000 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
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|
|
|
|
Insertion of catheter into left heart for diagnosis |
4347.6499999999996 |
93452 |
1956.4424999999999 |
4474.2240000000002 |
3912.8849999999998 |
3499.8582499999998 |
2904.2302 |
2795.5389499999997 |
4260.6969999999992 |
3912.8849999999998 |
4217.2204999999994 |
3912.8849999999998 |
4130.267499999999 |
4217.2204999999994 |
3130.3079999999995 |
3043.3549999999996 |
4260.6969999999992 |
3825.9319999999998 |
4217.2204999999994 |
4173.7439999999997 |
3912.8849999999998 |
4260.6969999999992 |
3912.8849999999998 |
3999.8379999999997 |
3912.8849999999998 |
3695.5024999999996 |
3695.5024999999996 |
1956.4424999999999 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2740.4621999999999 |
4474.2240000000002 |
2506.6650000000004 |
2458.9190000000003 |
2458.9190000000003 |
2506.6650000000004 |
2482.7920000000004 |
Sleep study |
4395.1000000000004 |
95810 |
869.51479999999992 |
4307.1980000000003 |
3955.5900000000006 |
3538.0555000000004 |
2935.9268000000002 |
2826.0493000000001 |
4307.1980000000003 |
3955.5900000000006 |
4263.2470000000003 |
3955.5900000000006 |
4175.3450000000003 |
4263.2470000000003 |
3164.4720000000002 |
3076.57 |
4307.1980000000003 |
3867.6880000000006 |
4263.2470000000003 |
4219.2960000000003 |
3955.5900000000006 |
4307.1980000000003 |
3955.5900000000006 |
4043.4920000000006 |
3955.5900000000006 |
3735.835 |
3735.835 |
1977.7950000000003 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
869.51479999999992 |
1419.616 |
1210.2615000000001 |
1187.2089000000001 |
1187.2089000000001 |
1210.2615000000001 |
1198.7352000000001 |
Physical therapy, therapeutic exercise |
244.6 |
97110 |
28.625800000000002 |
239.708 |
220.14 |
196.90300000000002 |
163.39279999999999 |
157.27780000000001 |
239.708 |
220.14 |
237.262 |
220.14 |
232.36999999999998 |
237.262 |
176.11199999999999 |
171.22 |
239.708 |
215.24799999999999 |
237.262 |
234.81599999999997 |
220.14 |
239.708 |
220.14 |
225.03200000000001 |
220.14 |
207.91 |
207.91 |
110.07 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
28.625800000000002 |
46.736000000000004 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
Routine obstetric care for vaginal delivery, including pre-and post-delivery care |
N/A |
59400 |
|
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|
Routine obstetric care for cesarean delivery, including pre-and post-delivery care |
N/A |
59510 |
|
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|
|
Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care |
N/A |
59610 |
|
|
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|
|
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities |
N/A |
216 |
|
|
|
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|
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|
|
Spinal fusion except cervical without major comorbid conditions or complications (MCC) |
N/A |
460 |
|
|
|
|
|
|
|
|
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|
|
|
|
MRI scan of brain before and after contrast |
4330.8500000000004 |
70553 |
347.98819999999995 |
4244.2330000000002 |
3897.7650000000003 |
3486.3342500000003 |
2893.0078000000003 |
2784.7365500000001 |
4244.2330000000002 |
3897.7650000000003 |
4200.9245000000001 |
3897.7650000000003 |
4114.3074999999999 |
4200.9245000000001 |
3118.212 |
3031.5950000000003 |
4244.2330000000002 |
3811.1480000000001 |
4200.9245000000001 |
4157.616 |
3897.7650000000003 |
4244.2330000000002 |
3897.7650000000003 |
3984.3820000000005 |
3897.7650000000003 |
3681.2225000000003 |
3681.2225000000003 |
1948.8825000000002 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
347.98819999999995 |
568.14400000000001 |
500.661 |
491.12459999999999 |
491.12459999999999 |
500.661 |
495.89280000000002 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan, pelvis, with contrast |
3354.45 |
72193 |
168.78539999999998 |
3287.3609999999999 |
3019.0050000000001 |
2700.3322499999999 |
2240.7725999999998 |
2156.9113499999999 |
3287.3609999999999 |
3019.0050000000001 |
3253.8164999999999 |
3019.0050000000001 |
3186.7274999999995 |
3253.8164999999999 |
2415.2039999999997 |
2348.1149999999998 |
3287.3609999999999 |
2951.9159999999997 |
3253.8164999999999 |
3220.2719999999995 |
3019.0050000000001 |
3287.3609999999999 |
3019.0050000000001 |
3086.0940000000001 |
3019.0050000000001 |
2851.2824999999998 |
2851.2824999999998 |
1509.5025000000001 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan of abdomen and pelvis with contrast |
6329.05 |
74177 |
347.98819999999995 |
6202.4690000000001 |
5696.1450000000004 |
5094.8852500000003 |
4227.8054000000002 |
4069.57915 |
6202.4690000000001 |
5696.1450000000004 |
6139.1785 |
5696.1450000000004 |
6012.5974999999999 |
6139.1785 |
4556.9160000000002 |
4430.335 |
6202.4690000000001 |
5569.5640000000003 |
6139.1785 |
6075.8879999999999 |
5696.1450000000004 |
6202.4690000000001 |
5696.1450000000004 |
5822.7260000000006 |
5696.1450000000004 |
5379.6925000000001 |
5379.6925000000001 |
2848.0725000000002 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
347.98819999999995 |
568.14400000000001 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of 1 or more breast growth, open procedure |
8930.6060000000016 |
19120 |
1439.1881000000001 |
8751.9938800000018 |
8037.5454000000018 |
7189.1378300000015 |
5965.6448080000018 |
5742.3796580000007 |
8751.9938800000018 |
8037.5454000000018 |
8662.687820000001 |
8037.5454000000018 |
8484.0757000000012 |
8662.687820000001 |
6430.0363200000011 |
6251.4242000000004 |
8751.9938800000018 |
7858.9332800000011 |
8662.687820000001 |
8573.381760000002 |
8037.5454000000018 |
8751.9938800000018 |
8037.5454000000018 |
8216.1575200000025 |
8037.5454000000018 |
7591.0151000000014 |
7591.0151000000014 |
4018.7727000000009 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
3045.96 |
2985.0407999999998 |
4873.5360000000001 |
1467.1335000000001 |
1439.1881000000001 |
1439.1881000000001 |
1467.1335000000001 |
1453.1608000000001 |
|
Pharmacy/drugs administered |
861.78000000000009 |
0250/0636 |
387.80100000000004 |
844.54440000000011 |
775.60200000000009 |
693.73290000000009 |
575.66904000000011 |
554.12454000000002 |
844.54440000000011 |
775.60200000000009 |
835.92660000000001 |
775.60200000000009 |
818.69100000000003 |
835.92660000000001 |
620.48160000000007 |
603.24599999999998 |
844.54440000000011 |
758.36640000000011 |
835.92660000000001 |
827.30880000000002 |
775.60200000000009 |
844.54440000000011 |
775.60200000000009 |
792.83760000000007 |
775.60200000000009 |
732.51300000000003 |
732.51300000000003 |
387.80100000000004 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
1115.491 |
0270-0278 |
501.97095000000002 |
1093.18118 |
1003.9419 |
897.97025500000007 |
745.14798800000005 |
717.26071300000001 |
1093.18118 |
1003.9419 |
1082.0262700000001 |
1003.9419 |
1059.7164499999999 |
1082.0262700000001 |
803.15351999999996 |
780.8436999999999 |
1093.18118 |
981.63207999999997 |
1082.0262700000001 |
1070.8713599999999 |
1003.9419 |
1093.18118 |
1003.9419 |
1026.25172 |
1003.9419 |
948.16734999999994 |
948.16734999999994 |
501.97095000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Urine pregnancy test |
86.814000000000007 |
81025 |
39.066300000000005 |
85.077719999999999 |
78.132600000000011 |
69.885270000000006 |
57.991752000000005 |
55.821402000000006 |
85.077719999999999 |
78.132600000000011 |
84.209580000000003 |
78.132600000000011 |
82.473300000000009 |
84.209580000000003 |
62.506080000000004 |
60.769800000000004 |
85.077719999999999 |
76.396320000000003 |
84.209580000000003 |
83.341440000000006 |
78.132600000000011 |
85.077719999999999 |
78.132600000000011 |
79.868880000000004 |
78.132600000000011 |
73.791899999999998 |
73.791899999999998 |
39.066300000000005 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
700.28899999999999 |
88307 |
241.8955 |
686.28322000000003 |
630.26009999999997 |
563.73264500000005 |
467.79305200000005 |
450.28582699999998 |
686.28322000000003 |
630.26009999999997 |
679.28032999999994 |
630.26009999999997 |
665.27454999999998 |
679.28032999999994 |
504.20808 |
490.20229999999998 |
686.28322000000003 |
616.25432000000001 |
679.28032999999994 |
672.27743999999996 |
630.26009999999997 |
686.28322000000003 |
630.26009999999997 |
644.26588000000004 |
630.26009999999997 |
595.24564999999996 |
595.24564999999996 |
315.13004999999998 |
280.95 |
280.95 |
280.95 |
280.95 |
280.95 |
280.95 |
280.95 |
280.95 |
280.95 |
280.95 |
275.33099999999996 |
449.52 |
246.5925 |
241.8955 |
241.8955 |
246.5925 |
244.244 |
|
Recovery Room |
989.93399999999997 |
0710 |
445.47030000000001 |
970.13531999999998 |
890.94060000000002 |
796.89687000000004 |
661.27591200000006 |
636.52756199999999 |
970.13531999999998 |
890.94060000000002 |
960.23597999999993 |
890.94060000000002 |
940.43729999999994 |
960.23597999999993 |
712.75247999999999 |
692.95379999999989 |
970.13531999999998 |
871.14192000000003 |
960.23597999999993 |
950.33663999999999 |
890.94060000000002 |
970.13531999999998 |
890.94060000000002 |
910.73928000000001 |
890.94060000000002 |
841.44389999999999 |
841.44389999999999 |
445.47030000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Shaving of shoulder bone using an endoscope |
4741.3 |
29826 |
2133.585 |
4646.4740000000002 |
4267.17 |
3816.7465000000002 |
3167.1884000000005 |
3048.6559000000002 |
4646.4740000000002 |
4267.17 |
4599.0609999999997 |
4267.17 |
4504.2349999999997 |
4599.0609999999997 |
3413.7359999999999 |
3318.91 |
4646.4740000000002 |
4172.3440000000001 |
4599.0609999999997 |
4551.6480000000001 |
4267.17 |
4646.4740000000002 |
4267.17 |
4361.9960000000001 |
4267.17 |
4030.105 |
4030.105 |
2133.585 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Consolidated |
Consolidated |
Consolidated |
Consolidated |
Consolidated |
|
Repair of shoulder socket cartilage using an endoscope |
4741.3 |
29807 |
2133.585 |
9669.0720000000001 |
4267.17 |
3816.7465000000002 |
3167.1884000000005 |
3048.6559000000002 |
4646.4740000000002 |
4267.17 |
4599.0609999999997 |
4267.17 |
4504.2349999999997 |
4599.0609999999997 |
3413.7359999999999 |
3318.91 |
4646.4740000000002 |
4172.3440000000001 |
4599.0609999999997 |
4551.6480000000001 |
4267.17 |
4646.4740000000002 |
4267.17 |
4361.9960000000001 |
4267.17 |
4030.105 |
4030.105 |
2133.585 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
6043.17 |
5922.3065999999999 |
9669.0720000000001 |
3188.6925000000001 |
3127.9555 |
3127.9555 |
3188.6925000000001 |
3158.3240000000001 |
|
Pharmacy/drugs administered |
1600.65 |
0250/0636 |
720.29250000000002 |
1568.6370000000002 |
1440.585 |
1288.5232500000002 |
1069.2342000000001 |
1029.21795 |
1568.6370000000002 |
1440.585 |
1552.6305 |
1440.585 |
1520.6175000000001 |
1552.6305 |
1152.4680000000001 |
1120.4549999999999 |
1568.6370000000002 |
1408.5720000000001 |
1552.6305 |
1536.624 |
1440.585 |
1568.6370000000002 |
1440.585 |
1472.5980000000002 |
1440.585 |
1360.5525 |
1360.5525 |
720.29250000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
10014.4 |
0270-0278 |
4506.4799999999996 |
9814.1119999999992 |
9012.9599999999991 |
8061.5920000000006 |
6689.6192000000001 |
6439.2591999999995 |
9814.1119999999992 |
9012.9599999999991 |
9713.9679999999989 |
9012.9599999999991 |
9513.6799999999985 |
9713.9679999999989 |
7210.3679999999995 |
7010.079999999999 |
9814.1119999999992 |
8812.6720000000005 |
9713.9679999999989 |
9613.8239999999987 |
9012.9599999999991 |
9814.1119999999992 |
9012.9599999999991 |
9213.2479999999996 |
9012.9599999999991 |
8512.24 |
8512.24 |
4506.4799999999996 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Recovery Room |
1979.87 |
0710 |
890.94150000000002 |
1940.2725999999998 |
1781.883 |
1593.7953500000001 |
1322.5531599999999 |
1273.0564099999999 |
1940.2725999999998 |
1781.883 |
1920.4738999999997 |
1781.883 |
1880.8764999999999 |
1920.4738999999997 |
1425.5063999999998 |
1385.9089999999999 |
1940.2725999999998 |
1742.2855999999999 |
1920.4738999999997 |
1900.6751999999999 |
1781.883 |
1940.2725999999998 |
1781.883 |
1821.4803999999999 |
1781.883 |
1682.8894999999998 |
1682.8894999999998 |
890.94150000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of one knee cartilage using an endoscope |
7000.82 |
29881 |
2351.6239 |
6860.8035999999993 |
6300.7380000000003 |
5635.6601000000001 |
4676.5477600000004 |
4501.5272599999998 |
6860.8035999999993 |
6300.7380000000003 |
6790.7954 |
6300.7380000000003 |
6650.7789999999995 |
6790.7954 |
5040.5904 |
4900.5739999999996 |
6860.8035999999993 |
6160.7215999999999 |
6790.7954 |
6720.7871999999998 |
6300.7380000000003 |
6860.8035999999993 |
6300.7380000000003 |
6440.7543999999998 |
6300.7380000000003 |
5950.6969999999992 |
5950.6969999999992 |
3150.3690000000001 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2730.2 |
2675.5959999999995 |
4368.32 |
2397.2865000000002 |
2351.6239 |
2351.6239 |
2397.2865000000002 |
2374.4552000000003 |
|
Pharmacy/drugs administered |
1445.27 |
0250/0636 |
650.37149999999997 |
1416.3645999999999 |
1300.7429999999999 |
1163.44235 |
965.44036000000006 |
929.30861000000004 |
1416.3645999999999 |
1300.7429999999999 |
1401.9118999999998 |
1300.7429999999999 |
1373.0065 |
1401.9118999999998 |
1040.5944 |
1011.689 |
1416.3645999999999 |
1271.8376000000001 |
1401.9118999999998 |
1387.4592 |
1300.7429999999999 |
1416.3645999999999 |
1300.7429999999999 |
1329.6484 |
1300.7429999999999 |
1228.4794999999999 |
1228.4794999999999 |
650.37149999999997 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
2123.5500000000002 |
0270-0278 |
955.59750000000008 |
2081.0790000000002 |
1911.1950000000002 |
1709.4577500000003 |
1418.5314000000003 |
1365.4426500000002 |
2081.0790000000002 |
1911.1950000000002 |
2059.8434999999999 |
1911.1950000000002 |
2017.3725000000002 |
2059.8434999999999 |
1528.9560000000001 |
1486.4850000000001 |
2081.0790000000002 |
1868.7240000000002 |
2059.8434999999999 |
2038.6080000000002 |
1911.1950000000002 |
2081.0790000000002 |
1911.1950000000002 |
1953.6660000000002 |
1911.1950000000002 |
1805.0175000000002 |
1805.0175000000002 |
955.59750000000008 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Recovery Room |
2297.5 |
0710 |
1033.875 |
2251.5500000000002 |
2067.75 |
1849.4875000000002 |
1534.73 |
1477.2925 |
2251.5500000000002 |
2067.75 |
2228.5749999999998 |
2067.75 |
2182.625 |
2228.5749999999998 |
1654.2 |
1608.25 |
2251.5500000000002 |
2021.8 |
2228.5749999999998 |
2205.6 |
2067.75 |
2251.5500000000002 |
2067.75 |
2113.7000000000003 |
2067.75 |
1952.875 |
1952.875 |
1033.875 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of tonsils and adenoid glands patient younger than age 12 |
6447.82 |
42820 |
1500.4628 |
7849.6 |
5803.0379999999996 |
5190.4951000000001 |
4307.1437599999999 |
4145.9482600000001 |
6318.8635999999997 |
5803.0379999999996 |
6254.3853999999992 |
5803.0379999999996 |
6125.4289999999992 |
6254.3853999999992 |
4642.4303999999993 |
4513.4739999999993 |
6318.8635999999997 |
5674.0815999999995 |
6254.3853999999992 |
6189.9071999999996 |
5803.0379999999996 |
6318.8635999999997 |
5803.0379999999996 |
5931.9943999999996 |
5803.0379999999996 |
5480.6469999999999 |
5480.6469999999999 |
2901.5189999999998 |
4906 |
4906 |
4906 |
4906 |
4906 |
4906 |
4906 |
4906 |
4906 |
4906 |
4807.88 |
7849.6 |
1529.598 |
1500.4628 |
1500.4628 |
1529.598 |
1515.0304000000001 |
|
Pharmacy/drugs administered |
1220.9100000000001 |
0250/0636 |
549.40950000000009 |
1196.4918 |
1098.8190000000002 |
982.83255000000008 |
815.56788000000006 |
785.04513000000009 |
1196.4918 |
1098.8190000000002 |
1184.2827 |
1098.8190000000002 |
1159.8645000000001 |
1184.2827 |
879.05520000000001 |
854.63700000000006 |
1196.4918 |
1074.4008000000001 |
1184.2827 |
1172.0735999999999 |
1098.8190000000002 |
1196.4918 |
1098.8190000000002 |
1123.2372 |
1098.8190000000002 |
1037.7735 |
1037.7735 |
549.40950000000009 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
1345.78 |
0270-0278 |
605.601 |
1318.8643999999999 |
1211.202 |
1083.3529000000001 |
898.98104000000001 |
865.33654000000001 |
1318.8643999999999 |
1211.202 |
1305.4066 |
1211.202 |
1278.491 |
1305.4066 |
968.96159999999998 |
942.04599999999994 |
1318.8643999999999 |
1184.2864 |
1305.4066 |
1291.9487999999999 |
1211.202 |
1318.8643999999999 |
1211.202 |
1238.1176 |
1211.202 |
1143.913 |
1143.913 |
605.601 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
665.79 |
88304 |
47.04 |
652.4742 |
599.21100000000001 |
535.96095000000003 |
444.74772000000002 |
428.10296999999997 |
652.4742 |
599.21100000000001 |
645.81629999999996 |
599.21100000000001 |
632.50049999999999 |
645.81629999999996 |
479.36879999999996 |
466.05299999999994 |
652.4742 |
585.89519999999993 |
645.81629999999996 |
639.15839999999992 |
599.21100000000001 |
652.4742 |
599.21100000000001 |
612.52679999999998 |
599.21100000000001 |
565.92149999999992 |
565.92149999999992 |
299.60550000000001 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
47.04 |
76.800000000000011 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Recovery Room |
2615.13 |
0710 |
1176.8085000000001 |
2562.8274000000001 |
2353.6170000000002 |
2105.17965 |
1746.9068400000001 |
1681.5285900000001 |
2562.8274000000001 |
2353.6170000000002 |
2536.6761000000001 |
2353.6170000000002 |
2484.3735000000001 |
2536.6761000000001 |
1882.8936000000001 |
1830.5909999999999 |
2562.8274000000001 |
2301.3144000000002 |
2536.6761000000001 |
2510.5248000000001 |
2353.6170000000002 |
2562.8274000000001 |
2353.6170000000002 |
2405.9196000000002 |
2353.6170000000002 |
2222.8605000000002 |
2222.8605000000002 |
1176.8085000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope |
3217.58 |
43235 |
765.32120000000009 |
3153.2284 |
2895.8220000000001 |
2590.1519000000003 |
2149.3434400000001 |
2068.9039400000001 |
3153.2284 |
2895.8220000000001 |
3121.0526 |
2895.8220000000001 |
3056.7009999999996 |
3121.0526 |
2316.6576 |
2252.3059999999996 |
3153.2284 |
2831.4704000000002 |
3121.0526 |
3088.8768 |
2895.8220000000001 |
3153.2284 |
2895.8220000000001 |
2960.1736000000001 |
2895.8220000000001 |
2734.9429999999998 |
2734.9429999999998 |
1447.9110000000001 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
765.32120000000009 |
1249.5040000000001 |
814.39050000000009 |
798.87830000000008 |
798.87830000000008 |
814.39050000000009 |
806.63440000000003 |
|
Pharmacy/drugs administered |
282.44 |
0250/0636 |
127.098 |
276.7912 |
254.196 |
227.36420000000001 |
188.66992000000002 |
181.60892000000001 |
276.7912 |
254.196 |
273.96679999999998 |
254.196 |
268.31799999999998 |
273.96679999999998 |
203.35679999999999 |
197.708 |
276.7912 |
248.5472 |
273.96679999999998 |
271.14240000000001 |
254.196 |
276.7912 |
254.196 |
259.84480000000002 |
254.196 |
240.07399999999998 |
240.07399999999998 |
127.098 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
309.41000000000003 |
0270-0278 |
139.23450000000003 |
303.22180000000003 |
278.46900000000005 |
249.07505000000003 |
206.68588000000003 |
198.95063000000002 |
303.22180000000003 |
278.46900000000005 |
300.1277 |
278.46900000000005 |
293.93950000000001 |
300.1277 |
222.77520000000001 |
216.58700000000002 |
303.22180000000003 |
272.2808 |
300.1277 |
297.03360000000004 |
278.46900000000005 |
303.22180000000003 |
278.46900000000005 |
284.65720000000005 |
278.46900000000005 |
262.99850000000004 |
262.99850000000004 |
139.23450000000003 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Laboratory |
79.5 |
86328 |
35.774999999999999 |
77.91 |
71.55 |
63.997500000000002 |
53.106000000000002 |
51.118500000000004 |
77.91 |
71.55 |
77.114999999999995 |
71.55 |
75.524999999999991 |
77.114999999999995 |
57.239999999999995 |
55.65 |
77.91 |
69.959999999999994 |
77.114999999999995 |
76.319999999999993 |
71.55 |
77.91 |
71.55 |
73.14 |
71.55 |
67.575000000000003 |
67.575000000000003 |
35.774999999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope |
3456.02 |
43239 |
765.32120000000009 |
3386.8995999999997 |
3110.4180000000001 |
2782.0961000000002 |
2308.6213600000001 |
2222.2208599999999 |
3386.8995999999997 |
3110.4180000000001 |
3352.3393999999998 |
3110.4180000000001 |
3283.2190000000001 |
3352.3393999999998 |
2488.3343999999997 |
2419.2139999999999 |
3386.8995999999997 |
3041.2975999999999 |
3352.3393999999998 |
3317.7791999999999 |
3110.4180000000001 |
3386.8995999999997 |
3110.4180000000001 |
3179.5383999999999 |
3110.4180000000001 |
2937.6169999999997 |
2937.6169999999997 |
1555.2090000000001 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
780.94 |
765.32120000000009 |
1249.5040000000001 |
814.39050000000009 |
798.87830000000008 |
798.87830000000008 |
814.39050000000009 |
806.63440000000003 |
|
Pharmacy/drugs administered |
301.08999999999997 |
0250/0636 |
135.4905 |
295.06819999999999 |
270.98099999999999 |
242.37744999999998 |
201.12812 |
193.60086999999999 |
295.06819999999999 |
270.98099999999999 |
292.05729999999994 |
270.98099999999999 |
286.03549999999996 |
292.05729999999994 |
216.78479999999996 |
210.76299999999998 |
295.06819999999999 |
264.95919999999995 |
292.05729999999994 |
289.04639999999995 |
270.98099999999999 |
295.06819999999999 |
270.98099999999999 |
277.00279999999998 |
270.98099999999999 |
255.92649999999998 |
255.92649999999998 |
135.4905 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
824.84 |
0270-0278 |
371.178 |
808.34320000000002 |
742.35599999999999 |
663.99620000000004 |
550.99312000000009 |
530.37212 |
808.34320000000002 |
742.35599999999999 |
800.09479999999996 |
742.35599999999999 |
783.59799999999996 |
800.09479999999996 |
593.88480000000004 |
577.38800000000003 |
808.34320000000002 |
725.85919999999999 |
800.09479999999996 |
791.84640000000002 |
742.35599999999999 |
808.34320000000002 |
742.35599999999999 |
758.85280000000012 |
742.35599999999999 |
701.11400000000003 |
701.11400000000003 |
371.178 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
1092.6500000000001 |
88305 |
47.04 |
1070.797 |
983.3850000000001 |
879.58325000000013 |
729.89020000000005 |
702.57395000000008 |
1070.797 |
983.3850000000001 |
1059.8705 |
983.3850000000001 |
1038.0174999999999 |
1059.8705 |
786.70800000000008 |
764.85500000000002 |
1070.797 |
961.53200000000004 |
1059.8705 |
1048.944 |
983.3850000000001 |
1070.797 |
983.3850000000001 |
1005.2380000000002 |
983.3850000000001 |
928.75250000000005 |
928.75250000000005 |
491.69250000000005 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
47.04 |
76.800000000000011 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
109.6 |
88313 |
49.32 |
107.40799999999999 |
98.64 |
88.227999999999994 |
73.212800000000001 |
70.472799999999992 |
107.40799999999999 |
98.64 |
106.312 |
98.64 |
104.11999999999999 |
106.312 |
78.911999999999992 |
76.719999999999985 |
107.40799999999999 |
96.447999999999993 |
106.312 |
105.21599999999999 |
98.64 |
107.40799999999999 |
98.64 |
100.83199999999999 |
98.64 |
93.16 |
93.16 |
49.32 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
298.39 |
88342 |
134.27549999999999 |
292.42219999999998 |
268.55099999999999 |
240.20394999999999 |
199.32452000000001 |
191.86476999999999 |
292.42219999999998 |
268.55099999999999 |
289.43829999999997 |
268.55099999999999 |
283.47049999999996 |
289.43829999999997 |
214.84079999999997 |
208.87299999999999 |
292.42219999999998 |
262.58319999999998 |
289.43829999999997 |
286.45439999999996 |
268.55099999999999 |
292.42219999999998 |
268.55099999999999 |
274.5188 |
268.55099999999999 |
253.63149999999999 |
253.63149999999999 |
134.27549999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Diagnostic examination of large bowel using an endoscope |
3255.31 |
45378 |
750.23899999999992 |
3190.2037999999998 |
2929.779 |
2620.5245500000001 |
2174.5470800000003 |
2093.1643300000001 |
3190.2037999999998 |
2929.779 |
3157.6506999999997 |
2929.779 |
3092.5445 |
3157.6506999999997 |
2343.8231999999998 |
2278.7169999999996 |
3190.2037999999998 |
2864.6727999999998 |
3157.6506999999997 |
3125.0976000000001 |
2929.779 |
3190.2037999999998 |
2929.779 |
2994.8852000000002 |
2929.779 |
2767.0135 |
2767.0135 |
1464.8895 |
765.55 |
765.55 |
765.55 |
765.55 |
765.55 |
765.55 |
765.55 |
765.55 |
765.55 |
765.55 |
750.23899999999992 |
1224.8799999999999 |
782.32350000000008 |
767.42210000000011 |
767.42210000000011 |
782.32350000000008 |
774.8728000000001 |
|
Pharmacy/drugs administered |
341.27 |
0250/0636 |
153.57149999999999 |
334.44459999999998 |
307.14299999999997 |
274.72235000000001 |
227.96835999999999 |
219.43661 |
334.44459999999998 |
307.14299999999997 |
331.03189999999995 |
307.14299999999997 |
324.20649999999995 |
331.03189999999995 |
245.71439999999998 |
238.88899999999998 |
334.44459999999998 |
300.31759999999997 |
331.03189999999995 |
327.61919999999998 |
307.14299999999997 |
334.44459999999998 |
307.14299999999997 |
313.96839999999997 |
307.14299999999997 |
290.0795 |
290.0795 |
153.57149999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
223.07 |
0270-0278 |
100.3815 |
218.6086 |
200.76300000000001 |
179.57135 |
149.01076 |
143.43401 |
218.6086 |
200.76300000000001 |
216.37789999999998 |
200.76300000000001 |
211.91649999999998 |
216.37789999999998 |
160.6104 |
156.14899999999997 |
218.6086 |
196.30160000000001 |
216.37789999999998 |
214.1472 |
200.76300000000001 |
218.6086 |
200.76300000000001 |
205.2244 |
200.76300000000001 |
189.6095 |
189.6095 |
100.3815 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Biopsy of large bowel using an endoscope |
3493.76 |
45380 |
767.42210000000011 |
3423.8848000000003 |
3144.3840000000005 |
2812.4768000000004 |
2333.8316800000002 |
2246.4876800000002 |
3423.8848000000003 |
3144.3840000000005 |
3388.9472000000001 |
3144.3840000000005 |
3319.0720000000001 |
3388.9472000000001 |
2515.5072 |
2445.6320000000001 |
3423.8848000000003 |
3074.5088000000001 |
3388.9472000000001 |
3354.0095999999999 |
3144.3840000000005 |
3423.8848000000003 |
3144.3840000000005 |
3214.2592000000004 |
3144.3840000000005 |
2969.6959999999999 |
2969.6959999999999 |
1572.1920000000002 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
980.245 |
1600.4 |
782.32350000000008 |
767.42210000000011 |
767.42210000000011 |
782.32350000000008 |
774.8728000000001 |
|
Pharmacy/drugs administered |
255.09 |
0250/0636 |
114.79050000000001 |
249.98820000000001 |
229.58100000000002 |
205.34745000000001 |
170.40012000000002 |
164.02287000000001 |
249.98820000000001 |
229.58100000000002 |
247.43729999999999 |
229.58100000000002 |
242.3355 |
247.43729999999999 |
183.66479999999999 |
178.56299999999999 |
249.98820000000001 |
224.47919999999999 |
247.43729999999999 |
244.88639999999998 |
229.58100000000002 |
249.98820000000001 |
229.58100000000002 |
234.68280000000001 |
229.58100000000002 |
216.82650000000001 |
216.82650000000001 |
114.79050000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
824.84 |
0270-0278 |
371.178 |
808.34320000000002 |
742.35599999999999 |
663.99620000000004 |
550.99312000000009 |
530.37212 |
808.34320000000002 |
742.35599999999999 |
800.09479999999996 |
742.35599999999999 |
783.59799999999996 |
800.09479999999996 |
593.88480000000004 |
577.38800000000003 |
808.34320000000002 |
725.85919999999999 |
800.09479999999996 |
791.84640000000002 |
742.35599999999999 |
808.34320000000002 |
742.35599999999999 |
758.85280000000012 |
742.35599999999999 |
701.11400000000003 |
701.11400000000003 |
371.178 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
1638.97 |
88305 |
737.53650000000005 |
1606.1905999999999 |
1475.0730000000001 |
1319.37085 |
1094.83196 |
1053.85771 |
1606.1905999999999 |
1475.0730000000001 |
1589.8009 |
1475.0730000000001 |
1557.0215000000001 |
1589.8009 |
1180.0583999999999 |
1147.279 |
1606.1905999999999 |
1442.2936 |
1589.8009 |
1573.4112 |
1475.0730000000001 |
1606.1905999999999 |
1475.0730000000001 |
1507.8524 |
1475.0730000000001 |
1393.1244999999999 |
1393.1244999999999 |
737.53650000000005 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of polyps or growths of large bowel using an endoscope |
3531.71 |
45385 |
980.245 |
3461.0758000000001 |
3178.5390000000002 |
2843.02655 |
2359.18228 |
2270.8895299999999 |
3461.0758000000001 |
3178.5390000000002 |
3425.7586999999999 |
3178.5390000000002 |
3355.1244999999999 |
3425.7586999999999 |
2542.8312000000001 |
2472.1969999999997 |
3461.0758000000001 |
3107.9048000000003 |
3425.7586999999999 |
3390.4416000000001 |
3178.5390000000002 |
3461.0758000000001 |
3178.5390000000002 |
3249.1732000000002 |
3178.5390000000002 |
3001.9535000000001 |
3001.9535000000001 |
1589.2695000000001 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
980.245 |
1600.4 |
1156.3544999999999 |
1134.3287 |
1134.3287 |
1156.3544999999999 |
1145.3416 |
|
Pharmacy/drugs administered |
200.61 |
0250/0636 |
90.274500000000003 |
196.59780000000001 |
180.54900000000001 |
161.49105000000003 |
134.00748000000002 |
128.99223000000001 |
196.59780000000001 |
180.54900000000001 |
194.5917 |
180.54900000000001 |
190.5795 |
194.5917 |
144.4392 |
140.42699999999999 |
196.59780000000001 |
176.5368 |
194.5917 |
192.5856 |
180.54900000000001 |
196.59780000000001 |
180.54900000000001 |
184.56120000000001 |
180.54900000000001 |
170.51850000000002 |
170.51850000000002 |
90.274500000000003 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
429.14 |
0270-0278 |
193.113 |
420.55719999999997 |
386.226 |
345.45769999999999 |
286.66552000000001 |
275.93702000000002 |
420.55719999999997 |
386.226 |
416.26579999999996 |
386.226 |
407.68299999999999 |
416.26579999999996 |
308.98079999999999 |
300.39799999999997 |
420.55719999999997 |
377.64319999999998 |
416.26579999999996 |
411.97439999999995 |
386.226 |
420.55719999999997 |
386.226 |
394.80880000000002 |
386.226 |
364.76900000000001 |
364.76900000000001 |
193.113 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Laboratory |
86.81 |
81025 |
39.064500000000002 |
85.073800000000006 |
78.129000000000005 |
69.882050000000007 |
57.989080000000001 |
55.818830000000005 |
85.073800000000006 |
78.129000000000005 |
84.205699999999993 |
78.129000000000005 |
82.469499999999996 |
84.205699999999993 |
62.5032 |
60.766999999999996 |
85.073800000000006 |
76.392800000000008 |
84.205699999999993 |
83.337599999999995 |
78.129000000000005 |
85.073800000000006 |
78.129000000000005 |
79.865200000000002 |
78.129000000000005 |
73.788499999999999 |
73.788499999999999 |
39.064500000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
|
|
|
|
|
Pathology |
546.32000000000005 |
88305 |
245.84400000000002 |
535.39359999999999 |
491.68800000000005 |
439.78760000000005 |
364.94176000000004 |
351.28376000000003 |
535.39359999999999 |
491.68800000000005 |
529.93040000000008 |
491.68800000000005 |
519.00400000000002 |
529.93040000000008 |
393.35040000000004 |
382.42400000000004 |
535.39359999999999 |
480.76160000000004 |
529.93040000000008 |
524.46720000000005 |
491.68800000000005 |
535.39359999999999 |
491.68800000000005 |
502.61440000000005 |
491.68800000000005 |
464.37200000000001 |
464.37200000000001 |
245.84400000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
|
|
|
|
|
Ultrasound examination of lower large bowel using an endoscope |
1308.6199999999999 |
45391 |
588.87900000000002 |
1600.4 |
1177.758 |
1053.4391000000001 |
874.15815999999995 |
841.44265999999993 |
1282.4476 |
1177.758 |
1269.3613999999998 |
1177.758 |
1243.1889999999999 |
1269.3613999999998 |
942.20639999999992 |
916.03399999999988 |
1282.4476 |
1151.5855999999999 |
1269.3613999999998 |
1256.2751999999998 |
1177.758 |
1282.4476 |
1177.758 |
1203.9304 |
1177.758 |
1112.3269999999998 |
1112.3269999999998 |
588.87900000000002 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
1000.25 |
980.245 |
1600.4 |
852.6 |
836.36 |
836.36 |
852.6 |
844.48 |
|
Pharmacy/drugs administered |
513.25 |
0250/0636 |
230.96250000000001 |
502.98500000000001 |
461.92500000000001 |
413.16625000000005 |
342.851 |
330.01974999999999 |
502.98500000000001 |
461.92500000000001 |
497.85249999999996 |
461.92500000000001 |
487.58749999999998 |
497.85249999999996 |
369.53999999999996 |
359.27499999999998 |
502.98500000000001 |
451.66 |
497.85249999999996 |
492.71999999999997 |
461.92500000000001 |
502.98500000000001 |
461.92500000000001 |
472.19 |
461.92500000000001 |
436.26249999999999 |
436.26249999999999 |
230.96250000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
617.09 |
0270-0278 |
277.69050000000004 |
604.7482 |
555.38100000000009 |
496.75745000000006 |
412.21612000000005 |
396.78887000000003 |
604.7482 |
555.38100000000009 |
598.57730000000004 |
555.38100000000009 |
586.2355 |
598.57730000000004 |
444.3048 |
431.96300000000002 |
604.7482 |
543.03920000000005 |
598.57730000000004 |
592.40639999999996 |
555.38100000000009 |
604.7482 |
555.38100000000009 |
567.72280000000001 |
555.38100000000009 |
524.52650000000006 |
524.52650000000006 |
277.69050000000004 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
486.17 |
88305 |
218.7765 |
476.44659999999999 |
437.553 |
391.36685000000006 |
324.76156000000003 |
312.60731000000004 |
476.44659999999999 |
437.553 |
471.5849 |
437.553 |
461.86149999999998 |
471.5849 |
350.04239999999999 |
340.31900000000002 |
476.44659999999999 |
427.82960000000003 |
471.5849 |
466.72320000000002 |
437.553 |
476.44659999999999 |
437.553 |
447.27640000000002 |
437.553 |
413.24450000000002 |
413.24450000000002 |
218.7765 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of gallbladder using an endoscope |
11587.18 |
47562 |
3336.3759999999997 |
11355.436400000001 |
10428.462000000001 |
9327.679900000001 |
7740.2362400000011 |
7450.55674 |
11355.436400000001 |
10428.462000000001 |
11239.5646 |
10428.462000000001 |
11007.821 |
11239.5646 |
8342.7695999999996 |
8111.0259999999998 |
11355.436400000001 |
10196.7184 |
11239.5646 |
11123.692800000001 |
10428.462000000001 |
11355.436400000001 |
10428.462000000001 |
10660.205600000001 |
10428.462000000001 |
9849.1029999999992 |
9849.1029999999992 |
5214.2310000000007 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4881.3 |
4783.674 |
7810.0800000000008 |
3401.16 |
3336.3759999999997 |
3336.3759999999997 |
3401.16 |
3368.768 |
|
Pharmacy/drugs administered |
2404.13 |
0250/0636 |
1081.8585 |
2356.0473999999999 |
2163.7170000000001 |
1935.3246500000002 |
1605.9588400000002 |
1545.8555900000001 |
2356.0473999999999 |
2163.7170000000001 |
2332.0061000000001 |
2163.7170000000001 |
2283.9234999999999 |
2332.0061000000001 |
1730.9736 |
1682.8910000000001 |
2356.0473999999999 |
2115.6343999999999 |
2332.0061000000001 |
2307.9648000000002 |
2163.7170000000001 |
2356.0473999999999 |
2163.7170000000001 |
2211.7996000000003 |
2163.7170000000001 |
2043.5105000000001 |
2043.5105000000001 |
1081.8585 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
5836.57 |
0270-0278 |
2626.4564999999998 |
5719.8386 |
5252.9129999999996 |
4698.4388500000005 |
3898.8287599999999 |
3752.9145100000001 |
5719.8386 |
5252.9129999999996 |
5661.4728999999998 |
5252.9129999999996 |
5544.7414999999992 |
5661.4728999999998 |
4202.3303999999998 |
4085.5989999999997 |
5719.8386 |
5136.1815999999999 |
5661.4728999999998 |
5603.1071999999995 |
5252.9129999999996 |
5719.8386 |
5252.9129999999996 |
5369.6444000000001 |
5252.9129999999996 |
4961.0844999999999 |
4961.0844999999999 |
2626.4564999999998 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Laboratory |
79.5 |
86328 |
35.774999999999999 |
77.91 |
71.55 |
63.997500000000002 |
53.106000000000002 |
51.118500000000004 |
77.91 |
71.55 |
77.114999999999995 |
71.55 |
75.524999999999991 |
77.114999999999995 |
57.239999999999995 |
55.65 |
77.91 |
69.959999999999994 |
77.114999999999995 |
76.319999999999993 |
71.55 |
77.91 |
71.55 |
73.14 |
71.55 |
67.575000000000003 |
67.575000000000003 |
35.774999999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
546.32000000000005 |
88304 |
245.84400000000002 |
535.39359999999999 |
491.68800000000005 |
439.78760000000005 |
364.94176000000004 |
351.28376000000003 |
535.39359999999999 |
491.68800000000005 |
529.93040000000008 |
491.68800000000005 |
519.00400000000002 |
529.93040000000008 |
393.35040000000004 |
382.42400000000004 |
535.39359999999999 |
480.76160000000004 |
529.93040000000008 |
524.46720000000005 |
491.68800000000005 |
535.39359999999999 |
491.68800000000005 |
502.61440000000005 |
491.68800000000005 |
464.37200000000001 |
464.37200000000001 |
245.84400000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Recovery Room |
1979.87 |
0710 |
890.94150000000002 |
1940.2725999999998 |
1781.883 |
1593.7953500000001 |
1322.5531599999999 |
1273.0564099999999 |
1940.2725999999998 |
1781.883 |
1920.4738999999997 |
1781.883 |
1880.8764999999999 |
1920.4738999999997 |
1425.5063999999998 |
1385.9089999999999 |
1940.2725999999998 |
1742.2855999999999 |
1920.4738999999997 |
1900.6751999999999 |
1781.883 |
1940.2725999999998 |
1781.883 |
1821.4803999999999 |
1781.883 |
1682.8894999999998 |
1682.8894999999998 |
890.94150000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Repair of groin hernia patient age 5 years or older |
7559.71 |
49505 |
2574.2378000000003 |
7408.5158000000001 |
6803.7390000000005 |
6085.5665500000005 |
5049.8862800000006 |
4860.8935300000003 |
7408.5158000000001 |
6803.7390000000005 |
7332.9187000000002 |
6803.7390000000005 |
7181.7244999999994 |
7332.9187000000002 |
5442.9911999999995 |
5291.7969999999996 |
7408.5158000000001 |
6652.5447999999997 |
7332.9187000000002 |
7257.3216000000002 |
6803.7390000000005 |
7408.5158000000001 |
6803.7390000000005 |
6954.9332000000004 |
6803.7390000000005 |
6425.7534999999998 |
6425.7534999999998 |
3401.8695000000002 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3070.72 |
3009.3055999999997 |
4913.152 |
2624.2230000000004 |
2574.2378000000003 |
2574.2378000000003 |
2624.2230000000004 |
2599.2304000000004 |
|
Pharmacy/drugs administered |
1039.75 |
0250/0636 |
467.88749999999999 |
1018.9549999999999 |
935.77499999999998 |
836.99875000000009 |
694.553 |
668.55925000000002 |
1018.9549999999999 |
935.77499999999998 |
1008.5575 |
935.77499999999998 |
987.76249999999993 |
1008.5575 |
748.62 |
727.82499999999993 |
1018.9549999999999 |
914.98 |
1008.5575 |
998.16 |
935.77499999999998 |
1018.9549999999999 |
935.77499999999998 |
956.57 |
935.77499999999998 |
883.78750000000002 |
883.78750000000002 |
467.88749999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
3409.91 |
0270-0278 |
1534.4594999999999 |
3341.7117999999996 |
3068.9189999999999 |
2744.9775500000001 |
2277.81988 |
2192.57213 |
3341.7117999999996 |
3068.9189999999999 |
3307.6126999999997 |
3068.9189999999999 |
3239.4144999999999 |
3307.6126999999997 |
2455.1351999999997 |
2386.9369999999999 |
3341.7117999999996 |
3000.7208000000001 |
3307.6126999999997 |
3273.5135999999998 |
3068.9189999999999 |
3341.7117999999996 |
3068.9189999999999 |
3137.1172000000001 |
3068.9189999999999 |
2898.4234999999999 |
2898.4234999999999 |
1534.4594999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Recovery Room |
2297.5 |
0710 |
1033.875 |
2251.5500000000002 |
2067.75 |
1849.4875000000002 |
1534.73 |
1477.2925 |
2251.5500000000002 |
2067.75 |
2228.5749999999998 |
2067.75 |
2182.625 |
2228.5749999999998 |
1654.2 |
1608.25 |
2251.5500000000002 |
2021.8 |
2228.5749999999998 |
2205.6 |
2067.75 |
2251.5500000000002 |
2067.75 |
2113.7000000000003 |
2067.75 |
1952.875 |
1952.875 |
1033.875 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Biopsy of prostate gland |
3048.7 |
55700 |
1371.915 |
2987.7259999999997 |
2743.83 |
2454.2035000000001 |
2036.5316 |
1960.3140999999998 |
2987.7259999999997 |
2743.83 |
2957.2389999999996 |
2743.83 |
2896.2649999999999 |
2957.2389999999996 |
2195.0639999999999 |
2134.0899999999997 |
2987.7259999999997 |
2682.8559999999998 |
2957.2389999999996 |
2926.7519999999995 |
2743.83 |
2987.7259999999997 |
2743.83 |
2804.8040000000001 |
2743.83 |
2591.395 |
2591.395 |
1371.915 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1729.52 |
1694.9295999999999 |
2767.232 |
1604.883 |
1574.3138000000001 |
1574.3138000000001 |
1604.883 |
1589.5984000000001 |
|
Supplies |
325.05 |
0270-0278 |
146.27250000000001 |
318.54899999999998 |
292.54500000000002 |
261.66525000000001 |
217.13340000000002 |
209.00715000000002 |
318.54899999999998 |
292.54500000000002 |
315.29849999999999 |
292.54500000000002 |
308.79750000000001 |
315.29849999999999 |
234.036 |
227.535 |
318.54899999999998 |
286.04400000000004 |
315.29849999999999 |
312.048 |
292.54500000000002 |
318.54899999999998 |
292.54500000000002 |
299.04600000000005 |
292.54500000000002 |
276.29250000000002 |
276.29250000000002 |
146.27250000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
2185.3000000000002 |
88305 |
983.3850000000001 |
2141.5940000000001 |
1966.7700000000002 |
1759.1665000000003 |
1459.7804000000001 |
1405.1479000000002 |
2141.5940000000001 |
1966.7700000000002 |
2119.741 |
1966.7700000000002 |
2076.0349999999999 |
2119.741 |
1573.4160000000002 |
1529.71 |
2141.5940000000001 |
1923.0640000000001 |
2119.741 |
2097.8879999999999 |
1966.7700000000002 |
2141.5940000000001 |
1966.7700000000002 |
2010.4760000000003 |
1966.7700000000002 |
1857.5050000000001 |
1857.5050000000001 |
983.3850000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pathology |
1193.56 |
88342 |
537.10199999999998 |
1169.6887999999999 |
1074.204 |
960.81579999999997 |
797.29808000000003 |
767.45907999999997 |
1169.6887999999999 |
1074.204 |
1157.7531999999999 |
1074.204 |
1133.8819999999998 |
1157.7531999999999 |
859.36319999999989 |
835.49199999999996 |
1169.6887999999999 |
1050.3327999999999 |
1157.7531999999999 |
1145.8175999999999 |
1074.204 |
1169.6887999999999 |
1074.204 |
1098.0752 |
1074.204 |
1014.526 |
1014.526 |
537.10199999999998 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Radiology |
1575.48 |
76872 |
226.09530000000001 |
1543.9703999999999 |
1417.932 |
1268.2614000000001 |
1052.42064 |
1013.03364 |
1543.9703999999999 |
1417.932 |
1528.2156 |
1417.932 |
1496.7059999999999 |
1528.2156 |
1134.3455999999999 |
1102.836 |
1543.9703999999999 |
1386.4223999999999 |
1528.2156 |
1512.4608000000001 |
1417.932 |
1543.9703999999999 |
1417.932 |
1449.4416000000001 |
1417.932 |
1339.1579999999999 |
1339.1579999999999 |
708.96600000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
230.4855 |
226.09530000000001 |
226.1 |
230.4855 |
228.29040000000001 |
|
CT scan, head or brain, with contrast |
2406.4 |
70460 |
168.78539999999998 |
2358.2719999999999 |
2165.7600000000002 |
1937.1520000000003 |
1607.4752000000001 |
1547.3152 |
2358.2719999999999 |
2165.7600000000002 |
2334.2080000000001 |
2165.7600000000002 |
2286.08 |
2334.2080000000001 |
1732.6079999999999 |
1684.48 |
2358.2719999999999 |
2117.6320000000001 |
2334.2080000000001 |
2310.1439999999998 |
2165.7600000000002 |
2358.2719999999999 |
2165.7600000000002 |
2213.8880000000004 |
2165.7600000000002 |
2045.44 |
2045.44 |
1082.8800000000001 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Injection of substance into spinal canal of lower back or sacrum using imaging guidance |
2239.41 |
62322-62323 |
599.88739999999996 |
2194.6217999999999 |
2015.4689999999998 |
1802.72505 |
1495.92588 |
1439.9406300000001 |
2194.6217999999999 |
2015.4689999999998 |
2172.2276999999999 |
2015.4689999999998 |
2127.4395 |
2172.2276999999999 |
1612.3751999999997 |
1567.5869999999998 |
2194.6217999999999 |
1970.6807999999999 |
2172.2276999999999 |
2149.8335999999999 |
2015.4689999999998 |
2194.6217999999999 |
2015.4689999999998 |
2060.2572 |
2015.4689999999998 |
1903.4984999999999 |
1903.4984999999999 |
1007.7344999999999 |
612.13 |
612.13 |
612.13 |
612.13 |
612.13 |
612.13 |
612.13 |
612.13 |
612.13 |
612.13 |
599.88739999999996 |
979.40800000000002 |
952.41300000000001 |
934.27179999999998 |
934.27179999999998 |
952.41300000000001 |
943.3424 |
|
Pharmacy/drugs administered |
225.41 |
0250/0636 |
101.4345 |
220.90179999999998 |
202.869 |
181.45505 |
150.57388 |
144.93862999999999 |
220.90179999999998 |
202.869 |
218.64769999999999 |
202.869 |
214.1395 |
218.64769999999999 |
162.29519999999999 |
157.78699999999998 |
220.90179999999998 |
198.36080000000001 |
218.64769999999999 |
216.39359999999999 |
202.869 |
220.90179999999998 |
202.869 |
207.37720000000002 |
202.869 |
191.5985 |
191.5985 |
101.4345 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
70.23 |
0270-0278 |
31.603500000000004 |
68.825400000000002 |
63.207000000000008 |
56.535150000000009 |
46.913640000000008 |
45.157890000000002 |
68.825400000000002 |
63.207000000000008 |
68.123100000000008 |
63.207000000000008 |
66.718500000000006 |
68.123100000000008 |
50.565600000000003 |
49.161000000000001 |
68.825400000000002 |
61.802400000000006 |
68.123100000000008 |
67.4208 |
63.207000000000008 |
68.825400000000002 |
63.207000000000008 |
64.61160000000001 |
63.207000000000008 |
59.695500000000003 |
59.695500000000003 |
31.603500000000004 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance |
1551.7 |
64483 |
698.26499999999999 |
1520.6659999999999 |
1396.53 |
1249.1185 |
1036.5356000000002 |
997.74310000000003 |
1520.6659999999999 |
1396.53 |
1505.1490000000001 |
1396.53 |
1474.115 |
1505.1490000000001 |
1117.2239999999999 |
1086.19 |
1520.6659999999999 |
1365.4960000000001 |
1505.1490000000001 |
1489.6320000000001 |
1396.53 |
1520.6659999999999 |
1396.53 |
1427.5640000000001 |
1396.53 |
1318.9449999999999 |
1318.9449999999999 |
698.26499999999999 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
777.47320000000002 |
1269.3440000000001 |
952.41300000000001 |
934.27179999999998 |
934.27179999999998 |
952.41300000000001 |
943.3424 |
|
Pharmacy/drugs administered |
141.96 |
0250/0636 |
63.882000000000005 |
139.1208 |
127.76400000000001 |
114.27780000000001 |
94.829280000000011 |
91.280280000000005 |
139.1208 |
127.76400000000001 |
137.7012 |
127.76400000000001 |
134.86199999999999 |
137.7012 |
102.21120000000001 |
99.372 |
139.1208 |
124.9248 |
137.7012 |
136.2816 |
127.76400000000001 |
139.1208 |
127.76400000000001 |
130.60320000000002 |
127.76400000000001 |
120.666 |
120.666 |
63.882000000000005 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
62.49 |
0270-0278 |
28.1205 |
61.240200000000002 |
56.241 |
50.304450000000003 |
41.743320000000004 |
40.181070000000005 |
61.240200000000002 |
56.241 |
60.615299999999998 |
56.241 |
59.365499999999997 |
60.615299999999998 |
44.992800000000003 |
43.743000000000002 |
61.240200000000002 |
54.991199999999999 |
60.615299999999998 |
59.990400000000001 |
56.241 |
61.240200000000002 |
56.241 |
57.490800000000007 |
56.241 |
53.116500000000002 |
53.116500000000002 |
28.1205 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of recurring cataract in lens capsule using laser |
1966.36 |
66821 |
476.2996 |
1927.0328 |
1769.7239999999999 |
1582.9198000000001 |
1313.5284799999999 |
1264.3694800000001 |
1927.0328 |
1769.7239999999999 |
1907.3691999999999 |
1769.7239999999999 |
1868.0419999999999 |
1907.3691999999999 |
1415.7791999999999 |
1376.4519999999998 |
1927.0328 |
1730.3968 |
1907.3691999999999 |
1887.7055999999998 |
1769.7239999999999 |
1927.0328 |
1769.7239999999999 |
1809.0511999999999 |
1769.7239999999999 |
1671.4059999999999 |
1671.4059999999999 |
884.86199999999997 |
486.02 |
486.02 |
486.02 |
486.02 |
486.02 |
486.02 |
486.02 |
486.02 |
486.02 |
486.02 |
476.2996 |
777.63200000000006 |
592.47300000000007 |
581.18780000000004 |
581.18780000000004 |
592.47300000000007 |
586.83040000000005 |
|
Pharmacy/drugs administered |
71.63 |
0250/0636 |
32.233499999999999 |
70.197399999999988 |
64.466999999999999 |
57.662149999999997 |
47.848840000000003 |
46.05809 |
70.197399999999988 |
64.466999999999999 |
69.481099999999998 |
64.466999999999999 |
68.04849999999999 |
69.481099999999998 |
51.573599999999992 |
50.140999999999991 |
70.197399999999988 |
63.034399999999998 |
69.481099999999998 |
68.764799999999994 |
64.466999999999999 |
70.197399999999988 |
64.466999999999999 |
65.899599999999992 |
64.466999999999999 |
60.885499999999993 |
60.885499999999993 |
32.233499999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Removal of cataract with insertion of lens |
5401.55 |
66984 |
1446.6967999999999 |
5293.5190000000002 |
4861.3950000000004 |
4348.2477500000005 |
3608.2354000000005 |
3473.1966500000003 |
5293.5190000000002 |
4861.3950000000004 |
5239.5034999999998 |
4861.3950000000004 |
5131.4724999999999 |
5239.5034999999998 |
3889.116 |
3781.085 |
5293.5190000000002 |
4753.3640000000005 |
5239.5034999999998 |
5185.4880000000003 |
4861.3950000000004 |
5293.5190000000002 |
4861.3950000000004 |
4969.4260000000004 |
4861.3950000000004 |
4591.3175000000001 |
4591.3175000000001 |
2430.6975000000002 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
2005.56 |
1965.4487999999999 |
3208.8960000000002 |
1474.788 |
1446.6967999999999 |
1446.6967999999999 |
1474.788 |
1460.7424000000001 |
|
Pharmacy/drugs administered |
1131.44 |
0250/0636 |
509.14800000000002 |
1108.8112000000001 |
1018.296 |
910.80920000000015 |
755.80192000000011 |
727.51592000000005 |
1108.8112000000001 |
1018.296 |
1097.4968000000001 |
1018.296 |
1074.8679999999999 |
1097.4968000000001 |
814.63679999999999 |
792.00800000000004 |
1108.8112000000001 |
995.66720000000009 |
1097.4968000000001 |
1086.1823999999999 |
1018.296 |
1108.8112000000001 |
1018.296 |
1040.9248 |
1018.296 |
961.72400000000005 |
961.72400000000005 |
509.14800000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
2231.1999999999998 |
0270-0278 |
1004.04 |
2186.5759999999996 |
2008.08 |
1796.116 |
1490.4415999999999 |
1434.6615999999999 |
2186.5759999999996 |
2008.08 |
2164.2639999999997 |
2008.08 |
2119.64 |
2164.2639999999997 |
1606.4639999999997 |
1561.8399999999997 |
2186.5759999999996 |
1963.4559999999999 |
2164.2639999999997 |
2141.9519999999998 |
2008.08 |
2186.5759999999996 |
2008.08 |
2052.7039999999997 |
2008.08 |
1896.5199999999998 |
1896.5199999999998 |
1004.04 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC). |
Estimated charges itemized below for average DRG case. |
Medicare DRG 470, Medicaid 3261 |
10103.7335 |
22870.944000000003 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14294.34 |
14008.4532 |
22870.944000000003 |
10299.922500000001 |
10103.7335 |
10103.7335 |
10299.922500000001 |
10201.828000000001 |
|
Room and Board accommodations |
3807 |
0121 |
1713.15 |
3730.86 |
3426.3 |
3064.6350000000002 |
2543.076 |
2447.9009999999998 |
3730.86 |
3426.3 |
3692.79 |
3426.3 |
3616.6499999999996 |
3692.79 |
2741.04 |
2664.8999999999996 |
3730.86 |
3350.16 |
3692.79 |
3654.72 |
3426.3 |
3730.86 |
3426.3 |
3502.44 |
3426.3 |
3235.95 |
3235.95 |
1713.15 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Pharmacy/drugs administered |
5328.11 |
0250/0636 |
2397.6495 |
5221.5477999999994 |
4795.299 |
4289.1285500000004 |
3559.1774799999998 |
3425.9747299999999 |
5221.5477999999994 |
4795.299 |
5168.2666999999992 |
4795.299 |
5061.7044999999998 |
5168.2666999999992 |
3836.2391999999995 |
3729.6769999999997 |
5221.5477999999994 |
4688.7367999999997 |
5168.2666999999992 |
5114.9855999999991 |
4795.299 |
5221.5477999999994 |
4795.299 |
4901.8612000000003 |
4795.299 |
4528.8934999999992 |
4528.8934999999992 |
2397.6495 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Supplies |
28317.58 |
0270-0278 |
12742.911000000002 |
27751.2284 |
25485.822000000004 |
22795.651900000004 |
18916.143440000003 |
18208.203940000003 |
27751.2284 |
25485.822000000004 |
27468.052600000003 |
25485.822000000004 |
26901.701000000001 |
27468.052600000003 |
20388.657600000002 |
19822.306 |
27751.2284 |
24919.470400000002 |
27468.052600000003 |
27184.876800000002 |
25485.822000000004 |
27751.2284 |
25485.822000000004 |
26052.173600000002 |
25485.822000000004 |
24069.942999999999 |
24069.942999999999 |
12742.911000000002 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Laboratory |
1020.62 |
0300 |
459.279 |
1000.2076 |
918.55799999999999 |
821.59910000000002 |
681.77416000000005 |
656.25865999999996 |
1000.2076 |
918.55799999999999 |
990.00139999999999 |
918.55799999999999 |
969.58899999999994 |
990.00139999999999 |
734.84640000000002 |
714.43399999999997 |
1000.2076 |
898.14560000000006 |
990.00139999999999 |
979.79520000000002 |
918.55799999999999 |
1000.2076 |
918.55799999999999 |
938.97040000000004 |
918.55799999999999 |
867.52699999999993 |
867.52699999999993 |
459.279 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Radiology |
549.22 |
0320 |
247.14900000000003 |
538.23559999999998 |
494.29800000000006 |
442.12210000000005 |
366.87896000000006 |
353.14846 |
538.23559999999998 |
494.29800000000006 |
532.74340000000007 |
494.29800000000006 |
521.75900000000001 |
532.74340000000007 |
395.4384 |
384.45400000000001 |
538.23559999999998 |
483.31360000000001 |
532.74340000000007 |
527.25120000000004 |
494.29800000000006 |
538.23559999999998 |
494.29800000000006 |
505.28240000000005 |
494.29800000000006 |
466.83699999999999 |
466.83699999999999 |
247.14900000000003 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Surgical procedure |
10299.42 |
0360 |
4634.7390000000005 |
10093.4316 |
9269.478000000001 |
8291.0331000000006 |
6880.0125600000001 |
6622.5270600000003 |
10093.4316 |
9269.478000000001 |
9990.4373999999989 |
9269.478000000001 |
9784.4489999999987 |
9990.4373999999989 |
7415.5823999999993 |
7209.5939999999991 |
10093.4316 |
9063.4896000000008 |
9990.4373999999989 |
9887.4431999999997 |
9269.478000000001 |
10093.4316 |
9269.478000000001 |
9475.4664000000012 |
9269.478000000001 |
8754.5069999999996 |
8754.5069999999996 |
4634.7390000000005 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Physical Therapy |
1745.68 |
0420-0424 |
785.55600000000004 |
1710.7664 |
1571.1120000000001 |
1405.2724000000001 |
1166.1142400000001 |
1122.4722400000001 |
1710.7664 |
1571.1120000000001 |
1693.3096 |
1571.1120000000001 |
1658.396 |
1693.3096 |
1256.8896 |
1221.9759999999999 |
1710.7664 |
1536.1984 |
1693.3096 |
1675.8527999999999 |
1571.1120000000001 |
1710.7664 |
1571.1120000000001 |
1606.0256000000002 |
1571.1120000000001 |
1483.828 |
1483.828 |
785.55600000000004 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Occupational Therapy |
286.01 |
0430-0434 |
128.7045 |
280.28980000000001 |
257.40899999999999 |
230.23805000000002 |
191.05468000000002 |
183.90442999999999 |
280.28980000000001 |
257.40899999999999 |
277.42969999999997 |
257.40899999999999 |
271.70949999999999 |
277.42969999999997 |
205.9272 |
200.20699999999999 |
280.28980000000001 |
251.68879999999999 |
277.42969999999997 |
274.56959999999998 |
257.40899999999999 |
280.28980000000001 |
257.40899999999999 |
263.12920000000003 |
257.40899999999999 |
243.10849999999999 |
243.10849999999999 |
128.7045 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Pulmonary Lab |
262.81 |
0460 |
118.2645 |
257.55380000000002 |
236.529 |
211.56205000000003 |
175.55708000000001 |
168.98683 |
257.55380000000002 |
236.529 |
254.92570000000001 |
236.529 |
249.6695 |
254.92570000000001 |
189.22319999999999 |
183.96699999999998 |
257.55380000000002 |
231.27279999999999 |
254.92570000000001 |
252.29759999999999 |
236.529 |
257.55380000000002 |
236.529 |
241.7852 |
236.529 |
223.38849999999999 |
223.38849999999999 |
118.2645 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Recovery Room |
2614.9499999999998 |
0710 |
1176.7275 |
2562.6509999999998 |
2353.4549999999999 |
2105.0347499999998 |
1746.7865999999999 |
1681.4128499999999 |
2562.6509999999998 |
2353.4549999999999 |
2536.5014999999999 |
2353.4549999999999 |
2484.2024999999999 |
2536.5014999999999 |
1882.7639999999999 |
1830.4649999999997 |
2562.6509999999998 |
2301.1559999999999 |
2536.5014999999999 |
2510.3519999999999 |
2353.4549999999999 |
2562.6509999999998 |
2353.4549999999999 |
2405.7539999999999 |
2353.4549999999999 |
2222.7075 |
2222.7075 |
1176.7275 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC) |
Estimated charges itemized below for average DRG case. |
Medicare DRG 743, Medicaid 5191 |
5231.4112000000005 |
13902.416000000001 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8689.01 |
8515.2297999999992 |
13902.416000000001 |
5332.9920000000002 |
5231.4112000000005 |
5231.4112000000005 |
5332.9920000000002 |
5282.2016000000003 |
|
Room and Board accommodations |
2538 |
0121 |
1142.1000000000001 |
2487.2399999999998 |
2284.2000000000003 |
2043.0900000000001 |
1695.384 |
1631.934 |
2487.2399999999998 |
2284.2000000000003 |
2461.86 |
2284.2000000000003 |
2411.1 |
2461.86 |
1827.36 |
1776.6 |
2487.2399999999998 |
2233.44 |
2461.86 |
2436.48 |
2284.2000000000003 |
2487.2399999999998 |
2284.2000000000003 |
2334.96 |
2284.2000000000003 |
2157.2999999999997 |
2157.2999999999997 |
1142.1000000000001 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Pharmacy/drugs administered |
5439.28 |
0250/0636 |
2447.6759999999999 |
5330.4943999999996 |
4895.3519999999999 |
4378.6203999999998 |
3633.4390400000002 |
3497.4570399999998 |
5330.4943999999996 |
4895.3519999999999 |
5276.1016 |
4895.3519999999999 |
5167.3159999999998 |
5276.1016 |
3916.2815999999998 |
3807.4959999999996 |
5330.4943999999996 |
4786.5663999999997 |
5276.1016 |
5221.7087999999994 |
4895.3519999999999 |
5330.4943999999996 |
4895.3519999999999 |
5004.1376 |
4895.3519999999999 |
4623.3879999999999 |
4623.3879999999999 |
2447.6759999999999 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Supplies |
3424.44 |
0270-0278 |
1540.998 |
3355.9512 |
3081.9960000000001 |
2756.6742000000004 |
2287.52592 |
2201.9149200000002 |
3355.9512 |
3081.9960000000001 |
3321.7067999999999 |
3081.9960000000001 |
3253.2179999999998 |
3321.7067999999999 |
2465.5967999999998 |
2397.1079999999997 |
3355.9512 |
3013.5072 |
3321.7067999999999 |
3287.4623999999999 |
3081.9960000000001 |
3355.9512 |
3081.9960000000001 |
3150.4848000000002 |
3081.9960000000001 |
2910.7739999999999 |
2910.7739999999999 |
1540.998 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Laboratory |
949.02 |
0300 |
427.05900000000003 |
930.03959999999995 |
854.11800000000005 |
763.96109999999999 |
633.94536000000005 |
610.21986000000004 |
930.03959999999995 |
854.11800000000005 |
920.54939999999999 |
854.11800000000005 |
901.56899999999996 |
920.54939999999999 |
683.2944 |
664.31399999999996 |
930.03959999999995 |
835.13760000000002 |
920.54939999999999 |
911.05919999999992 |
854.11800000000005 |
930.03959999999995 |
854.11800000000005 |
873.09839999999997 |
854.11800000000005 |
806.66699999999992 |
806.66699999999992 |
427.05900000000003 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Uterine and/or adnexa procedure |
16231.46 |
0360 |
7304.1570000000002 |
15906.8308 |
14608.314 |
13066.3253 |
10842.61528 |
10436.82878 |
15906.8308 |
14608.314 |
15744.516199999998 |
14608.314 |
15419.886999999999 |
15744.516199999998 |
11686.651199999998 |
11362.021999999999 |
15906.8308 |
14283.684799999999 |
15744.516199999998 |
15582.201599999999 |
14608.314 |
15906.8308 |
14608.314 |
14932.9432 |
14608.314 |
13796.740999999998 |
13796.740999999998 |
7304.1570000000002 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Recovery Room |
2615.13 |
0710 |
1176.8085000000001 |
2562.8274000000001 |
2353.6170000000002 |
2105.17965 |
1746.9068400000001 |
1681.5285900000001 |
2562.8274000000001 |
2353.6170000000002 |
2536.6761000000001 |
2353.6170000000002 |
2484.3735000000001 |
2536.6761000000001 |
1882.8936000000001 |
1830.5909999999999 |
2562.8274000000001 |
2301.3144000000002 |
2536.6761000000001 |
2510.5248000000001 |
2353.6170000000002 |
2562.8274000000001 |
2353.6170000000002 |
2405.9196000000002 |
2353.6170000000002 |
2222.8605000000002 |
2222.8605000000002 |
1176.8085000000001 |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
Packaged in DRG |
|
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC). |
N/A |
473 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Urgent Care Visit Level 1 |
131.05000000000001 |
99211 |
58.972500000000004 |
183.26400000000001 |
117.94500000000001 |
105.49525000000001 |
87.54140000000001 |
84.265150000000006 |
128.429 |
117.94500000000001 |
127.11850000000001 |
117.94500000000001 |
124.4975 |
127.11850000000001 |
94.356000000000009 |
91.734999999999999 |
128.429 |
115.32400000000001 |
127.11850000000001 |
125.80800000000001 |
117.94500000000001 |
128.429 |
117.94500000000001 |
120.56600000000002 |
117.94500000000001 |
111.39250000000001 |
111.39250000000001 |
58.972500000000004 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Urgent Care Visit Level 2 |
165.45 |
99212 |
74.452500000000001 |
183.26400000000001 |
148.905 |
133.18725000000001 |
110.5206 |
106.38435 |
162.14099999999999 |
148.905 |
160.48649999999998 |
148.905 |
157.17749999999998 |
160.48649999999998 |
119.12399999999998 |
115.81499999999998 |
162.14099999999999 |
145.596 |
160.48649999999998 |
158.83199999999999 |
148.905 |
162.14099999999999 |
148.905 |
152.214 |
148.905 |
140.63249999999999 |
140.63249999999999 |
74.452500000000001 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Urgent Care Visit Level 3 |
185.4 |
99213 |
83.43 |
183.26400000000001 |
166.86 |
149.24700000000001 |
123.84720000000002 |
119.21220000000001 |
181.69200000000001 |
166.86 |
179.83799999999999 |
166.86 |
176.13 |
179.83799999999999 |
133.488 |
129.78 |
181.69200000000001 |
163.15200000000002 |
179.83799999999999 |
177.98400000000001 |
166.86 |
181.69200000000001 |
166.86 |
170.56800000000001 |
166.86 |
157.59 |
157.59 |
83.43 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Electrocardiogram (ECG) |
168.75 |
93005 |
52.616199999999999 |
165.375 |
151.875 |
135.84375 |
112.72500000000001 |
108.50625000000001 |
165.375 |
151.875 |
163.6875 |
151.875 |
160.3125 |
163.6875 |
121.5 |
118.12499999999999 |
165.375 |
148.5 |
163.6875 |
162 |
151.875 |
165.375 |
151.875 |
155.25 |
151.875 |
143.4375 |
143.4375 |
75.9375 |
53.69 |
53.69 |
53.69 |
53.69 |
53.69 |
53.69 |
53.69 |
53.69 |
53.69 |
53.69 |
52.616199999999999 |
85.903999999999996 |
64.449000000000012 |
63.221400000000003 |
63.221400000000003 |
64.449000000000012 |
63.835200000000007 |
Lab Test: Magnesium |
39.6 |
83735 |
6.5659999999999998 |
38.808 |
35.64 |
31.878000000000004 |
26.452800000000003 |
25.462800000000001 |
38.808 |
35.64 |
38.411999999999999 |
35.64 |
37.619999999999997 |
38.411999999999999 |
28.512 |
27.72 |
38.808 |
34.847999999999999 |
38.411999999999999 |
38.015999999999998 |
35.64 |
38.808 |
35.64 |
36.432000000000002 |
35.64 |
33.660000000000004 |
33.660000000000004 |
17.82 |
6.7 |
6.7 |
6.7 |
6.7 |
6.7 |
6.7 |
6.7 |
6.7 |
6.7 |
6.7 |
6.5659999999999998 |
10.72 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
Lab Test: Hemoglobin A1C |
86.75 |
83036 |
9.5158000000000005 |
85.015000000000001 |
78.075000000000003 |
69.833750000000009 |
57.949000000000005 |
55.780250000000002 |
85.015000000000001 |
78.075000000000003 |
84.147499999999994 |
78.075000000000003 |
82.412499999999994 |
84.147499999999994 |
62.46 |
60.724999999999994 |
85.015000000000001 |
76.34 |
84.147499999999994 |
83.28 |
78.075000000000003 |
85.015000000000001 |
78.075000000000003 |
79.81 |
78.075000000000003 |
73.737499999999997 |
73.737499999999997 |
39.037500000000001 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.7100000000000009 |
9.5158000000000005 |
15.536000000000001 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
Nebulizer treatment with Aerosol |
94.05 |
94640 |
42.322499999999998 |
384.53100000000006 |
84.644999999999996 |
75.710250000000002 |
62.825400000000002 |
60.474150000000002 |
92.168999999999997 |
84.644999999999996 |
91.228499999999997 |
84.644999999999996 |
89.347499999999997 |
91.228499999999997 |
67.715999999999994 |
65.834999999999994 |
92.168999999999997 |
82.763999999999996 |
91.228499999999997 |
90.287999999999997 |
84.644999999999996 |
92.168999999999997 |
84.644999999999996 |
86.525999999999996 |
84.644999999999996 |
79.942499999999995 |
79.942499999999995 |
42.322499999999998 |
181.23 |
181.23 |
181.23 |
181.23 |
181.23 |
181.23 |
181.23 |
181.23 |
181.23 |
181.23 |
177.60539999999997 |
289.96800000000002 |
384.53100000000006 |
377.20660000000004 |
377.20660000000004 |
384.53100000000006 |
380.86880000000002 |
Urine culture test |
51.25 |
87086 |
7.9085999999999999 |
50.225000000000001 |
46.125 |
41.256250000000001 |
34.234999999999999 |
32.953749999999999 |
50.225000000000001 |
46.125 |
49.712499999999999 |
46.125 |
48.6875 |
49.712499999999999 |
36.9 |
35.875 |
50.225000000000001 |
45.1 |
49.712499999999999 |
49.199999999999996 |
46.125 |
50.225000000000001 |
46.125 |
47.15 |
46.125 |
43.5625 |
43.5625 |
23.0625 |
8.07 |
8.07 |
8.07 |
8.07 |
8.07 |
8.07 |
8.07 |
8.07 |
8.07 |
8.07 |
7.9085999999999999 |
12.912000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
Lab Test: Troponin I |
173.1 |
84484 |
12.220600000000001 |
169.63800000000001 |
155.79 |
139.34550000000002 |
115.63080000000001 |
111.30329999999999 |
169.63800000000001 |
155.79 |
167.90699999999998 |
155.79 |
164.44499999999999 |
167.90699999999998 |
124.63199999999999 |
121.16999999999999 |
169.63800000000001 |
152.328 |
167.90699999999998 |
166.17599999999999 |
155.79 |
169.63800000000001 |
155.79 |
159.25200000000001 |
155.79 |
147.13499999999999 |
147.13499999999999 |
77.894999999999996 |
12.47 |
12.47 |
12.47 |
12.47 |
12.47 |
12.47 |
12.47 |
12.47 |
12.47 |
12.47 |
12.220600000000001 |
19.952000000000002 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
X-ray of chest and left lateral area |
440.35 |
71046 |
76.479200000000006 |
431.54300000000001 |
396.31500000000005 |
354.48175000000003 |
294.15380000000005 |
283.14505000000003 |
431.54300000000001 |
396.31500000000005 |
427.1395 |
396.31500000000005 |
418.33249999999998 |
427.1395 |
317.05200000000002 |
308.245 |
431.54300000000001 |
387.50800000000004 |
427.1395 |
422.73599999999999 |
396.31500000000005 |
431.54300000000001 |
396.31500000000005 |
405.12200000000001 |
396.31500000000005 |
374.29750000000001 |
374.29750000000001 |
198.15750000000003 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
Knee X-ray, 1 or 2 views (unilateral) |
549.25 |
73560 |
75.205199999999991 |
538.26499999999999 |
494.32499999999999 |
442.14625000000001 |
366.899 |
353.16775000000001 |
538.26499999999999 |
494.32499999999999 |
532.77250000000004 |
494.32499999999999 |
521.78750000000002 |
532.77250000000004 |
395.46 |
384.47499999999997 |
538.26499999999999 |
483.34 |
532.77250000000004 |
527.28 |
494.32499999999999 |
538.26499999999999 |
494.32499999999999 |
505.31 |
494.32499999999999 |
466.86250000000001 |
466.86250000000001 |
247.16249999999999 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
76.739999999999995 |
75.205199999999991 |
122.78399999999999 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
Knee X-ray, 1 or 2 views (bilateral) |
1098.5 |
73560 - 50 |
76.479200000000006 |
1076.53 |
988.65 |
884.29250000000002 |
733.798 |
706.33550000000002 |
1076.53 |
988.65 |
1065.5450000000001 |
988.65 |
1043.575 |
1065.5450000000001 |
790.92 |
768.94999999999993 |
1076.53 |
966.68 |
1065.5450000000001 |
1054.56 |
988.65 |
1076.53 |
988.65 |
1010.62 |
988.65 |
933.72500000000002 |
933.72500000000002 |
494.32499999999999 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Ankle (3 views) |
413.6 |
73610 |
76.479200000000006 |
405.32800000000003 |
372.24 |
332.94800000000004 |
276.28480000000002 |
265.94480000000004 |
405.32800000000003 |
372.24 |
401.19200000000001 |
372.24 |
392.92 |
401.19200000000001 |
297.79200000000003 |
289.52 |
405.32800000000003 |
363.96800000000002 |
401.19200000000001 |
397.05599999999998 |
372.24 |
405.32800000000003 |
372.24 |
380.51200000000006 |
372.24 |
351.56 |
351.56 |
186.12 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
Ankle X-ray, 3 views (bilateral) |
827.2 |
73610 - 50 |
76.479200000000006 |
810.65600000000006 |
744.48 |
665.89600000000007 |
552.56960000000004 |
531.88960000000009 |
810.65600000000006 |
744.48 |
802.38400000000001 |
744.48 |
785.84 |
802.38400000000001 |
595.58400000000006 |
579.04 |
810.65600000000006 |
727.93600000000004 |
802.38400000000001 |
794.11199999999997 |
744.48 |
810.65600000000006 |
744.48 |
761.02400000000011 |
744.48 |
703.12 |
703.12 |
372.24 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
X-Ray of the shoulder, 4 views |
599.20000000000005 |
73030 |
76.479200000000006 |
587.21600000000001 |
539.28000000000009 |
482.35600000000005 |
400.26560000000006 |
385.28560000000004 |
587.21600000000001 |
539.28000000000009 |
581.22400000000005 |
539.28000000000009 |
569.24 |
581.22400000000005 |
431.42400000000004 |
419.44 |
587.21600000000001 |
527.29600000000005 |
581.22400000000005 |
575.23199999999997 |
539.28000000000009 |
587.21600000000001 |
539.28000000000009 |
551.26400000000001 |
539.28000000000009 |
509.32000000000005 |
509.32000000000005 |
269.64000000000004 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
Coagulation Visit Level |
219.4 |
G0463 |
98.73 |
215.012 |
197.46 |
176.61700000000002 |
146.5592 |
141.07420000000002 |
215.012 |
197.46 |
212.81800000000001 |
197.46 |
208.43 |
212.81800000000001 |
157.96799999999999 |
153.57999999999998 |
215.012 |
193.072 |
212.81800000000001 |
210.624 |
197.46 |
215.012 |
197.46 |
201.84800000000001 |
197.46 |
186.49 |
186.49 |
98.73 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Screening mammogram, tomosynthesis used |
44.95 |
77063 |
20.227500000000003 |
44.051000000000002 |
40.455000000000005 |
36.184750000000001 |
30.026600000000002 |
28.902850000000001 |
44.051000000000002 |
40.455000000000005 |
43.601500000000001 |
40.455000000000005 |
42.702500000000001 |
43.601500000000001 |
32.364000000000004 |
31.465 |
44.051000000000002 |
39.556000000000004 |
43.601500000000001 |
43.152000000000001 |
40.455000000000005 |
44.051000000000002 |
40.455000000000005 |
41.354000000000006 |
40.455000000000005 |
38.207500000000003 |
38.207500000000003 |
20.227500000000003 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
22.794800000000002 |
37.216000000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
X-ray of the chest, single frontal view |
312.7 |
71045 |
76.479200000000006 |
306.44599999999997 |
281.43 |
251.7235 |
208.8836 |
201.06610000000001 |
306.44599999999997 |
281.43 |
303.31899999999996 |
281.43 |
297.065 |
303.31899999999996 |
225.14399999999998 |
218.89 |
306.44599999999997 |
275.17599999999999 |
303.31899999999996 |
300.19199999999995 |
281.43 |
306.44599999999997 |
281.43 |
287.68400000000003 |
281.43 |
265.79499999999996 |
265.79499999999996 |
140.715 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
Lab Test: Vitamin D levels |
266.89999999999998 |
82306 |
28.4788 |
261.56199999999995 |
240.20999999999998 |
214.8545 |
178.28919999999999 |
171.61669999999998 |
261.56199999999995 |
240.20999999999998 |
258.89299999999997 |
240.20999999999998 |
253.55499999999998 |
258.89299999999997 |
192.16799999999998 |
186.82999999999998 |
261.56199999999995 |
234.87199999999999 |
258.89299999999997 |
256.22399999999999 |
240.20999999999998 |
261.56199999999995 |
240.20999999999998 |
245.548 |
240.20999999999998 |
226.86499999999998 |
226.86499999999998 |
120.10499999999999 |
29.06 |
29.06 |
29.06 |
29.06 |
29.06 |
29.06 |
29.06 |
29.06 |
29.06 |
29.06 |
28.4788 |
46.496000000000002 |
58.778999999999996 |
57.659399999999998 |
57.659399999999998 |
58.778999999999996 |
58.219200000000001 |
Ct scan of face |
2154.5 |
70486 |
103.0078 |
2111.41 |
1939.05 |
1734.3725000000002 |
1439.2060000000001 |
1385.3434999999999 |
2111.41 |
1939.05 |
2089.8649999999998 |
1939.05 |
2046.7749999999999 |
2089.8649999999998 |
1551.24 |
1508.1499999999999 |
2111.41 |
1895.96 |
2089.8649999999998 |
2068.3199999999997 |
1939.05 |
2111.41 |
1939.05 |
1982.14 |
1939.05 |
1831.325 |
1831.325 |
969.52499999999998 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
266.04899999999998 |
260.98140000000001 |
260.98140000000001 |
266.04899999999998 |
263.51519999999999 |
Lab Test: Lipase using serum |
86.35 |
83690 |
6.7521999999999993 |
84.62299999999999 |
77.715000000000003 |
69.511750000000006 |
57.681800000000003 |
55.523049999999998 |
84.62299999999999 |
77.715000000000003 |
83.759499999999989 |
77.715000000000003 |
82.032499999999985 |
83.759499999999989 |
62.171999999999997 |
60.444999999999993 |
84.62299999999999 |
75.988 |
83.759499999999989 |
82.895999999999987 |
77.715000000000003 |
84.62299999999999 |
77.715000000000003 |
79.441999999999993 |
77.715000000000003 |
73.397499999999994 |
73.397499999999994 |
38.857500000000002 |
6.89 |
6.89 |
6.89 |
6.89 |
6.89 |
6.89 |
6.89 |
6.89 |
6.89 |
6.89 |
6.7521999999999993 |
11.024000000000001 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
Lab Test: Identification of Organism 1st |
44.9 |
87077 |
7.9184000000000001 |
46.6935 |
40.409999999999997 |
36.144500000000001 |
29.993200000000002 |
28.870699999999999 |
44.001999999999995 |
40.409999999999997 |
43.552999999999997 |
40.409999999999997 |
42.654999999999994 |
43.552999999999997 |
32.327999999999996 |
31.429999999999996 |
44.001999999999995 |
39.512 |
43.552999999999997 |
43.103999999999999 |
40.409999999999997 |
44.001999999999995 |
40.409999999999997 |
41.308 |
40.409999999999997 |
38.164999999999999 |
38.164999999999999 |
20.204999999999998 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
7.9184000000000001 |
12.928000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
Lab Test: Bacterial culture for aerobic isolates, ea additional |
44.9 |
87077 |
7.9184000000000001 |
46.6935 |
40.409999999999997 |
36.144500000000001 |
29.993200000000002 |
28.870699999999999 |
44.001999999999995 |
40.409999999999997 |
43.552999999999997 |
40.409999999999997 |
42.654999999999994 |
43.552999999999997 |
32.327999999999996 |
31.429999999999996 |
44.001999999999995 |
39.512 |
43.552999999999997 |
43.103999999999999 |
40.409999999999997 |
44.001999999999995 |
40.409999999999997 |
41.308 |
40.409999999999997 |
38.164999999999999 |
38.164999999999999 |
20.204999999999998 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
8.08 |
7.9184000000000001 |
12.928000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Lab Test: LDL Direct |
81.400000000000006 |
83721 |
10.29 |
79.772000000000006 |
73.260000000000005 |
65.527000000000015 |
54.375200000000007 |
52.340200000000003 |
79.772000000000006 |
73.260000000000005 |
78.957999999999998 |
73.260000000000005 |
77.33 |
78.957999999999998 |
58.608000000000004 |
56.98 |
79.772000000000006 |
71.632000000000005 |
78.957999999999998 |
78.144000000000005 |
73.260000000000005 |
79.772000000000006 |
73.260000000000005 |
74.888000000000005 |
73.260000000000005 |
69.19 |
69.19 |
36.630000000000003 |
10.5 |
10.5 |
10.5 |
10.5 |
10.5 |
10.5 |
10.5 |
10.5 |
10.5 |
10.5 |
10.29 |
16.8 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
Screening for Strep via throat culture |
92 |
87081 |
6.4973999999999998 |
90.16 |
82.8 |
74.06 |
61.456000000000003 |
59.155999999999999 |
90.16 |
82.8 |
89.24 |
82.8 |
87.399999999999991 |
89.24 |
66.239999999999995 |
64.399999999999991 |
90.16 |
80.959999999999994 |
89.24 |
88.32 |
82.8 |
90.16 |
82.8 |
84.64 |
82.8 |
78.2 |
78.2 |
41.4 |
6.63 |
6.63 |
6.63 |
6.63 |
6.63 |
6.63 |
6.63 |
6.63 |
6.63 |
6.63 |
6.4973999999999998 |
10.608000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
Lab Test: Micro Albumin/Creatine |
237.4 |
82043 |
5.6644000000000005 |
232.65200000000002 |
213.66 |
191.10700000000003 |
158.58320000000001 |
152.6482 |
232.65200000000002 |
213.66 |
230.27799999999999 |
213.66 |
225.53 |
230.27799999999999 |
170.928 |
166.18 |
232.65200000000002 |
208.91200000000001 |
230.27799999999999 |
227.904 |
213.66 |
232.65200000000002 |
213.66 |
218.40800000000002 |
213.66 |
201.79 |
201.79 |
106.83 |
5.78 |
5.78 |
5.78 |
5.78 |
5.78 |
5.78 |
5.78 |
5.78 |
5.78 |
5.78 |
5.6644000000000005 |
9.2480000000000011 |
16.768500000000003 |
16.449100000000001 |
16.449100000000001 |
16.768500000000003 |
16.608800000000002 |
Lab Test: Vitamin B12 |
115.4 |
82607 |
14.7784 |
113.092 |
103.86000000000001 |
92.897000000000006 |
77.08720000000001 |
74.202200000000005 |
113.092 |
103.86000000000001 |
111.938 |
103.86000000000001 |
109.63 |
111.938 |
83.088000000000008 |
80.78 |
113.092 |
101.55200000000001 |
111.938 |
110.78400000000001 |
103.86000000000001 |
113.092 |
103.86000000000001 |
106.16800000000001 |
103.86000000000001 |
98.09 |
98.09 |
51.930000000000007 |
15.08 |
15.08 |
15.08 |
15.08 |
15.08 |
15.08 |
15.08 |
15.08 |
15.08 |
15.08 |
14.7784 |
24.128 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
X-ray of the left wrist, 3 views |
524.25 |
73110 |
76.479200000000006 |
513.76499999999999 |
471.82499999999999 |
422.02125000000001 |
350.19900000000001 |
337.09275000000002 |
513.76499999999999 |
471.82499999999999 |
508.52249999999998 |
471.82499999999999 |
498.03749999999997 |
508.52249999999998 |
377.46 |
366.97499999999997 |
513.76499999999999 |
461.34 |
508.52249999999998 |
503.28 |
471.82499999999999 |
513.76499999999999 |
471.82499999999999 |
482.31 |
471.82499999999999 |
445.61250000000001 |
445.61250000000001 |
235.91249999999999 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
Lab Test: Blood culture |
94.2 |
87040 |
10.1136 |
92.316000000000003 |
84.78 |
75.831000000000003 |
62.925600000000003 |
60.570600000000006 |
92.316000000000003 |
84.78 |
91.373999999999995 |
84.78 |
89.49 |
91.373999999999995 |
67.823999999999998 |
65.94 |
92.316000000000003 |
82.896000000000001 |
91.373999999999995 |
90.432000000000002 |
84.78 |
92.316000000000003 |
84.78 |
86.664000000000001 |
84.78 |
80.070000000000007 |
80.070000000000007 |
42.39 |
10.32 |
10.32 |
10.32 |
10.32 |
10.32 |
10.32 |
10.32 |
10.32 |
10.32 |
10.32 |
10.1136 |
16.512 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
Lab Test: Gram Negative sensitivity |
43.1 |
87186 |
8.4770000000000003 |
46.6935 |
38.79 |
34.695500000000003 |
28.790800000000001 |
27.7133 |
42.238 |
38.79 |
41.807000000000002 |
38.79 |
40.945 |
41.807000000000002 |
31.032 |
30.169999999999998 |
42.238 |
37.928000000000004 |
41.807000000000002 |
41.375999999999998 |
38.79 |
42.238 |
38.79 |
39.652000000000001 |
38.79 |
36.634999999999998 |
36.634999999999998 |
19.395 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.4770000000000003 |
13.840000000000002 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
Lab Test: Chlamydia RNA |
202.95 |
87491 |
34.388200000000005 |
198.89099999999999 |
182.655 |
163.37475000000001 |
135.57060000000001 |
130.49684999999999 |
198.89099999999999 |
182.655 |
196.86149999999998 |
182.655 |
192.80249999999998 |
196.86149999999998 |
146.124 |
142.06499999999997 |
198.89099999999999 |
178.596 |
196.86149999999998 |
194.83199999999999 |
182.655 |
198.89099999999999 |
182.655 |
186.714 |
182.655 |
172.50749999999999 |
172.50749999999999 |
91.327500000000001 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
Lab Test: Lactic Acid |
120.15 |
83605 |
11.3386 |
117.747 |
108.13500000000001 |
96.72075000000001 |
80.260200000000012 |
77.256450000000001 |
117.747 |
108.13500000000001 |
116.5455 |
108.13500000000001 |
114.1425 |
116.5455 |
86.507999999999996 |
84.105000000000004 |
117.747 |
105.732 |
116.5455 |
115.34399999999999 |
108.13500000000001 |
117.747 |
108.13500000000001 |
110.53800000000001 |
108.13500000000001 |
102.1275 |
102.1275 |
54.067500000000003 |
11.57 |
11.57 |
11.57 |
11.57 |
11.57 |
11.57 |
11.57 |
11.57 |
11.57 |
11.57 |
11.3386 |
18.512 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
Lab Test: Gonorrhea RNA |
202.95 |
87591 |
34.388200000000005 |
198.89099999999999 |
182.655 |
163.37475000000001 |
135.57060000000001 |
130.49684999999999 |
198.89099999999999 |
182.655 |
196.86149999999998 |
182.655 |
192.80249999999998 |
196.86149999999998 |
146.124 |
142.06499999999997 |
198.89099999999999 |
178.596 |
196.86149999999998 |
194.83199999999999 |
182.655 |
198.89099999999999 |
182.655 |
186.714 |
182.655 |
172.50749999999999 |
172.50749999999999 |
91.327500000000001 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
Lab Test: ALT/SGPT |
43.55 |
84460 |
5.194 |
42.678999999999995 |
39.195 |
35.057749999999999 |
29.0914 |
28.002649999999999 |
42.678999999999995 |
39.195 |
42.243499999999997 |
39.195 |
41.372499999999995 |
42.243499999999997 |
31.355999999999998 |
30.484999999999996 |
42.678999999999995 |
38.323999999999998 |
42.243499999999997 |
41.807999999999993 |
39.195 |
42.678999999999995 |
39.195 |
40.066000000000003 |
39.195 |
37.017499999999998 |
37.017499999999998 |
19.5975 |
5.3 |
5.3 |
5.3 |
5.3 |
5.3 |
5.3 |
5.3 |
5.3 |
5.3 |
5.3 |
5.194 |
8.48 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Lab Test: Hematocrit level |
26.05 |
85014 |
2.3226 |
25.529 |
23.445 |
20.970250000000004 |
17.401400000000002 |
16.750150000000001 |
25.529 |
23.445 |
25.2685 |
23.445 |
24.747499999999999 |
25.2685 |
18.756 |
18.234999999999999 |
25.529 |
22.923999999999999 |
25.2685 |
25.007999999999999 |
23.445 |
25.529 |
23.445 |
23.966000000000001 |
23.445 |
22.142499999999998 |
22.142499999999998 |
11.7225 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.3226 |
3.7920000000000003 |
22.344000000000001 |
21.918400000000002 |
21.918400000000002 |
22.344000000000001 |
22.131200000000003 |
|
Lab Test: Hemoglobin level |
26.05 |
85018 |
2.3226 |
25.529 |
23.445 |
20.970250000000004 |
17.401400000000002 |
16.750150000000001 |
25.529 |
23.445 |
25.2685 |
23.445 |
24.747499999999999 |
25.2685 |
18.756 |
18.234999999999999 |
25.529 |
22.923999999999999 |
25.2685 |
25.007999999999999 |
23.445 |
25.529 |
23.445 |
23.966000000000001 |
23.445 |
22.142499999999998 |
22.142499999999998 |
11.7225 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.37 |
2.3226 |
3.7920000000000003 |
22.344000000000001 |
21.918400000000002 |
21.918400000000002 |
22.344000000000001 |
22.131200000000003 |
|
Lab Test: B Type Natriuretic Protein (BNP) |
135.30000000000001 |
83880 |
38.474799999999995 |
132.59400000000002 |
121.77000000000001 |
108.91650000000001 |
90.380400000000009 |
86.997900000000016 |
132.59400000000002 |
121.77000000000001 |
131.24100000000001 |
121.77000000000001 |
128.535 |
131.24100000000001 |
97.416000000000011 |
94.710000000000008 |
132.59400000000002 |
119.06400000000001 |
131.24100000000001 |
129.88800000000001 |
121.77000000000001 |
132.59400000000002 |
121.77000000000001 |
124.47600000000001 |
121.77000000000001 |
115.00500000000001 |
115.00500000000001 |
60.885000000000005 |
39.26 |
39.26 |
39.26 |
39.26 |
39.26 |
39.26 |
39.26 |
39.26 |
39.26 |
39.26 |
38.474799999999995 |
62.816000000000003 |
58.778999999999996 |
57.659399999999998 |
57.659399999999998 |
58.778999999999996 |
58.219200000000001 |
|
Screening Pap Smear, Thinprep |
216 |
88142 |
19.854800000000001 |
211.68 |
194.4 |
173.88000000000002 |
144.28800000000001 |
138.88800000000001 |
211.68 |
194.4 |
209.51999999999998 |
194.4 |
205.2 |
209.51999999999998 |
155.51999999999998 |
151.19999999999999 |
211.68 |
190.08 |
209.51999999999998 |
207.35999999999999 |
194.4 |
211.68 |
194.4 |
198.72 |
194.4 |
183.6 |
183.6 |
97.2 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
20.260000000000002 |
19.854800000000001 |
32.416000000000004 |
38.262 |
37.533200000000001 |
37.533200000000001 |
38.262 |
37.897599999999997 |
|
Pathology examination of tissue, intermediate complexity |
546.35 |
88305 |
47.04 |
535.423 |
491.71500000000003 |
439.81175000000002 |
364.96180000000004 |
351.30305000000004 |
535.423 |
491.71500000000003 |
529.95950000000005 |
491.71500000000003 |
519.03250000000003 |
529.95950000000005 |
393.37200000000001 |
382.44499999999999 |
535.423 |
480.78800000000001 |
529.95950000000005 |
524.49599999999998 |
491.71500000000003 |
535.423 |
491.71500000000003 |
502.64200000000005 |
491.71500000000003 |
464.39749999999998 |
464.39749999999998 |
245.85750000000002 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
47.04 |
76.800000000000011 |
109.23150000000001 |
107.15090000000001 |
107.15090000000001 |
109.23150000000001 |
108.19120000000001 |
|
Rapid Strep testing, point of care |
86.3 |
87880 |
16.199400000000001 |
84.573999999999998 |
77.67 |
69.471500000000006 |
57.648400000000002 |
55.490899999999996 |
84.573999999999998 |
77.67 |
83.710999999999999 |
77.67 |
81.984999999999999 |
83.710999999999999 |
62.135999999999996 |
60.41 |
84.573999999999998 |
75.944000000000003 |
83.710999999999999 |
82.847999999999999 |
77.67 |
84.573999999999998 |
77.67 |
79.396000000000001 |
77.67 |
73.35499999999999 |
73.35499999999999 |
38.835000000000001 |
16.53 |
16.53 |
16.53 |
16.53 |
16.53 |
16.53 |
16.53 |
16.53 |
16.53 |
16.53 |
16.199400000000001 |
26.448000000000004 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Lab Test: Ferritin level |
110 |
82728 |
13.3574 |
107.8 |
99 |
88.550000000000011 |
73.48 |
70.73 |
107.8 |
99 |
106.7 |
99 |
104.5 |
106.7 |
79.2 |
77 |
107.8 |
96.8 |
106.7 |
105.6 |
99 |
107.8 |
99 |
101.2 |
99 |
93.5 |
93.5 |
49.5 |
13.63 |
13.63 |
13.63 |
13.63 |
13.63 |
13.63 |
13.63 |
13.63 |
13.63 |
13.63 |
13.3574 |
21.808000000000003 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Lab Test: RH Type |
102.7 |
86901 |
17.4894 |
100.646 |
92.43 |
82.673500000000004 |
68.6036 |
66.036100000000005 |
100.646 |
92.43 |
99.619 |
92.43 |
97.564999999999998 |
99.619 |
73.944000000000003 |
71.89 |
100.646 |
90.376000000000005 |
99.619 |
98.591999999999999 |
92.43 |
100.646 |
92.43 |
94.484000000000009 |
92.43 |
87.295000000000002 |
87.295000000000002 |
46.215000000000003 |
32.64 |
32.64 |
32.64 |
32.64 |
32.64 |
32.64 |
32.64 |
32.64 |
32.64 |
32.64 |
31.987200000000001 |
52.224000000000004 |
17.829000000000001 |
17.4894 |
17.4894 |
17.829000000000001 |
17.659200000000002 |
|
Lab Test: Blood group typing |
208.75 |
86900 |
51.6648 |
204.57499999999999 |
187.875 |
168.04375000000002 |
139.44500000000002 |
134.22624999999999 |
204.57499999999999 |
187.875 |
202.48749999999998 |
187.875 |
198.3125 |
202.48749999999998 |
150.29999999999998 |
146.125 |
204.57499999999999 |
183.7 |
202.48749999999998 |
200.4 |
187.875 |
204.57499999999999 |
187.875 |
192.05 |
187.875 |
177.4375 |
177.4375 |
93.9375 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
105.83019999999999 |
172.78399999999999 |
52.667999999999999 |
51.6648 |
51.6648 |
52.667999999999999 |
52.166399999999996 |
|
CT scan of the middle spine |
2633.85 |
72128 |
103.0078 |
2581.1729999999998 |
2370.4650000000001 |
2120.2492499999998 |
1759.4118000000001 |
1693.56555 |
2581.1729999999998 |
2370.4650000000001 |
2554.8344999999999 |
2370.4650000000001 |
2502.1574999999998 |
2554.8344999999999 |
1896.3719999999998 |
1843.6949999999997 |
2581.1729999999998 |
2317.788 |
2554.8344999999999 |
2528.4959999999996 |
2370.4650000000001 |
2581.1729999999998 |
2370.4650000000001 |
2423.1419999999998 |
2370.4650000000001 |
2238.7725 |
2238.7725 |
1185.2325000000001 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
266.04899999999998 |
260.98140000000001 |
260.98140000000001 |
266.04899999999998 |
263.51519999999999 |
|
Physical Therapy - Gait Training per 15 mins |
96.3 |
97116 |
28.625800000000002 |
157.36350000000002 |
86.67 |
77.521500000000003 |
64.328400000000002 |
61.920900000000003 |
94.373999999999995 |
86.67 |
93.411000000000001 |
86.67 |
91.484999999999999 |
93.411000000000001 |
69.335999999999999 |
67.41 |
94.373999999999995 |
84.744 |
93.411000000000001 |
92.447999999999993 |
86.67 |
94.373999999999995 |
86.67 |
88.596000000000004 |
86.67 |
81.85499999999999 |
81.85499999999999 |
43.335000000000001 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
29.21 |
28.625800000000002 |
46.736000000000004 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Lab Test: LDH |
35.6 |
83615 |
5.9192 |
34.887999999999998 |
32.04 |
28.658000000000001 |
23.780800000000003 |
22.890800000000002 |
34.887999999999998 |
32.04 |
34.532000000000004 |
32.04 |
33.82 |
34.532000000000004 |
25.632000000000001 |
24.919999999999998 |
34.887999999999998 |
31.328000000000003 |
34.532000000000004 |
34.176000000000002 |
32.04 |
34.887999999999998 |
32.04 |
32.752000000000002 |
32.04 |
30.26 |
30.26 |
16.02 |
6.04 |
6.04 |
6.04 |
6.04 |
6.04 |
6.04 |
6.04 |
6.04 |
6.04 |
6.04 |
5.9192 |
9.6640000000000015 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Lab Test: Iron, Total |
53.25 |
83540 |
6.3405999999999993 |
52.185000000000002 |
47.925000000000004 |
42.866250000000001 |
35.571000000000005 |
34.239750000000001 |
52.185000000000002 |
47.925000000000004 |
51.652499999999996 |
47.925000000000004 |
50.587499999999999 |
51.652499999999996 |
38.339999999999996 |
37.274999999999999 |
52.185000000000002 |
46.86 |
51.652499999999996 |
51.12 |
47.925000000000004 |
52.185000000000002 |
47.925000000000004 |
48.99 |
47.925000000000004 |
45.262499999999996 |
45.262499999999996 |
23.962500000000002 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.47 |
6.3405999999999993 |
10.352 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Lab Test: Thyroxine (thyroid chemical) measurement |
315.64999999999998 |
84439 |
8.839599999999999 |
309.33699999999999 |
284.08499999999998 |
254.09825000000001 |
210.85419999999999 |
202.96294999999998 |
309.33699999999999 |
284.08499999999998 |
306.18049999999999 |
284.08499999999998 |
299.86749999999995 |
306.18049999999999 |
227.26799999999997 |
220.95499999999998 |
309.33699999999999 |
277.77199999999999 |
306.18049999999999 |
303.02399999999994 |
284.08499999999998 |
309.33699999999999 |
284.08499999999998 |
290.39799999999997 |
284.08499999999998 |
268.30249999999995 |
268.30249999999995 |
142.04249999999999 |
9.02 |
9.02 |
9.02 |
9.02 |
9.02 |
9.02 |
9.02 |
9.02 |
9.02 |
9.02 |
8.839599999999999 |
14.432 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Lab Test: Screening test for red blood cell antibodies |
186.85 |
86850 |
47.04 |
183.113 |
168.16499999999999 |
150.41425000000001 |
124.81580000000001 |
120.14455 |
183.113 |
168.16499999999999 |
181.24449999999999 |
168.16499999999999 |
177.50749999999999 |
181.24449999999999 |
134.53199999999998 |
130.79499999999999 |
183.113 |
164.428 |
181.24449999999999 |
179.37599999999998 |
168.16499999999999 |
183.113 |
168.16499999999999 |
171.90200000000002 |
168.16499999999999 |
158.82249999999999 |
158.82249999999999 |
84.082499999999996 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
48 |
47.04 |
76.800000000000011 |
52.667999999999999 |
51.6648 |
51.6648 |
52.667999999999999 |
52.166399999999996 |
|
Lab Test: Blood creatinine level |
53.95 |
82565 |
5.1057999999999995 |
52.871000000000002 |
48.555000000000007 |
43.429750000000006 |
36.038600000000002 |
34.68985 |
52.871000000000002 |
48.555000000000007 |
52.331499999999998 |
48.555000000000007 |
51.252499999999998 |
52.331499999999998 |
38.844000000000001 |
37.765000000000001 |
52.871000000000002 |
47.476000000000006 |
52.331499999999998 |
51.792000000000002 |
48.555000000000007 |
52.871000000000002 |
48.555000000000007 |
49.634000000000007 |
48.555000000000007 |
45.857500000000002 |
45.857500000000002 |
24.277500000000003 |
5.21 |
5.21 |
5.21 |
5.21 |
5.21 |
5.21 |
5.21 |
5.21 |
5.21 |
5.21 |
5.1057999999999995 |
8.3360000000000003 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Detection test by immunoassay for influenza virus A |
105.75 |
87804 |
16.219000000000001 |
103.63500000000001 |
95.174999999999997 |
85.128750000000011 |
70.641000000000005 |
67.997250000000008 |
103.63500000000001 |
95.174999999999997 |
102.5775 |
95.174999999999997 |
100.46249999999999 |
102.5775 |
76.14 |
74.024999999999991 |
103.63500000000001 |
93.06 |
102.5775 |
101.52 |
95.174999999999997 |
103.63500000000001 |
95.174999999999997 |
97.29 |
95.174999999999997 |
89.887500000000003 |
89.887500000000003 |
47.587499999999999 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.219000000000001 |
26.480000000000004 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Detection test by immunoassay for influenza virus B |
105.75 |
87804 |
16.219000000000001 |
103.63500000000001 |
95.174999999999997 |
85.128750000000011 |
70.641000000000005 |
67.997250000000008 |
103.63500000000001 |
95.174999999999997 |
102.5775 |
95.174999999999997 |
100.46249999999999 |
102.5775 |
76.14 |
74.024999999999991 |
103.63500000000001 |
93.06 |
102.5775 |
101.52 |
95.174999999999997 |
103.63500000000001 |
95.174999999999997 |
97.29 |
95.174999999999997 |
89.887500000000003 |
89.887500000000003 |
47.587499999999999 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.55 |
16.219000000000001 |
26.480000000000004 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Red blood cell sedimentation rate, to detect inflammation |
84.5 |
85652 |
2.6459999999999999 |
82.81 |
76.05 |
68.022500000000008 |
56.446000000000005 |
54.333500000000001 |
82.81 |
76.05 |
81.965000000000003 |
76.05 |
80.274999999999991 |
81.965000000000003 |
60.839999999999996 |
59.15 |
82.81 |
74.36 |
81.965000000000003 |
81.11999999999999 |
76.05 |
82.81 |
76.05 |
77.740000000000009 |
76.05 |
71.825000000000003 |
71.825000000000003 |
38.024999999999999 |
2.7 |
2.7 |
2.7 |
2.7 |
2.7 |
2.7 |
2.7 |
2.7 |
2.7 |
2.7 |
2.6459999999999999 |
4.32 |
22.344000000000001 |
21.918400000000002 |
21.918400000000002 |
22.344000000000001 |
22.131200000000003 |
|
Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow |
918.45 |
93976 |
103.0078 |
900.08100000000002 |
826.60500000000002 |
739.35225000000003 |
613.52460000000008 |
590.56335000000001 |
900.08100000000002 |
826.60500000000002 |
890.89650000000006 |
826.60500000000002 |
872.52750000000003 |
890.89650000000006 |
661.28399999999999 |
642.91499999999996 |
900.08100000000002 |
808.23599999999999 |
890.89650000000006 |
881.71199999999999 |
826.60500000000002 |
900.08100000000002 |
826.60500000000002 |
844.97400000000005 |
826.60500000000002 |
780.6825 |
780.6825 |
413.30250000000001 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
363.28950000000003 |
356.36970000000002 |
356.36970000000002 |
363.28950000000003 |
359.82960000000003 |
|
Application of hot or cold packs to 1 or more areas |
32.1 |
97010 |
0 |
62.2545 |
28.89 |
25.840500000000002 |
21.442800000000002 |
20.6403 |
31.458000000000002 |
28.89 |
31.137 |
28.89 |
30.495000000000001 |
31.137 |
23.112000000000002 |
22.47 |
31.458000000000002 |
28.248000000000001 |
31.137 |
30.815999999999999 |
28.89 |
31.458000000000002 |
28.89 |
29.532000000000004 |
28.89 |
27.285 |
27.285 |
14.445 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
62.2545 |
61.0687 |
61.0687 |
62.2545 |
61.6616 |
|
Lab Test: Procalcitonin (hormone) level |
326.45 |
84145 |
26.675599999999999 |
319.92099999999999 |
293.80500000000001 |
262.79225000000002 |
218.0686 |
209.90735000000001 |
319.92099999999999 |
293.80500000000001 |
316.65649999999999 |
293.80500000000001 |
310.1275 |
316.65649999999999 |
235.04399999999998 |
228.51499999999999 |
319.92099999999999 |
287.27600000000001 |
316.65649999999999 |
313.392 |
293.80500000000001 |
319.92099999999999 |
293.80500000000001 |
300.334 |
293.80500000000001 |
277.48249999999996 |
277.48249999999996 |
146.9025 |
27.22 |
27.22 |
27.22 |
27.22 |
27.22 |
27.22 |
27.22 |
27.22 |
27.22 |
27.22 |
26.675599999999999 |
43.552 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Lab Test: Iron binding capacity |
62.1 |
83550 |
8.5652000000000008 |
60.857999999999997 |
55.89 |
49.990500000000004 |
41.482800000000005 |
39.930300000000003 |
60.857999999999997 |
55.89 |
60.237000000000002 |
55.89 |
58.994999999999997 |
60.237000000000002 |
44.711999999999996 |
43.47 |
60.857999999999997 |
54.648000000000003 |
60.237000000000002 |
59.616 |
55.89 |
60.857999999999997 |
55.89 |
57.132000000000005 |
55.89 |
52.784999999999997 |
52.784999999999997 |
27.945 |
8.74 |
8.74 |
8.74 |
8.74 |
8.74 |
8.74 |
8.74 |
8.74 |
8.74 |
8.74 |
8.5652000000000008 |
13.984000000000002 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Outpatient heart rehabilitation with continuous EKG monitoring per session |
223.15 |
93798 |
100.4175 |
218.68700000000001 |
200.83500000000001 |
179.63575 |
149.0642 |
143.48545000000001 |
218.68700000000001 |
200.83500000000001 |
216.4555 |
200.83500000000001 |
211.99250000000001 |
216.4555 |
160.66800000000001 |
156.20499999999998 |
218.68700000000001 |
196.37200000000001 |
216.4555 |
214.22399999999999 |
200.83500000000001 |
218.68700000000001 |
200.83500000000001 |
205.298 |
200.83500000000001 |
189.67750000000001 |
189.67750000000001 |
100.4175 |
111.95 |
111.95 |
111.95 |
111.95 |
111.95 |
111.95 |
111.95 |
111.95 |
111.95 |
111.95 |
109.711 |
179.12 |
128.40450000000001 |
125.95870000000001 |
125.95870000000001 |
128.40450000000001 |
127.18160000000002 |
|
Coagulation function measurement |
114.1 |
85379 |
9.9763999999999999 |
111.818 |
102.69 |
91.850499999999997 |
76.218800000000002 |
73.366299999999995 |
111.818 |
102.69 |
110.67699999999999 |
102.69 |
108.395 |
110.67699999999999 |
82.151999999999987 |
79.86999999999999 |
111.818 |
100.408 |
110.67699999999999 |
109.53599999999999 |
102.69 |
111.818 |
102.69 |
104.97199999999999 |
102.69 |
96.984999999999999 |
96.984999999999999 |
51.344999999999999 |
10.18 |
10.18 |
10.18 |
10.18 |
10.18 |
10.18 |
10.18 |
10.18 |
10.18 |
10.18 |
9.9763999999999999 |
16.288 |
22.921499999999998 |
22.4849 |
22.4849 |
22.921499999999998 |
22.703199999999999 |
|
CT of the abdomen and pelvis |
5539.4 |
74176 |
217.54039999999998 |
5428.6119999999992 |
4985.46 |
4459.2169999999996 |
3700.3191999999999 |
3561.8341999999998 |
5428.6119999999992 |
4985.46 |
5373.2179999999998 |
4985.46 |
5262.4299999999994 |
5373.2179999999998 |
3988.3679999999995 |
3877.5799999999995 |
5428.6119999999992 |
4874.6719999999996 |
5373.2179999999998 |
5317.8239999999996 |
4985.46 |
5428.6119999999992 |
4985.46 |
5096.2479999999996 |
4985.46 |
4708.49 |
4708.49 |
2492.73 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
Special Gram or Giemsa stain for microorganism |
35.200000000000003 |
87205 |
4.1845999999999997 |
46.6935 |
31.680000000000003 |
28.336000000000006 |
23.513600000000004 |
22.633600000000001 |
34.496000000000002 |
31.680000000000003 |
34.143999999999998 |
31.680000000000003 |
33.44 |
34.143999999999998 |
25.344000000000001 |
24.64 |
34.496000000000002 |
30.976000000000003 |
34.143999999999998 |
33.792000000000002 |
31.680000000000003 |
34.496000000000002 |
31.680000000000003 |
32.384000000000007 |
31.680000000000003 |
29.92 |
29.92 |
15.840000000000002 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.1845999999999997 |
6.8319999999999999 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Blood gases measurement |
203.15 |
82803 |
25.5486 |
199.08699999999999 |
182.83500000000001 |
163.53575000000001 |
135.70420000000001 |
130.62545 |
199.08699999999999 |
182.83500000000001 |
197.05549999999999 |
182.83500000000001 |
192.99250000000001 |
197.05549999999999 |
146.268 |
142.20499999999998 |
199.08699999999999 |
178.77200000000002 |
197.05549999999999 |
195.024 |
182.83500000000001 |
199.08699999999999 |
182.83500000000001 |
186.89800000000002 |
182.83500000000001 |
172.67750000000001 |
172.67750000000001 |
91.417500000000004 |
26.07 |
26.07 |
26.07 |
26.07 |
26.07 |
26.07 |
26.07 |
26.07 |
26.07 |
26.07 |
25.5486 |
41.712000000000003 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Blood glucose (sugar) test performed by hand-held instrument |
21.85 |
82962 |
3.2143999999999999 |
25.283999999999999 |
19.665000000000003 |
17.589250000000003 |
14.595800000000002 |
14.049550000000002 |
21.413 |
19.665000000000003 |
21.194500000000001 |
19.665000000000003 |
20.7575 |
21.194500000000001 |
15.732000000000001 |
15.295 |
21.413 |
19.228000000000002 |
21.194500000000001 |
20.975999999999999 |
19.665000000000003 |
21.413 |
19.665000000000003 |
20.102000000000004 |
19.665000000000003 |
18.572500000000002 |
18.572500000000002 |
9.8325000000000014 |
3.28 |
3.28 |
3.28 |
3.28 |
3.28 |
3.28 |
3.28 |
3.28 |
3.28 |
3.28 |
3.2143999999999999 |
5.2480000000000002 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Lab Test: Valproic acid level |
104.45 |
80164 |
13.2692 |
102.361 |
94.00500000000001 |
84.082250000000002 |
69.772600000000011 |
67.161349999999999 |
102.361 |
94.00500000000001 |
101.3165 |
94.00500000000001 |
99.227499999999992 |
101.3165 |
75.203999999999994 |
73.114999999999995 |
102.361 |
91.915999999999997 |
101.3165 |
100.27200000000001 |
94.00500000000001 |
102.361 |
94.00500000000001 |
96.094000000000008 |
94.00500000000001 |
88.782499999999999 |
88.782499999999999 |
47.002500000000005 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.2692 |
21.664000000000001 |
46.861500000000007 |
45.968900000000005 |
45.968900000000005 |
46.861500000000007 |
46.415200000000006 |
|
Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function |
1947.65 |
93306 |
456.48399999999998 |
1908.6970000000001 |
1752.8850000000002 |
1567.8582500000002 |
1301.0302000000001 |
1252.3389500000001 |
1908.6970000000001 |
1752.8850000000002 |
1889.2205000000001 |
1752.8850000000002 |
1850.2674999999999 |
1889.2205000000001 |
1402.308 |
1363.355 |
1908.6970000000001 |
1713.932 |
1889.2205000000001 |
1869.7439999999999 |
1752.8850000000002 |
1908.6970000000001 |
1752.8850000000002 |
1791.8380000000002 |
1752.8850000000002 |
1655.5025000000001 |
1655.5025000000001 |
876.44250000000011 |
465.8 |
465.8 |
465.8 |
465.8 |
465.8 |
465.8 |
465.8 |
465.8 |
465.8 |
465.8 |
456.48399999999998 |
745.28000000000009 |
548.05800000000011 |
537.61880000000008 |
537.61880000000008 |
548.05800000000011 |
542.83840000000009 |
|
Lab Test: Folic acid level |
115.4 |
82746 |
14.405999999999999 |
113.092 |
103.86000000000001 |
92.897000000000006 |
77.08720000000001 |
74.202200000000005 |
113.092 |
103.86000000000001 |
111.938 |
103.86000000000001 |
109.63 |
111.938 |
83.088000000000008 |
80.78 |
113.092 |
101.55200000000001 |
111.938 |
110.78400000000001 |
103.86000000000001 |
113.092 |
103.86000000000001 |
106.16800000000001 |
103.86000000000001 |
98.09 |
98.09 |
51.930000000000007 |
14.7 |
14.7 |
14.7 |
14.7 |
14.7 |
14.7 |
14.7 |
14.7 |
14.7 |
14.7 |
14.405999999999999 |
23.52 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Lab Test: Parathormone (parathyroid hormone) level |
364.65 |
83970 |
40.4544 |
357.35699999999997 |
328.185 |
293.54325 |
243.58619999999999 |
234.46994999999998 |
357.35699999999997 |
328.185 |
353.71049999999997 |
328.185 |
346.41749999999996 |
353.71049999999997 |
262.548 |
255.25499999999997 |
357.35699999999997 |
320.892 |
353.71049999999997 |
350.06399999999996 |
328.185 |
357.35699999999997 |
328.185 |
335.47800000000001 |
328.185 |
309.95249999999999 |
309.95249999999999 |
164.0925 |
41.28 |
41.28 |
41.28 |
41.28 |
41.28 |
41.28 |
41.28 |
41.28 |
41.28 |
41.28 |
40.4544 |
66.048000000000002 |
74.192999999999998 |
72.779799999999994 |
72.779799999999994 |
74.192999999999998 |
73.486400000000003 |
|
Lab Test: Uric acid level, blood |
43.55 |
84550 |
4.4295999999999998 |
42.678999999999995 |
39.195 |
35.057749999999999 |
29.0914 |
28.002649999999999 |
42.678999999999995 |
39.195 |
42.243499999999997 |
39.195 |
41.372499999999995 |
42.243499999999997 |
31.355999999999998 |
30.484999999999996 |
42.678999999999995 |
38.323999999999998 |
42.243499999999997 |
41.807999999999993 |
39.195 |
42.678999999999995 |
39.195 |
40.066000000000003 |
39.195 |
37.017499999999998 |
37.017499999999998 |
19.5975 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.5199999999999996 |
4.4295999999999998 |
7.2319999999999993 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Detection test by nucleic acid for human papillomavirus (hpv), high-risk types |
396.75 |
87624 |
34.388200000000005 |
388.815 |
357.07499999999999 |
319.38375000000002 |
265.029 |
255.11025000000001 |
388.815 |
357.07499999999999 |
384.84749999999997 |
357.07499999999999 |
376.91249999999997 |
384.84749999999997 |
285.65999999999997 |
277.72499999999997 |
388.815 |
349.14 |
384.84749999999997 |
380.88 |
357.07499999999999 |
388.815 |
357.07499999999999 |
365.01 |
357.07499999999999 |
337.23750000000001 |
337.23750000000001 |
178.53749999999999 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Bacterial urine culture |
37.15 |
87088 |
7.9281999999999995 |
46.6935 |
33.435000000000002 |
29.905750000000001 |
24.816200000000002 |
23.887450000000001 |
36.406999999999996 |
33.435000000000002 |
36.035499999999999 |
33.435000000000002 |
35.292499999999997 |
36.035499999999999 |
26.747999999999998 |
26.004999999999999 |
36.406999999999996 |
32.692 |
36.035499999999999 |
35.663999999999994 |
33.435000000000002 |
36.406999999999996 |
33.435000000000002 |
34.177999999999997 |
33.435000000000002 |
31.577499999999997 |
31.577499999999997 |
16.717500000000001 |
8.09 |
8.09 |
8.09 |
8.09 |
8.09 |
8.09 |
8.09 |
8.09 |
8.09 |
8.09 |
7.9281999999999995 |
12.944000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Evaluation of physical therapy, low complexity |
286.05 |
97161 |
96.049800000000005 |
280.32900000000001 |
257.44499999999999 |
230.27025000000003 |
191.08140000000003 |
183.93015000000003 |
280.32900000000001 |
257.44499999999999 |
277.46850000000001 |
257.44499999999999 |
271.7475 |
277.46850000000001 |
205.95599999999999 |
200.23499999999999 |
280.32900000000001 |
251.72400000000002 |
277.46850000000001 |
274.608 |
257.44499999999999 |
280.32900000000001 |
257.44499999999999 |
263.166 |
257.44499999999999 |
243.14250000000001 |
243.14250000000001 |
128.7225 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
96.049800000000005 |
156.81600000000003 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Detection test by immunoassay technique for HIV-1 and HIV-2 |
338.05 |
87389 |
23.598399999999998 |
331.28899999999999 |
304.245 |
272.13025000000005 |
225.81740000000002 |
217.36615 |
331.28899999999999 |
304.245 |
327.9085 |
304.245 |
321.14749999999998 |
327.9085 |
243.39599999999999 |
236.63499999999999 |
331.28899999999999 |
297.48400000000004 |
327.9085 |
324.52800000000002 |
304.245 |
331.28899999999999 |
304.245 |
311.00600000000003 |
304.245 |
287.34250000000003 |
287.34250000000003 |
152.1225 |
24.08 |
24.08 |
24.08 |
24.08 |
24.08 |
24.08 |
24.08 |
24.08 |
24.08 |
24.08 |
23.598399999999998 |
38.527999999999999 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Lab Test: Measurement of bilirubin |
63.95 |
88720 |
4.9195999999999991 |
62.670999999999999 |
57.555000000000007 |
51.479750000000003 |
42.718600000000002 |
41.11985 |
62.670999999999999 |
57.555000000000007 |
62.031500000000001 |
57.555000000000007 |
60.752499999999998 |
62.031500000000001 |
46.043999999999997 |
44.765000000000001 |
62.670999999999999 |
56.276000000000003 |
62.031500000000001 |
61.392000000000003 |
57.555000000000007 |
62.670999999999999 |
57.555000000000007 |
58.834000000000003 |
57.555000000000007 |
54.357500000000002 |
54.357500000000002 |
28.777500000000003 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
4.9195999999999991 |
8.032 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Lab Test: Measurement C-reactive protein for detection of infection or inflammation |
105.75 |
86140 |
5.0763999999999996 |
103.63500000000001 |
95.174999999999997 |
85.128750000000011 |
70.641000000000005 |
67.997250000000008 |
103.63500000000001 |
95.174999999999997 |
102.5775 |
95.174999999999997 |
100.46249999999999 |
102.5775 |
76.14 |
74.024999999999991 |
103.63500000000001 |
93.06 |
102.5775 |
101.52 |
95.174999999999997 |
103.63500000000001 |
95.174999999999997 |
97.29 |
95.174999999999997 |
89.887500000000003 |
89.887500000000003 |
47.587499999999999 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.0763999999999996 |
8.2880000000000003 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Lab Test: Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) |
43.1 |
87186 |
8.4770000000000003 |
46.6935 |
38.79 |
34.695500000000003 |
28.790800000000001 |
27.7133 |
42.238 |
38.79 |
41.807000000000002 |
38.79 |
40.945 |
41.807000000000002 |
31.032 |
30.169999999999998 |
42.238 |
37.928000000000004 |
41.807000000000002 |
41.375999999999998 |
38.79 |
42.238 |
38.79 |
39.652000000000001 |
38.79 |
36.634999999999998 |
36.634999999999998 |
19.395 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.65 |
8.4770000000000003 |
13.840000000000002 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Fungal culture (mold or yeast) |
123.45 |
87102 |
8.2417999999999996 |
120.98099999999999 |
111.105 |
99.377250000000004 |
82.464600000000004 |
79.378349999999998 |
120.98099999999999 |
111.105 |
119.7465 |
111.105 |
117.2775 |
119.7465 |
88.884 |
86.414999999999992 |
120.98099999999999 |
108.63600000000001 |
119.7465 |
118.512 |
111.105 |
120.98099999999999 |
111.105 |
113.57400000000001 |
111.105 |
104.9325 |
104.9325 |
55.552500000000002 |
8.41 |
8.41 |
8.41 |
8.41 |
8.41 |
8.41 |
8.41 |
8.41 |
8.41 |
8.41 |
8.2417999999999996 |
13.456000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Bacterial culture |
85.05 |
87070 |
8.4475999999999996 |
83.34899999999999 |
76.545000000000002 |
68.465249999999997 |
56.813400000000001 |
54.687150000000003 |
83.34899999999999 |
76.545000000000002 |
82.498499999999993 |
76.545000000000002 |
80.797499999999999 |
82.498499999999993 |
61.235999999999997 |
59.534999999999997 |
83.34899999999999 |
74.843999999999994 |
82.498499999999993 |
81.647999999999996 |
76.545000000000002 |
83.34899999999999 |
76.545000000000002 |
78.245999999999995 |
76.545000000000002 |
72.29249999999999 |
72.29249999999999 |
38.272500000000001 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.6199999999999992 |
8.4475999999999996 |
13.792 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Blood glucose (sugar) level |
71.349999999999994 |
82947 |
3.8513999999999999 |
69.922999999999988 |
64.215000000000003 |
57.436749999999996 |
47.661799999999999 |
45.878049999999995 |
69.922999999999988 |
64.215000000000003 |
69.209499999999991 |
64.215000000000003 |
67.782499999999985 |
69.209499999999991 |
51.371999999999993 |
49.944999999999993 |
69.922999999999988 |
62.787999999999997 |
69.209499999999991 |
68.495999999999995 |
64.215000000000003 |
69.922999999999988 |
64.215000000000003 |
65.641999999999996 |
64.215000000000003 |
60.647499999999994 |
60.647499999999994 |
32.107500000000002 |
3.93 |
3.93 |
3.93 |
3.93 |
3.93 |
3.93 |
3.93 |
3.93 |
3.93 |
3.93 |
3.8513999999999999 |
6.2880000000000003 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Evaluation of physical therapy, moderate complexity |
286.05 |
97162 |
96.049800000000005 |
280.32900000000001 |
257.44499999999999 |
230.27025000000003 |
191.08140000000003 |
183.93015000000003 |
280.32900000000001 |
257.44499999999999 |
277.46850000000001 |
257.44499999999999 |
271.7475 |
277.46850000000001 |
205.95599999999999 |
200.23499999999999 |
280.32900000000001 |
251.72400000000002 |
277.46850000000001 |
274.608 |
257.44499999999999 |
280.32900000000001 |
257.44499999999999 |
263.166 |
257.44499999999999 |
243.14250000000001 |
243.14250000000001 |
128.7225 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
96.049800000000005 |
156.81600000000003 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Bone density measurement of the core or central skeleton |
806.9 |
77080 |
103.0078 |
790.76199999999994 |
726.21 |
649.55450000000008 |
539.00919999999996 |
518.83669999999995 |
790.76199999999994 |
726.21 |
782.69299999999998 |
726.21 |
766.55499999999995 |
782.69299999999998 |
580.96799999999996 |
564.82999999999993 |
790.76199999999994 |
710.072 |
782.69299999999998 |
774.62399999999991 |
726.21 |
790.76199999999994 |
726.21 |
742.34799999999996 |
726.21 |
685.86500000000001 |
685.86500000000001 |
363.10500000000002 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
117.53700000000001 |
115.29819999999999 |
115.29819999999999 |
117.53700000000001 |
116.41760000000001 |
|
Pain Clinic Visit Level 2 |
265.55 |
99212 |
112.2492 |
260.23900000000003 |
238.995 |
213.76775000000004 |
177.38740000000001 |
170.74865 |
260.23900000000003 |
238.995 |
257.58350000000002 |
238.995 |
252.27250000000001 |
257.58350000000002 |
191.196 |
185.88499999999999 |
260.23900000000003 |
233.684 |
257.58350000000002 |
254.928 |
238.995 |
260.23900000000003 |
238.995 |
244.30600000000001 |
238.995 |
225.7175 |
225.7175 |
119.4975 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Pain Clinic Vist Level 3 |
538.35 |
99213 |
112.2492 |
527.58299999999997 |
484.51500000000004 |
433.37175000000002 |
359.61780000000005 |
346.15905000000004 |
527.58299999999997 |
484.51500000000004 |
522.19950000000006 |
484.51500000000004 |
511.4325 |
522.19950000000006 |
387.61200000000002 |
376.84499999999997 |
527.58299999999997 |
473.74800000000005 |
522.19950000000006 |
516.81600000000003 |
484.51500000000004 |
527.58299999999997 |
484.51500000000004 |
495.28200000000004 |
484.51500000000004 |
457.59750000000003 |
457.59750000000003 |
242.25750000000002 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Detection test for gardnerella vaginalis (bacteria) |
177.35 |
87510 |
19.649000000000001 |
173.803 |
159.61500000000001 |
142.76675 |
118.46980000000001 |
114.03605 |
173.803 |
159.61500000000001 |
172.02949999999998 |
159.61500000000001 |
168.48249999999999 |
172.02949999999998 |
127.69199999999999 |
124.14499999999998 |
173.803 |
156.06799999999998 |
172.02949999999998 |
170.256 |
159.61500000000001 |
173.803 |
159.61500000000001 |
163.16200000000001 |
159.61500000000001 |
150.7475 |
150.7475 |
79.807500000000005 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
19.649000000000001 |
32.080000000000005 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
X-ray of abdomen, 1 view |
409.5 |
74018 |
76.479200000000006 |
401.31 |
368.55 |
329.64750000000004 |
273.54599999999999 |
263.30849999999998 |
401.31 |
368.55 |
397.21499999999997 |
368.55 |
389.02499999999998 |
397.21499999999997 |
294.83999999999997 |
286.64999999999998 |
401.31 |
360.36 |
397.21499999999997 |
393.12 |
368.55 |
401.31 |
368.55 |
376.74 |
368.55 |
348.07499999999999 |
348.07499999999999 |
184.27500000000001 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Prostate cancer screening; prostate specific antigen test (psa) |
232.85 |
G0103 |
18.9238 |
228.19299999999998 |
209.565 |
187.44425000000001 |
155.5438 |
149.72255000000001 |
228.19299999999998 |
209.565 |
225.86449999999999 |
209.565 |
221.20749999999998 |
225.86449999999999 |
167.65199999999999 |
162.99499999999998 |
228.19299999999998 |
204.90799999999999 |
225.86449999999999 |
223.53599999999997 |
209.565 |
228.19299999999998 |
209.565 |
214.22200000000001 |
209.565 |
197.92249999999999 |
197.92249999999999 |
104.7825 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
19.309999999999999 |
18.9238 |
30.896000000000001 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
CT scan of upper spine |
2696 |
72125 |
103.0078 |
2642.08 |
2426.4 |
2170.2800000000002 |
1800.9280000000001 |
1733.528 |
2642.08 |
2426.4 |
2615.12 |
2426.4 |
2561.1999999999998 |
2615.12 |
1941.12 |
1887.1999999999998 |
2642.08 |
2372.48 |
2615.12 |
2588.16 |
2426.4 |
2642.08 |
2426.4 |
2480.3200000000002 |
2426.4 |
2291.6 |
2291.6 |
1213.2 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
266.04899999999998 |
260.98140000000001 |
260.98140000000001 |
266.04899999999998 |
263.51519999999999 |
|
Detection test for candida species (yeast) |
177.35 |
87480 |
19.649000000000001 |
173.803 |
159.61500000000001 |
142.76675 |
118.46980000000001 |
114.03605 |
173.803 |
159.61500000000001 |
172.02949999999998 |
159.61500000000001 |
168.48249999999999 |
172.02949999999998 |
127.69199999999999 |
124.14499999999998 |
173.803 |
156.06799999999998 |
172.02949999999998 |
170.256 |
159.61500000000001 |
173.803 |
159.61500000000001 |
163.16200000000001 |
159.61500000000001 |
150.7475 |
150.7475 |
79.807500000000005 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
19.649000000000001 |
32.080000000000005 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Lab Test: Phosphate level |
32.299999999999997 |
84100 |
4.6452 |
31.653999999999996 |
29.069999999999997 |
26.0015 |
21.5764 |
20.768899999999999 |
31.653999999999996 |
29.069999999999997 |
31.330999999999996 |
29.069999999999997 |
30.684999999999995 |
31.330999999999996 |
23.255999999999997 |
22.609999999999996 |
31.653999999999996 |
28.423999999999996 |
31.330999999999996 |
31.007999999999996 |
29.069999999999997 |
31.653999999999996 |
29.069999999999997 |
29.715999999999998 |
29.069999999999997 |
27.454999999999998 |
27.454999999999998 |
14.534999999999998 |
4.74 |
4.74 |
4.74 |
4.74 |
4.74 |
4.74 |
4.74 |
4.74 |
4.74 |
4.74 |
4.6452 |
7.5840000000000005 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older |
232.8 |
90732 |
35.112700000000004 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
232.8 |
104.76 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
60.528000000000006 |
59.317440000000005 |
96.844800000000021 |
35.794500000000006 |
35.112700000000004 |
35.112700000000004 |
35.794500000000006 |
35.453600000000002 |
|
Lab Test: Creatine kinase (cardiac enzyme) level |
32.299999999999997 |
82550 |
6.3797999999999995 |
31.653999999999996 |
29.069999999999997 |
26.0015 |
21.5764 |
20.768899999999999 |
31.653999999999996 |
29.069999999999997 |
31.330999999999996 |
29.069999999999997 |
30.684999999999995 |
31.330999999999996 |
23.255999999999997 |
22.609999999999996 |
31.653999999999996 |
28.423999999999996 |
31.330999999999996 |
31.007999999999996 |
29.069999999999997 |
31.653999999999996 |
29.069999999999997 |
29.715999999999998 |
29.069999999999997 |
27.454999999999998 |
27.454999999999998 |
14.534999999999998 |
6.51 |
6.51 |
6.51 |
6.51 |
6.51 |
6.51 |
6.51 |
6.51 |
6.51 |
6.51 |
6.3797999999999995 |
10.416 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Urine pregnancy test |
93.35 |
81025 |
8.4377999999999993 |
91.48299999999999 |
84.015000000000001 |
75.146749999999997 |
62.357799999999997 |
60.024049999999995 |
91.48299999999999 |
84.015000000000001 |
90.549499999999995 |
84.015000000000001 |
88.68249999999999 |
90.549499999999995 |
67.211999999999989 |
65.344999999999999 |
91.48299999999999 |
82.147999999999996 |
90.549499999999995 |
89.615999999999985 |
84.015000000000001 |
91.48299999999999 |
84.015000000000001 |
85.882000000000005 |
84.015000000000001 |
79.347499999999997 |
79.347499999999997 |
42.0075 |
8.61 |
8.61 |
8.61 |
8.61 |
8.61 |
8.61 |
8.61 |
8.61 |
8.61 |
8.61 |
8.4377999999999993 |
13.776 |
16.768500000000003 |
16.449100000000001 |
16.449100000000001 |
16.768500000000003 |
16.608800000000002 |
|
Ultrasound of abdomen |
1094.0999999999999 |
76705 |
103.0078 |
1072.2179999999998 |
984.68999999999994 |
880.75049999999999 |
730.85879999999997 |
703.50630000000001 |
1072.2179999999998 |
984.68999999999994 |
1061.2769999999998 |
984.68999999999994 |
1039.3949999999998 |
1061.2769999999998 |
787.75199999999995 |
765.86999999999989 |
1072.2179999999998 |
962.80799999999988 |
1061.2769999999998 |
1050.3359999999998 |
984.68999999999994 |
1072.2179999999998 |
984.68999999999994 |
1006.572 |
984.68999999999994 |
929.9849999999999 |
929.9849999999999 |
492.34499999999997 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Lab Test: Liver enzyme (SGOT), level |
32.299999999999997 |
84450 |
5.0763999999999996 |
31.653999999999996 |
29.069999999999997 |
26.0015 |
21.5764 |
20.768899999999999 |
31.653999999999996 |
29.069999999999997 |
31.330999999999996 |
29.069999999999997 |
30.684999999999995 |
31.330999999999996 |
23.255999999999997 |
22.609999999999996 |
31.653999999999996 |
28.423999999999996 |
31.330999999999996 |
31.007999999999996 |
29.069999999999997 |
31.653999999999996 |
29.069999999999997 |
29.715999999999998 |
29.069999999999997 |
27.454999999999998 |
27.454999999999998 |
14.534999999999998 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.0763999999999996 |
8.2880000000000003 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Creatinine level to test for kidney function or muscle injury |
146 |
82570 |
5.0763999999999996 |
143.07999999999998 |
131.4 |
117.53 |
97.528000000000006 |
93.878 |
143.07999999999998 |
131.4 |
141.62 |
131.4 |
138.69999999999999 |
141.62 |
105.11999999999999 |
102.19999999999999 |
143.07999999999998 |
128.47999999999999 |
141.62 |
140.16 |
131.4 |
143.07999999999998 |
131.4 |
134.32 |
131.4 |
124.1 |
124.1 |
65.7 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.0763999999999996 |
8.2880000000000003 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Lab Test: Blood potassium level |
48.35 |
84132 |
4.6647999999999996 |
47.383000000000003 |
43.515000000000001 |
38.921750000000003 |
32.297800000000002 |
31.08905 |
47.383000000000003 |
43.515000000000001 |
46.899500000000003 |
43.515000000000001 |
45.932499999999997 |
46.899500000000003 |
34.811999999999998 |
33.844999999999999 |
47.383000000000003 |
42.548000000000002 |
46.899500000000003 |
46.415999999999997 |
43.515000000000001 |
47.383000000000003 |
43.515000000000001 |
44.482000000000006 |
43.515000000000001 |
41.097499999999997 |
41.097499999999997 |
21.7575 |
4.76 |
4.76 |
4.76 |
4.76 |
4.76 |
4.76 |
4.76 |
4.76 |
4.76 |
4.76 |
4.6647999999999996 |
7.6159999999999997 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Heart rhythm tracing of 48-hour EKG |
892.8 |
93225 |
105.83019999999999 |
874.94399999999996 |
803.52 |
718.70399999999995 |
596.3904 |
574.07039999999995 |
874.94399999999996 |
803.52 |
866.01599999999996 |
803.52 |
848.16 |
866.01599999999996 |
642.81599999999992 |
624.95999999999992 |
874.94399999999996 |
785.66399999999999 |
866.01599999999996 |
857.08799999999997 |
803.52 |
874.94399999999996 |
803.52 |
821.37599999999998 |
803.52 |
758.88 |
758.88 |
401.76 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
105.83019999999999 |
172.78399999999999 |
261.01949999999999 |
256.04770000000002 |
256.04770000000002 |
261.01949999999999 |
258.53360000000004 |
|
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria) |
150.30000000000001 |
86618 |
16.689399999999999 |
147.29400000000001 |
135.27000000000001 |
120.99150000000002 |
100.40040000000002 |
96.642900000000012 |
147.29400000000001 |
135.27000000000001 |
145.791 |
135.27000000000001 |
142.785 |
145.791 |
108.21600000000001 |
105.21000000000001 |
147.29400000000001 |
132.26400000000001 |
145.791 |
144.28800000000001 |
135.27000000000001 |
147.29400000000001 |
135.27000000000001 |
138.27600000000001 |
135.27000000000001 |
127.75500000000001 |
127.75500000000001 |
67.635000000000005 |
17.03 |
17.03 |
17.03 |
17.03 |
17.03 |
17.03 |
17.03 |
17.03 |
17.03 |
17.03 |
16.689399999999999 |
27.248000000000005 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Lead level |
154.25 |
83655 |
11.867799999999999 |
151.16499999999999 |
138.82500000000002 |
124.17125 |
103.039 |
99.182749999999999 |
151.16499999999999 |
138.82500000000002 |
149.6225 |
138.82500000000002 |
146.53749999999999 |
149.6225 |
111.06 |
107.97499999999999 |
151.16499999999999 |
135.74 |
149.6225 |
148.07999999999998 |
138.82500000000002 |
151.16499999999999 |
138.82500000000002 |
141.91 |
138.82500000000002 |
131.11249999999998 |
131.11249999999998 |
69.412500000000009 |
12.11 |
12.11 |
12.11 |
12.11 |
12.11 |
12.11 |
12.11 |
12.11 |
12.11 |
12.11 |
11.867799999999999 |
19.376000000000001 |
45.317999999999998 |
44.454799999999999 |
44.454799999999999 |
45.317999999999998 |
44.886399999999995 |
|
Occupational Therapy-Therapeutic activity per 15 MIN |
133.35 |
97530 - GO |
36.710799999999999 |
157.36350000000002 |
120.015 |
107.34675 |
89.077799999999996 |
85.744050000000001 |
130.68299999999999 |
120.015 |
129.34949999999998 |
120.015 |
126.68249999999999 |
129.34949999999998 |
96.011999999999986 |
93.344999999999985 |
130.68299999999999 |
117.348 |
129.34949999999998 |
128.01599999999999 |
120.015 |
130.68299999999999 |
120.015 |
122.682 |
120.015 |
113.3475 |
113.3475 |
60.0075 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
36.710799999999999 |
59.936000000000007 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Gonadotropin, chorionic (reproductive hormone) level |
195.35 |
84702 |
14.749000000000001 |
191.44299999999998 |
175.815 |
157.25675000000001 |
130.49379999999999 |
125.61005 |
191.44299999999998 |
175.815 |
189.48949999999999 |
175.815 |
185.58249999999998 |
189.48949999999999 |
140.65199999999999 |
136.74499999999998 |
191.44299999999998 |
171.90799999999999 |
189.48949999999999 |
187.536 |
175.815 |
191.44299999999998 |
175.815 |
179.72200000000001 |
175.815 |
166.04749999999999 |
166.04749999999999 |
87.907499999999999 |
15.05 |
15.05 |
15.05 |
15.05 |
15.05 |
15.05 |
15.05 |
15.05 |
15.05 |
15.05 |
14.749000000000001 |
24.080000000000002 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Removal of skin and tissue first 20 sq cm or less |
756.35 |
11042 |
317.4563 |
741.22299999999996 |
680.71500000000003 |
608.86175000000003 |
505.24180000000007 |
486.33305000000001 |
741.22299999999996 |
680.71500000000003 |
733.65949999999998 |
680.71500000000003 |
718.53250000000003 |
733.65949999999998 |
544.572 |
529.44499999999994 |
741.22299999999996 |
665.58800000000008 |
733.65949999999998 |
726.096 |
680.71500000000003 |
741.22299999999996 |
680.71500000000003 |
695.8420000000001 |
680.71500000000003 |
642.89750000000004 |
642.89750000000004 |
340.35750000000002 |
333.6 |
333.6 |
333.6 |
333.6 |
333.6 |
333.6 |
333.6 |
333.6 |
333.6 |
333.6 |
326.928 |
533.7600000000001 |
323.62049999999999 |
317.4563 |
317.4563 |
323.62049999999999 |
320.53839999999997 |
|
Identification of organisms by immunologic analysis |
24.8 |
87147 |
5.0763999999999996 |
46.6935 |
22.32 |
19.964000000000002 |
16.566400000000002 |
15.946400000000001 |
24.303999999999998 |
22.32 |
24.056000000000001 |
22.32 |
23.56 |
24.056000000000001 |
17.855999999999998 |
17.36 |
24.303999999999998 |
21.824000000000002 |
24.056000000000001 |
23.808 |
22.32 |
24.303999999999998 |
22.32 |
22.816000000000003 |
22.32 |
21.08 |
21.08 |
11.16 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.0763999999999996 |
8.2880000000000003 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Total protein level, urine |
54.4 |
84156 |
3.5966 |
53.311999999999998 |
48.96 |
43.792000000000002 |
36.339199999999998 |
34.979199999999999 |
53.311999999999998 |
48.96 |
52.768000000000001 |
48.96 |
51.68 |
52.768000000000001 |
39.167999999999999 |
38.08 |
53.311999999999998 |
47.872 |
52.768000000000001 |
52.223999999999997 |
48.96 |
53.311999999999998 |
48.96 |
50.048000000000002 |
48.96 |
46.239999999999995 |
46.239999999999995 |
24.48 |
3.67 |
3.67 |
3.67 |
3.67 |
3.67 |
3.67 |
3.67 |
3.67 |
3.67 |
3.67 |
3.5966 |
5.8719999999999999 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Treatment of speech, language, voice, communication, and/or hearing processing disorder |
357.3 |
92507 |
74.107600000000005 |
350.154 |
321.57 |
287.62650000000002 |
238.67640000000003 |
229.74390000000002 |
350.154 |
321.57 |
346.58100000000002 |
321.57 |
339.435 |
346.58100000000002 |
257.25599999999997 |
250.10999999999999 |
350.154 |
314.42400000000004 |
346.58100000000002 |
343.00799999999998 |
321.57 |
350.154 |
321.57 |
328.71600000000001 |
321.57 |
303.70499999999998 |
303.70499999999998 |
160.785 |
75.62 |
75.62 |
75.62 |
75.62 |
75.62 |
75.62 |
75.62 |
75.62 |
75.62 |
75.62 |
74.107600000000005 |
120.99200000000002 |
131.54400000000001 |
129.0384 |
129.0384 |
131.54400000000001 |
130.2912 |
|
Obstetrical Assessment - clinic visit |
876 |
99211 |
112.2492 |
858.48 |
788.4 |
705.18000000000006 |
585.16800000000001 |
563.26800000000003 |
858.48 |
788.4 |
849.72 |
788.4 |
832.19999999999993 |
849.72 |
630.72 |
613.19999999999993 |
858.48 |
770.88 |
849.72 |
840.95999999999992 |
788.4 |
858.48 |
788.4 |
805.92000000000007 |
788.4 |
744.6 |
744.6 |
394.2 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Evaluation of occupational therapy, moderate complexity |
286.05 |
97166 |
93.247 |
280.32900000000001 |
257.44499999999999 |
230.27025000000003 |
191.08140000000003 |
183.93015000000003 |
280.32900000000001 |
257.44499999999999 |
277.46850000000001 |
257.44499999999999 |
271.7475 |
277.46850000000001 |
205.95599999999999 |
200.23499999999999 |
280.32900000000001 |
251.72400000000002 |
277.46850000000001 |
274.608 |
257.44499999999999 |
280.32900000000001 |
257.44499999999999 |
263.166 |
257.44499999999999 |
243.14250000000001 |
243.14250000000001 |
128.7225 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
93.247 |
152.24 |
143.62950000000001 |
140.8937 |
140.8937 |
143.62950000000001 |
142.26159999999999 |
|
X-ray of lower and sacral spine, 2 or 3 views |
754.2 |
72100 |
103.0078 |
739.11599999999999 |
678.78000000000009 |
607.13100000000009 |
503.80560000000008 |
484.95060000000007 |
739.11599999999999 |
678.78000000000009 |
731.57400000000007 |
678.78000000000009 |
716.49 |
731.57400000000007 |
543.024 |
527.94000000000005 |
739.11599999999999 |
663.69600000000003 |
731.57400000000007 |
724.03200000000004 |
678.78000000000009 |
739.11599999999999 |
678.78000000000009 |
693.86400000000003 |
678.78000000000009 |
641.07000000000005 |
641.07000000000005 |
339.39000000000004 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Urea nitrogen level to assess kidney function |
41.8 |
84520 |
3.871 |
40.963999999999999 |
37.619999999999997 |
33.649000000000001 |
27.9224 |
26.877399999999998 |
40.963999999999999 |
37.619999999999997 |
40.545999999999999 |
37.619999999999997 |
39.709999999999994 |
40.545999999999999 |
30.095999999999997 |
29.259999999999994 |
40.963999999999999 |
36.783999999999999 |
40.545999999999999 |
40.127999999999993 |
37.619999999999997 |
40.963999999999999 |
37.619999999999997 |
38.455999999999996 |
37.619999999999997 |
35.529999999999994 |
35.529999999999994 |
18.809999999999999 |
3.95 |
3.95 |
3.95 |
3.95 |
3.95 |
3.95 |
3.95 |
3.95 |
3.95 |
3.95 |
3.871 |
6.32 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Inpatient Rehab: Self-care or home management training, each 15 mins |
143.44999999999999 |
97535 |
31.7422 |
143.62950000000001 |
129.10499999999999 |
115.47725 |
95.824600000000004 |
92.238349999999997 |
140.58099999999999 |
129.10499999999999 |
139.14649999999997 |
129.10499999999999 |
136.27749999999997 |
139.14649999999997 |
103.28399999999999 |
100.41499999999999 |
140.58099999999999 |
126.23599999999999 |
139.14649999999997 |
137.71199999999999 |
129.10499999999999 |
140.58099999999999 |
129.10499999999999 |
131.97399999999999 |
129.10499999999999 |
121.93249999999999 |
121.93249999999999 |
64.552499999999995 |
32.39 |
32.39 |
32.39 |
32.39 |
32.39 |
32.39 |
32.39 |
32.39 |
32.39 |
32.39 |
31.7422 |
51.824000000000005 |
143.62950000000001 |
140.8937 |
140.8937 |
143.62950000000001 |
142.26159999999999 |
|
Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 mins |
117 |
97112 |
33.143599999999999 |
157.36350000000002 |
105.3 |
94.185000000000002 |
78.156000000000006 |
75.231000000000009 |
114.66 |
105.3 |
113.49 |
105.3 |
111.14999999999999 |
113.49 |
84.24 |
81.899999999999991 |
114.66 |
102.96 |
113.49 |
112.32 |
105.3 |
114.66 |
105.3 |
107.64 |
105.3 |
99.45 |
99.45 |
52.65 |
33.82 |
33.82 |
33.82 |
33.82 |
33.82 |
33.82 |
33.82 |
33.82 |
33.82 |
33.82 |
33.143599999999999 |
54.112000000000002 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Drug test(s), definitive; 22 or more drug class(es), including metabolite(s) if performed |
23.45 |
G0483 |
10.5525 |
395.072 |
21.105 |
18.87725 |
15.6646 |
15.07835 |
22.980999999999998 |
21.105 |
22.746499999999997 |
21.105 |
22.2775 |
22.746499999999997 |
16.884 |
16.414999999999999 |
22.980999999999998 |
20.635999999999999 |
22.746499999999997 |
22.511999999999997 |
21.105 |
22.980999999999998 |
21.105 |
21.574000000000002 |
21.105 |
19.932499999999997 |
19.932499999999997 |
10.5525 |
246.92 |
246.92 |
246.92 |
246.92 |
246.92 |
246.92 |
246.92 |
246.92 |
246.92 |
246.92 |
241.98159999999999 |
395.072 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Acute hepatitis panel |
601.79999999999995 |
80074 |
46.677399999999999 |
589.7639999999999 |
541.62 |
484.44900000000001 |
402.00239999999997 |
386.95740000000001 |
589.7639999999999 |
541.62 |
583.74599999999998 |
541.62 |
571.70999999999992 |
583.74599999999998 |
433.29599999999994 |
421.25999999999993 |
589.7639999999999 |
529.58399999999995 |
583.74599999999998 |
577.72799999999995 |
541.62 |
589.7639999999999 |
541.62 |
553.65599999999995 |
541.62 |
511.53 |
511.53 |
270.81 |
47.63 |
47.63 |
47.63 |
47.63 |
47.63 |
47.63 |
47.63 |
47.63 |
47.63 |
47.63 |
46.677399999999999 |
76.208000000000013 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique |
177.35 |
87660 |
19.649000000000001 |
173.803 |
159.61500000000001 |
142.76675 |
118.46980000000001 |
114.03605 |
173.803 |
159.61500000000001 |
172.02949999999998 |
159.61500000000001 |
168.48249999999999 |
172.02949999999998 |
127.69199999999999 |
124.14499999999998 |
173.803 |
156.06799999999998 |
172.02949999999998 |
170.256 |
159.61500000000001 |
173.803 |
159.61500000000001 |
163.16200000000001 |
159.61500000000001 |
150.7475 |
150.7475 |
79.807500000000005 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
19.649000000000001 |
32.080000000000005 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Physical Therapy-Transfer Training per 15 MIN |
143.44999999999999 |
97530 - GP |
36.710799999999999 |
157.36350000000002 |
129.10499999999999 |
115.47725 |
95.824600000000004 |
92.238349999999997 |
140.58099999999999 |
129.10499999999999 |
139.14649999999997 |
129.10499999999999 |
136.27749999999997 |
139.14649999999997 |
103.28399999999999 |
100.41499999999999 |
140.58099999999999 |
126.23599999999999 |
139.14649999999997 |
137.71199999999999 |
129.10499999999999 |
140.58099999999999 |
129.10499999999999 |
131.97399999999999 |
129.10499999999999 |
121.93249999999999 |
121.93249999999999 |
64.552499999999995 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
36.710799999999999 |
59.936000000000007 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
CT scan chest |
2632.6 |
71250 |
103.0078 |
2579.9479999999999 |
2369.34 |
2119.2429999999999 |
1758.5768 |
1692.7618 |
2579.9479999999999 |
2369.34 |
2553.6219999999998 |
2369.34 |
2500.9699999999998 |
2553.6219999999998 |
1895.4719999999998 |
1842.8199999999997 |
2579.9479999999999 |
2316.6880000000001 |
2553.6219999999998 |
2527.2959999999998 |
2369.34 |
2579.9479999999999 |
2369.34 |
2421.9920000000002 |
2369.34 |
2237.71 |
2237.71 |
1184.67 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
266.04899999999998 |
260.98140000000001 |
260.98140000000001 |
266.04899999999998 |
263.51519999999999 |
|
Blood unit compatibility test |
343.3 |
86920 |
51.6648 |
336.43400000000003 |
308.97000000000003 |
276.35650000000004 |
229.32440000000003 |
220.74190000000002 |
336.43400000000003 |
308.97000000000003 |
333.00099999999998 |
308.97000000000003 |
326.13499999999999 |
333.00099999999998 |
247.17599999999999 |
240.31 |
336.43400000000003 |
302.10399999999998 |
333.00099999999998 |
329.56799999999998 |
308.97000000000003 |
336.43400000000003 |
308.97000000000003 |
315.83600000000001 |
308.97000000000003 |
291.80500000000001 |
291.80500000000001 |
154.48500000000001 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
141.00239999999999 |
230.208 |
52.667999999999999 |
51.6648 |
51.6648 |
52.667999999999999 |
52.166399999999996 |
|
Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique |
203.55 |
87661 |
34.388200000000005 |
199.47900000000001 |
183.19500000000002 |
163.85775000000001 |
135.97140000000002 |
130.88265000000001 |
199.47900000000001 |
183.19500000000002 |
197.4435 |
183.19500000000002 |
193.3725 |
197.4435 |
146.55600000000001 |
142.48499999999999 |
199.47900000000001 |
179.12400000000002 |
197.4435 |
195.40800000000002 |
183.19500000000002 |
199.47900000000001 |
183.19500000000002 |
187.26600000000002 |
183.19500000000002 |
173.01750000000001 |
173.01750000000001 |
91.597500000000011 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies |
7374 |
78452 |
828.77920000000006 |
7226.5199999999995 |
6636.6 |
5936.0700000000006 |
4925.8320000000003 |
4741.482 |
7226.5199999999995 |
6636.6 |
7152.78 |
6636.6 |
7005.2999999999993 |
7152.78 |
5309.28 |
5161.7999999999993 |
7226.5199999999995 |
6489.12 |
7152.78 |
7079.04 |
6636.6 |
7226.5199999999995 |
6636.6 |
6784.08 |
6636.6 |
6267.9 |
6267.9 |
3318.3 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1259.71 |
1234.5158000000001 |
2015.5360000000001 |
844.87200000000007 |
828.77920000000006 |
828.77920000000006 |
844.87200000000007 |
836.82560000000001 |
|
Blood gases measurement |
215.35 |
82805 |
77.194599999999994 |
211.04299999999998 |
193.815 |
173.35675000000001 |
143.85380000000001 |
138.47004999999999 |
211.04299999999998 |
193.815 |
208.8895 |
193.815 |
204.58249999999998 |
208.8895 |
155.05199999999999 |
150.74499999999998 |
211.04299999999998 |
189.50800000000001 |
208.8895 |
206.73599999999999 |
193.815 |
211.04299999999998 |
193.815 |
198.12200000000001 |
193.815 |
183.04749999999999 |
183.04749999999999 |
96.907499999999999 |
78.77 |
78.77 |
78.77 |
78.77 |
78.77 |
78.77 |
78.77 |
78.77 |
78.77 |
78.77 |
77.194599999999994 |
126.032 |
92.788500000000013 |
91.021100000000004 |
91.021100000000004 |
92.788500000000013 |
91.904800000000009 |
|
Bacterial culture |
181.3 |
87075 |
9.2805999999999997 |
177.67400000000001 |
163.17000000000002 |
145.94650000000001 |
121.10840000000002 |
116.5759 |
177.67400000000001 |
163.17000000000002 |
175.86100000000002 |
163.17000000000002 |
172.23500000000001 |
175.86100000000002 |
130.536 |
126.91 |
177.67400000000001 |
159.54400000000001 |
175.86100000000002 |
174.048 |
163.17000000000002 |
177.67400000000001 |
163.17000000000002 |
166.79600000000002 |
163.17000000000002 |
154.10500000000002 |
154.10500000000002 |
81.585000000000008 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.4700000000000006 |
9.2805999999999997 |
15.152000000000001 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Detection test by nucleic acid for clostridium difficile, amplified probe technique |
332.6 |
87493 |
36.5246 |
325.94800000000004 |
299.34000000000003 |
267.74300000000005 |
222.17680000000001 |
213.86180000000002 |
325.94800000000004 |
299.34000000000003 |
322.62200000000001 |
299.34000000000003 |
315.97000000000003 |
322.62200000000001 |
239.47200000000001 |
232.82 |
325.94800000000004 |
292.68800000000005 |
322.62200000000001 |
319.29599999999999 |
299.34000000000003 |
325.94800000000004 |
299.34000000000003 |
305.99200000000002 |
299.34000000000003 |
282.71000000000004 |
282.71000000000004 |
149.67000000000002 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
37.270000000000003 |
36.5246 |
59.632000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Medical nutrition therapy re-assessment and intervention, each 15 mins |
68.3 |
97803 |
26.754000000000001 |
133.90649999999999 |
61.47 |
54.981500000000004 |
45.624400000000001 |
43.916899999999998 |
66.933999999999997 |
61.47 |
66.250999999999991 |
61.47 |
64.884999999999991 |
66.250999999999991 |
49.175999999999995 |
47.809999999999995 |
66.933999999999997 |
60.103999999999999 |
66.250999999999991 |
65.567999999999998 |
61.47 |
66.933999999999997 |
61.47 |
62.835999999999999 |
61.47 |
58.054999999999993 |
58.054999999999993 |
30.734999999999999 |
27.3 |
27.3 |
27.3 |
27.3 |
27.3 |
27.3 |
27.3 |
27.3 |
27.3 |
27.3 |
26.754000000000001 |
43.680000000000007 |
133.90649999999999 |
131.35589999999999 |
131.35589999999999 |
133.90649999999999 |
132.63120000000001 |
|
Red blood count, automated test |
56.4 |
85045 |
3.9102000000000001 |
55.271999999999998 |
50.76 |
45.402000000000001 |
37.675200000000004 |
36.2652 |
55.271999999999998 |
50.76 |
54.707999999999998 |
50.76 |
53.58 |
54.707999999999998 |
40.607999999999997 |
39.479999999999997 |
55.271999999999998 |
49.631999999999998 |
54.707999999999998 |
54.143999999999998 |
50.76 |
55.271999999999998 |
50.76 |
51.887999999999998 |
50.76 |
47.94 |
47.94 |
25.38 |
3.99 |
3.99 |
3.99 |
3.99 |
3.99 |
3.99 |
3.99 |
3.99 |
3.99 |
3.99 |
3.9102000000000001 |
6.3840000000000003 |
22.344000000000001 |
21.918400000000002 |
21.918400000000002 |
22.344000000000001 |
22.131200000000003 |
|
Low dose CT scan of chest for lung cancer screening |
757.55 |
71271 |
76.479200000000006 |
742.39899999999989 |
681.79499999999996 |
609.82775000000004 |
506.04340000000002 |
487.10464999999999 |
742.39899999999989 |
681.79499999999996 |
734.82349999999997 |
681.79499999999996 |
719.6724999999999 |
734.82349999999997 |
545.43599999999992 |
530.28499999999997 |
742.39899999999989 |
666.64400000000001 |
734.82349999999997 |
727.24799999999993 |
681.79499999999996 |
742.39899999999989 |
681.79499999999996 |
696.94600000000003 |
681.79499999999996 |
643.9174999999999 |
643.9174999999999 |
340.89749999999998 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
266.04899999999998 |
260.98140000000001 |
260.98140000000001 |
266.04899999999998 |
263.51519999999999 |
|
Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) |
160.55000000000001 |
80051 |
6.8697999999999997 |
157.339 |
144.495 |
129.24275000000003 |
107.24740000000001 |
103.23365000000001 |
157.339 |
144.495 |
155.73350000000002 |
144.495 |
152.52250000000001 |
155.73350000000002 |
115.596 |
112.38500000000001 |
157.339 |
141.28400000000002 |
155.73350000000002 |
154.12800000000001 |
144.495 |
157.339 |
144.495 |
147.70600000000002 |
144.495 |
136.4675 |
136.4675 |
72.247500000000002 |
7.01 |
7.01 |
7.01 |
7.01 |
7.01 |
7.01 |
7.01 |
7.01 |
7.01 |
7.01 |
6.8697999999999997 |
11.216000000000001 |
56.227499999999999 |
55.156500000000001 |
55.156500000000001 |
56.227499999999999 |
55.692 |
|
Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique |
314.05 |
87641 |
34.388200000000005 |
307.76900000000001 |
282.64500000000004 |
252.81025000000002 |
209.78540000000001 |
201.93415000000002 |
307.76900000000001 |
282.64500000000004 |
304.62850000000003 |
282.64500000000004 |
298.34750000000003 |
304.62850000000003 |
226.11600000000001 |
219.83500000000001 |
307.76900000000001 |
276.36400000000003 |
304.62850000000003 |
301.488 |
282.64500000000004 |
307.76900000000001 |
282.64500000000004 |
288.92600000000004 |
282.64500000000004 |
266.9425 |
266.9425 |
141.32250000000002 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Urine sodium level |
120.2 |
84300 |
4.9587999999999992 |
117.79600000000001 |
108.18 |
96.76100000000001 |
80.293600000000012 |
77.288600000000002 |
117.79600000000001 |
108.18 |
116.59399999999999 |
108.18 |
114.19 |
116.59399999999999 |
86.543999999999997 |
84.14 |
117.79600000000001 |
105.776 |
116.59399999999999 |
115.392 |
108.18 |
117.79600000000001 |
108.18 |
110.584 |
108.18 |
102.17 |
102.17 |
54.09 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
5.0599999999999996 |
4.9587999999999992 |
8.0960000000000001 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Manual (physical) therapy techniques to 1 or more regions, each 15 mins |
143.69999999999999 |
97140 |
26.381600000000002 |
157.36350000000002 |
129.32999999999998 |
115.6785 |
95.991599999999991 |
92.39909999999999 |
140.82599999999999 |
129.32999999999998 |
139.38899999999998 |
129.32999999999998 |
136.51499999999999 |
139.38899999999998 |
103.46399999999998 |
100.58999999999999 |
140.82599999999999 |
126.45599999999999 |
139.38899999999998 |
137.952 |
129.32999999999998 |
140.82599999999999 |
129.32999999999998 |
132.20400000000001 |
129.32999999999998 |
122.14499999999998 |
122.14499999999998 |
64.664999999999992 |
26.92 |
26.92 |
26.92 |
26.92 |
26.92 |
26.92 |
26.92 |
26.92 |
26.92 |
26.92 |
26.381600000000002 |
43.072000000000003 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Ultrasound behind abdominal cavity, limited |
712.55 |
76775 |
103.0078 |
698.29899999999998 |
641.29499999999996 |
573.60275000000001 |
475.98340000000002 |
458.16964999999999 |
698.29899999999998 |
641.29499999999996 |
691.17349999999999 |
641.29499999999996 |
676.9224999999999 |
691.17349999999999 |
513.03599999999994 |
498.78499999999991 |
698.29899999999998 |
627.04399999999998 |
691.17349999999999 |
684.04799999999989 |
641.29499999999996 |
698.29899999999998 |
641.29499999999996 |
655.54599999999994 |
641.29499999999996 |
605.6674999999999 |
605.6674999999999 |
320.64749999999998 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Thyroxine (thyroid chemical) measurement |
112.65 |
84436 |
6.7325999999999997 |
110.39700000000001 |
101.38500000000001 |
90.683250000000015 |
75.250200000000007 |
72.43395000000001 |
110.39700000000001 |
101.38500000000001 |
109.2705 |
101.38500000000001 |
107.0175 |
109.2705 |
81.108000000000004 |
78.855000000000004 |
110.39700000000001 |
99.132000000000005 |
109.2705 |
108.14400000000001 |
101.38500000000001 |
110.39700000000001 |
101.38500000000001 |
103.63800000000001 |
101.38500000000001 |
95.752499999999998 |
95.752499999999998 |
50.692500000000003 |
6.87 |
6.87 |
6.87 |
6.87 |
6.87 |
6.87 |
6.87 |
6.87 |
6.87 |
6.87 |
6.7325999999999997 |
10.992000000000001 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Inp Rehab Facility -Physical Therapy Therapuetic Activity per 15 mins |
171.8 |
97530 |
36.710799999999999 |
168.364 |
154.62 |
138.29900000000001 |
114.76240000000001 |
110.46740000000001 |
168.364 |
154.62 |
166.64600000000002 |
154.62 |
163.21 |
166.64600000000002 |
123.696 |
120.26 |
168.364 |
151.184 |
166.64600000000002 |
164.928 |
154.62 |
168.364 |
154.62 |
158.05600000000001 |
154.62 |
146.03 |
146.03 |
77.31 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
37.46 |
36.710799999999999 |
59.936000000000007 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Blood glucose (sugar) level after receiving dose of glucose |
108 |
82950 |
4.6550000000000002 |
105.84 |
97.2 |
86.940000000000012 |
72.144000000000005 |
69.444000000000003 |
105.84 |
97.2 |
104.75999999999999 |
97.2 |
102.6 |
104.75999999999999 |
77.759999999999991 |
75.599999999999994 |
105.84 |
95.04 |
104.75999999999999 |
103.67999999999999 |
97.2 |
105.84 |
97.2 |
99.36 |
97.2 |
91.8 |
91.8 |
48.6 |
4.75 |
4.75 |
4.75 |
4.75 |
4.75 |
4.75 |
4.75 |
4.75 |
4.75 |
4.75 |
4.6550000000000002 |
7.6000000000000005 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Hepatitis C antibody measurement |
341.2 |
86803 |
13.984599999999999 |
334.37599999999998 |
307.08 |
274.666 |
227.92160000000001 |
219.39160000000001 |
334.37599999999998 |
307.08 |
330.964 |
307.08 |
324.14 |
330.964 |
245.66399999999999 |
238.83999999999997 |
334.37599999999998 |
300.25599999999997 |
330.964 |
327.55199999999996 |
307.08 |
334.37599999999998 |
307.08 |
313.904 |
307.08 |
290.02 |
290.02 |
153.54 |
14.27 |
14.27 |
14.27 |
14.27 |
14.27 |
14.27 |
14.27 |
14.27 |
14.27 |
14.27 |
13.984599999999999 |
22.832000000000001 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Measurement of antibody for assessment of autoimmune disorder |
192.5 |
86039 |
10.9368 |
188.65 |
173.25 |
154.96250000000001 |
128.59 |
123.7775 |
188.65 |
173.25 |
186.72499999999999 |
173.25 |
182.875 |
186.72499999999999 |
138.6 |
134.75 |
188.65 |
169.4 |
186.72499999999999 |
184.79999999999998 |
173.25 |
188.65 |
173.25 |
177.1 |
173.25 |
163.625 |
163.625 |
86.625 |
11.16 |
11.16 |
11.16 |
11.16 |
11.16 |
11.16 |
11.16 |
11.16 |
11.16 |
11.16 |
10.9368 |
17.856000000000002 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Bilirubin level |
72.900000000000006 |
82248 |
4.9195999999999991 |
71.442000000000007 |
65.610000000000014 |
58.684500000000007 |
48.697200000000009 |
46.874700000000004 |
71.442000000000007 |
65.610000000000014 |
70.713000000000008 |
65.610000000000014 |
69.254999999999995 |
70.713000000000008 |
52.488 |
51.03 |
71.442000000000007 |
64.152000000000001 |
70.713000000000008 |
69.984000000000009 |
65.610000000000014 |
71.442000000000007 |
65.610000000000014 |
67.068000000000012 |
65.610000000000014 |
61.965000000000003 |
61.965000000000003 |
32.805000000000007 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
4.9195999999999991 |
8.032 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Measurement of lung diffusing capacity |
208.7 |
94729 |
0 |
336.43050000000005 |
187.82999999999998 |
168.0035 |
139.41159999999999 |
134.19409999999999 |
204.52599999999998 |
187.82999999999998 |
202.43899999999999 |
187.82999999999998 |
198.26499999999999 |
202.43899999999999 |
150.26399999999998 |
146.08999999999997 |
204.52599999999998 |
183.65599999999998 |
202.43899999999999 |
200.35199999999998 |
187.82999999999998 |
204.52599999999998 |
187.82999999999998 |
192.00399999999999 |
187.82999999999998 |
177.39499999999998 |
177.39499999999998 |
93.914999999999992 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
0 |
336.43050000000005 |
330.02230000000003 |
330.02230000000003 |
336.43050000000005 |
333.22640000000001 |
|
Bilirubin level |
72.900000000000006 |
82247 |
4.9195999999999991 |
71.442000000000007 |
65.610000000000014 |
58.684500000000007 |
48.697200000000009 |
46.874700000000004 |
71.442000000000007 |
65.610000000000014 |
70.713000000000008 |
65.610000000000014 |
69.254999999999995 |
70.713000000000008 |
52.488 |
51.03 |
71.442000000000007 |
64.152000000000001 |
70.713000000000008 |
69.984000000000009 |
65.610000000000014 |
71.442000000000007 |
65.610000000000014 |
67.068000000000012 |
65.610000000000014 |
61.965000000000003 |
61.965000000000003 |
32.805000000000007 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
5.0199999999999996 |
4.9195999999999991 |
8.032 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Insulin Clinic Visit Level 1 |
219.4 |
99211 |
98.73 |
215.012 |
197.46 |
176.61700000000002 |
146.5592 |
141.07420000000002 |
215.012 |
197.46 |
212.81800000000001 |
197.46 |
208.43 |
212.81800000000001 |
157.96799999999999 |
153.57999999999998 |
215.012 |
193.072 |
212.81800000000001 |
210.624 |
197.46 |
215.012 |
197.46 |
201.84800000000001 |
197.46 |
186.49 |
186.49 |
98.73 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Insulin Clinic Level 2 |
219.4 |
99212 |
98.73 |
215.012 |
197.46 |
176.61700000000002 |
146.5592 |
141.07420000000002 |
215.012 |
197.46 |
212.81800000000001 |
197.46 |
208.43 |
212.81800000000001 |
157.96799999999999 |
153.57999999999998 |
215.012 |
193.072 |
212.81800000000001 |
210.624 |
197.46 |
215.012 |
197.46 |
201.84800000000001 |
197.46 |
186.49 |
186.49 |
98.73 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Evaluation of brain response to sound for determination of hearing status with interpretation and report |
229.05 |
92651 |
103.07250000000001 |
224.46899999999999 |
206.14500000000001 |
184.38525000000001 |
153.00540000000001 |
147.27915000000002 |
224.46899999999999 |
206.14500000000001 |
222.17850000000001 |
206.14500000000001 |
217.5975 |
222.17850000000001 |
164.916 |
160.33500000000001 |
224.46899999999999 |
201.56400000000002 |
222.17850000000001 |
219.88800000000001 |
206.14500000000001 |
224.46899999999999 |
206.14500000000001 |
210.72600000000003 |
206.14500000000001 |
194.6925 |
194.6925 |
103.07250000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
131.9178 |
215.37600000000003 |
172.0635 |
168.7861 |
168.7861 |
172.0635 |
170.4248 |
|
Amylase (enzyme) level |
65 |
82150 |
6.3504000000000005 |
63.699999999999996 |
58.5 |
52.325000000000003 |
43.42 |
41.795000000000002 |
63.699999999999996 |
58.5 |
63.05 |
58.5 |
61.75 |
63.05 |
46.8 |
45.5 |
63.699999999999996 |
57.2 |
63.05 |
62.4 |
58.5 |
63.699999999999996 |
58.5 |
59.800000000000004 |
58.5 |
55.25 |
55.25 |
29.25 |
6.48 |
6.48 |
6.48 |
6.48 |
6.48 |
6.48 |
6.48 |
6.48 |
6.48 |
6.48 |
6.3504000000000005 |
10.368000000000002 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Testosterone (hormone) level |
374.25 |
84403 |
25.293799999999997 |
366.76499999999999 |
336.82499999999999 |
301.27125000000001 |
249.99900000000002 |
240.64275000000001 |
366.76499999999999 |
336.82499999999999 |
363.02249999999998 |
336.82499999999999 |
355.53749999999997 |
363.02249999999998 |
269.45999999999998 |
261.97499999999997 |
366.76499999999999 |
329.34 |
363.02249999999998 |
359.28 |
336.82499999999999 |
366.76499999999999 |
336.82499999999999 |
344.31 |
336.82499999999999 |
318.11250000000001 |
318.11250000000001 |
168.41249999999999 |
25.81 |
25.81 |
25.81 |
25.81 |
25.81 |
25.81 |
25.81 |
25.81 |
25.81 |
25.81 |
25.293799999999997 |
41.295999999999999 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Determination of lung volumes using plethysmography |
359.55 |
94726 |
161.79750000000001 |
408.14400000000001 |
323.59500000000003 |
289.43775000000005 |
240.17940000000002 |
231.19065000000001 |
352.35899999999998 |
323.59500000000003 |
348.76350000000002 |
323.59500000000003 |
341.57249999999999 |
348.76350000000002 |
258.87599999999998 |
251.685 |
352.35899999999998 |
316.404 |
348.76350000000002 |
345.16800000000001 |
323.59500000000003 |
352.35899999999998 |
323.59500000000003 |
330.786 |
323.59500000000003 |
305.61750000000001 |
305.61750000000001 |
161.79750000000001 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
249.98820000000001 |
408.14400000000001 |
336.43050000000005 |
330.02230000000003 |
330.02230000000003 |
336.43050000000005 |
333.22640000000001 |
|
Hepatitis B surface antibody measurement |
253.15 |
86706 |
10.5252 |
248.08699999999999 |
227.83500000000001 |
203.78575000000001 |
169.10420000000002 |
162.77545000000001 |
248.08699999999999 |
227.83500000000001 |
245.55549999999999 |
227.83500000000001 |
240.49250000000001 |
245.55549999999999 |
182.268 |
177.20499999999998 |
248.08699999999999 |
222.77200000000002 |
245.55549999999999 |
243.024 |
227.83500000000001 |
248.08699999999999 |
227.83500000000001 |
232.89800000000002 |
227.83500000000001 |
215.17750000000001 |
215.17750000000001 |
113.9175 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.5252 |
17.184000000000001 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Testing for presence of drug |
39.25 |
80305 |
12.347999999999999 |
41.580000000000005 |
35.325000000000003 |
31.596250000000001 |
26.219000000000001 |
25.237750000000002 |
38.464999999999996 |
35.325000000000003 |
38.072499999999998 |
35.325000000000003 |
37.287500000000001 |
38.072499999999998 |
28.259999999999998 |
27.474999999999998 |
38.464999999999996 |
34.54 |
38.072499999999998 |
37.68 |
35.325000000000003 |
38.464999999999996 |
35.325000000000003 |
36.11 |
35.325000000000003 |
33.362499999999997 |
33.362499999999997 |
17.662500000000001 |
12.6 |
12.6 |
12.6 |
12.6 |
12.6 |
12.6 |
12.6 |
12.6 |
12.6 |
12.6 |
12.347999999999999 |
20.16 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Evaluation of wheezing |
416.6 |
94060 |
187.47000000000003 |
408.26800000000003 |
374.94000000000005 |
335.36300000000006 |
278.28880000000004 |
267.87380000000002 |
408.26800000000003 |
374.94000000000005 |
404.10200000000003 |
374.94000000000005 |
395.77 |
404.10200000000003 |
299.952 |
291.62 |
408.26800000000003 |
366.608 |
404.10200000000003 |
399.93599999999998 |
374.94000000000005 |
408.26800000000003 |
374.94000000000005 |
383.27200000000005 |
374.94000000000005 |
354.11 |
354.11 |
187.47000000000003 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
249.98820000000001 |
408.14400000000001 |
336.43050000000005 |
330.02230000000003 |
330.02230000000003 |
336.43050000000005 |
333.22640000000001 |
|
Detection test by nucleic acid for Strep (Streptococcus, group B), amplified probe technique |
218.15 |
87653 |
34.388200000000005 |
213.78700000000001 |
196.33500000000001 |
175.61075000000002 |
145.72420000000002 |
140.27045000000001 |
213.78700000000001 |
196.33500000000001 |
211.60550000000001 |
196.33500000000001 |
207.24250000000001 |
211.60550000000001 |
157.06800000000001 |
152.70499999999998 |
213.78700000000001 |
191.97200000000001 |
211.60550000000001 |
209.42400000000001 |
196.33500000000001 |
213.78700000000001 |
196.33500000000001 |
200.69800000000001 |
196.33500000000001 |
185.42750000000001 |
185.42750000000001 |
98.167500000000004 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older |
344.3 |
90715 |
35.112700000000004 |
337.41399999999999 |
309.87 |
277.16150000000005 |
229.99240000000003 |
221.38490000000002 |
337.41399999999999 |
309.87 |
333.971 |
309.87 |
327.08499999999998 |
333.971 |
247.89599999999999 |
241.01 |
337.41399999999999 |
302.98400000000004 |
333.971 |
330.52800000000002 |
309.87 |
337.41399999999999 |
309.87 |
316.75600000000003 |
309.87 |
292.65500000000003 |
292.65500000000003 |
154.935 |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
35.794500000000006 |
35.112700000000004 |
35.112700000000004 |
35.794500000000006 |
35.453600000000002 |
|
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring |
1284.1500000000001 |
93017 |
233.1611 |
1258.4670000000001 |
1155.7350000000001 |
1033.7407500000002 |
857.81220000000008 |
825.70845000000008 |
1258.4670000000001 |
1155.7350000000001 |
1245.6255000000001 |
1155.7350000000001 |
1219.9425000000001 |
1245.6255000000001 |
924.58800000000008 |
898.90499999999997 |
1258.4670000000001 |
1130.0520000000001 |
1245.6255000000001 |
1232.7840000000001 |
1155.7350000000001 |
1258.4670000000001 |
1155.7350000000001 |
1181.4180000000001 |
1155.7350000000001 |
1091.5275000000001 |
1091.5275000000001 |
577.86750000000006 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
255.09 |
249.98820000000001 |
408.14400000000001 |
237.6885 |
233.1611 |
233.1611 |
237.6885 |
235.4248 |
|
Ammonia level |
149.55000000000001 |
82140 |
14.278600000000001 |
146.559 |
134.59500000000003 |
120.38775000000001 |
99.899400000000014 |
96.160650000000004 |
146.559 |
134.59500000000003 |
145.0635 |
134.59500000000003 |
142.07249999999999 |
145.0635 |
107.676 |
104.685 |
146.559 |
131.60400000000001 |
145.0635 |
143.56800000000001 |
134.59500000000003 |
146.559 |
134.59500000000003 |
137.58600000000001 |
134.59500000000003 |
127.11750000000001 |
127.11750000000001 |
67.297500000000014 |
14.57 |
14.57 |
14.57 |
14.57 |
14.57 |
14.57 |
14.57 |
14.57 |
14.57 |
14.57 |
14.278600000000001 |
23.312000000000001 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Tuberculosis test |
362.55 |
86480 |
60.740399999999994 |
355.29899999999998 |
326.29500000000002 |
291.85275000000001 |
242.18340000000003 |
233.11965000000001 |
355.29899999999998 |
326.29500000000002 |
351.67349999999999 |
326.29500000000002 |
344.42250000000001 |
351.67349999999999 |
261.036 |
253.785 |
355.29899999999998 |
319.04400000000004 |
351.67349999999999 |
348.048 |
326.29500000000002 |
355.29899999999998 |
326.29500000000002 |
333.54600000000005 |
326.29500000000002 |
308.16750000000002 |
308.16750000000002 |
163.14750000000001 |
61.98 |
61.98 |
61.98 |
61.98 |
61.98 |
61.98 |
61.98 |
61.98 |
61.98 |
61.98 |
60.740399999999994 |
99.168000000000006 |
104.67450000000001 |
102.6807 |
102.6807 |
104.67450000000001 |
103.6776 |
|
CT scan of lower spine |
2865.1 |
72131 |
103.0078 |
2807.7979999999998 |
2578.59 |
2306.4054999999998 |
1913.8868 |
1842.2592999999999 |
2807.7979999999998 |
2578.59 |
2779.1469999999999 |
2578.59 |
2721.8449999999998 |
2779.1469999999999 |
2062.8719999999998 |
2005.5699999999997 |
2807.7979999999998 |
2521.288 |
2779.1469999999999 |
2750.4959999999996 |
2578.59 |
2807.7979999999998 |
2578.59 |
2635.8919999999998 |
2578.59 |
2435.335 |
2435.335 |
1289.2950000000001 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
266.04899999999998 |
260.98140000000001 |
260.98140000000001 |
266.04899999999998 |
263.51519999999999 |
|
Imaging of liver and bile duct system with use of drugs |
2462.35 |
78227 |
362.91019999999997 |
2413.1030000000001 |
2216.1149999999998 |
1982.19175 |
1644.8498 |
1583.29105 |
2413.1030000000001 |
2216.1149999999998 |
2388.4794999999999 |
2216.1149999999998 |
2339.2324999999996 |
2388.4794999999999 |
1772.8919999999998 |
1723.6449999999998 |
2413.1030000000001 |
2166.8679999999999 |
2388.4794999999999 |
2363.8559999999998 |
2216.1149999999998 |
2413.1030000000001 |
2216.1149999999998 |
2265.3620000000001 |
2216.1149999999998 |
2092.9974999999999 |
2092.9974999999999 |
1108.0574999999999 |
472.08 |
472.08 |
472.08 |
472.08 |
472.08 |
472.08 |
472.08 |
472.08 |
472.08 |
472.08 |
462.63839999999999 |
755.32799999999997 |
369.95699999999999 |
362.91019999999997 |
362.91019999999997 |
369.95699999999999 |
366.43360000000001 |
|
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers |
1088.45 |
93971 |
103.0078 |
1066.681 |
979.60500000000002 |
876.20225000000005 |
727.08460000000002 |
699.87335000000007 |
1066.681 |
979.60500000000002 |
1055.7964999999999 |
979.60500000000002 |
1034.0274999999999 |
1055.7964999999999 |
783.68399999999997 |
761.91499999999996 |
1066.681 |
957.83600000000001 |
1055.7964999999999 |
1044.912 |
979.60500000000002 |
1066.681 |
979.60500000000002 |
1001.3740000000001 |
979.60500000000002 |
925.1825 |
925.1825 |
489.80250000000001 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
X-ray of middle spine, 2 views |
456.1 |
72070 |
103.0078 |
446.97800000000001 |
410.49 |
367.16050000000001 |
304.6748 |
293.27230000000003 |
446.97800000000001 |
410.49 |
442.41700000000003 |
410.49 |
433.29500000000002 |
442.41700000000003 |
328.392 |
319.27 |
446.97800000000001 |
401.36799999999999 |
442.41700000000003 |
437.85599999999999 |
410.49 |
446.97800000000001 |
410.49 |
419.61200000000002 |
410.49 |
387.685 |
387.685 |
205.245 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
CT scan of neck with contrast |
2469.5 |
70491 |
168.78539999999998 |
2420.11 |
2222.5500000000002 |
1987.9475000000002 |
1649.6260000000002 |
1587.8885 |
2420.11 |
2222.5500000000002 |
2395.415 |
2222.5500000000002 |
2346.0250000000001 |
2395.415 |
1778.04 |
1728.6499999999999 |
2420.11 |
2173.16 |
2395.415 |
2370.7199999999998 |
2222.5500000000002 |
2420.11 |
2222.5500000000002 |
2271.94 |
2222.5500000000002 |
2099.0749999999998 |
2099.0749999999998 |
1111.2750000000001 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
Application of blood vessel compression or decompression device to 1 or more areas |
126.05 |
97016 |
11.524799999999999 |
123.529 |
113.44499999999999 |
101.47025000000001 |
84.201400000000007 |
81.050150000000002 |
123.529 |
113.44499999999999 |
122.26849999999999 |
113.44499999999999 |
119.74749999999999 |
122.26849999999999 |
90.756 |
88.234999999999999 |
123.529 |
110.92399999999999 |
122.26849999999999 |
121.008 |
113.44499999999999 |
123.529 |
113.44499999999999 |
115.96600000000001 |
113.44499999999999 |
107.1425 |
107.1425 |
56.722499999999997 |
11.76 |
11.76 |
11.76 |
11.76 |
11.76 |
11.76 |
11.76 |
11.76 |
11.76 |
11.76 |
11.524799999999999 |
18.815999999999999 |
62.2545 |
61.0687 |
61.0687 |
62.2545 |
61.6616 |
|
Stool lactoferrin (immune system protein) analysis |
159.55000000000001 |
83630 |
19.305999999999997 |
156.35900000000001 |
143.59500000000003 |
128.43775000000002 |
106.57940000000001 |
102.59065000000001 |
156.35900000000001 |
143.59500000000003 |
154.76349999999999 |
143.59500000000003 |
151.57249999999999 |
154.76349999999999 |
114.876 |
111.685 |
156.35900000000001 |
140.40400000000002 |
154.76349999999999 |
153.16800000000001 |
143.59500000000003 |
156.35900000000001 |
143.59500000000003 |
146.78600000000003 |
143.59500000000003 |
135.61750000000001 |
135.61750000000001 |
71.797500000000014 |
19.7 |
19.7 |
19.7 |
19.7 |
19.7 |
19.7 |
19.7 |
19.7 |
19.7 |
19.7 |
19.305999999999997 |
31.52 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Wound Clinic Visit Level 3 |
219.4 |
99213 |
98.73 |
215.012 |
197.46 |
176.61700000000002 |
146.5592 |
141.07420000000002 |
215.012 |
197.46 |
212.81800000000001 |
197.46 |
208.43 |
212.81800000000001 |
157.96799999999999 |
153.57999999999998 |
215.012 |
193.072 |
212.81800000000001 |
210.624 |
197.46 |
215.012 |
197.46 |
201.84800000000001 |
197.46 |
186.49 |
186.49 |
98.73 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
|
Stool culture |
101 |
87045 |
9.251199999999999 |
98.98 |
90.9 |
81.305000000000007 |
67.468000000000004 |
64.942999999999998 |
98.98 |
90.9 |
97.97 |
90.9 |
95.949999999999989 |
97.97 |
72.72 |
70.699999999999989 |
98.98 |
88.88 |
97.97 |
96.96 |
90.9 |
98.98 |
90.9 |
92.92 |
90.9 |
85.85 |
85.85 |
45.45 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.251199999999999 |
15.103999999999999 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Stool culture, each addtl |
101 |
87046 |
9.251199999999999 |
98.98 |
90.9 |
81.305000000000007 |
67.468000000000004 |
64.942999999999998 |
98.98 |
90.9 |
97.97 |
90.9 |
95.949999999999989 |
97.97 |
72.72 |
70.699999999999989 |
98.98 |
88.88 |
97.97 |
96.96 |
90.9 |
98.98 |
90.9 |
92.92 |
90.9 |
85.85 |
85.85 |
45.45 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.44 |
9.251199999999999 |
15.103999999999999 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin) |
101 |
87427 |
11.740400000000001 |
98.98 |
90.9 |
81.305000000000007 |
67.468000000000004 |
64.942999999999998 |
98.98 |
90.9 |
97.97 |
90.9 |
95.949999999999989 |
97.97 |
72.72 |
70.699999999999989 |
98.98 |
88.88 |
97.97 |
96.96 |
90.9 |
98.98 |
90.9 |
92.92 |
90.9 |
85.85 |
85.85 |
45.45 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.740400000000001 |
19.168000000000003 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Detection test by immunoassay for identification of organism |
101 |
87899 |
15.7486 |
98.98 |
90.9 |
81.305000000000007 |
67.468000000000004 |
64.942999999999998 |
98.98 |
90.9 |
97.97 |
90.9 |
95.949999999999989 |
97.97 |
72.72 |
70.699999999999989 |
98.98 |
88.88 |
97.97 |
96.96 |
90.9 |
98.98 |
90.9 |
92.92 |
90.9 |
85.85 |
85.85 |
45.45 |
16.07 |
16.07 |
16.07 |
16.07 |
16.07 |
16.07 |
16.07 |
16.07 |
16.07 |
16.07 |
15.7486 |
25.712000000000003 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Stool analysis for blood to screen for colon tumors |
44.65 |
82270 |
4.2923999999999998 |
43.756999999999998 |
40.185000000000002 |
35.943249999999999 |
29.8262 |
28.709949999999999 |
43.756999999999998 |
40.185000000000002 |
43.310499999999998 |
40.185000000000002 |
42.417499999999997 |
43.310499999999998 |
32.147999999999996 |
31.254999999999995 |
43.756999999999998 |
39.292000000000002 |
43.310499999999998 |
42.863999999999997 |
40.185000000000002 |
43.756999999999998 |
40.185000000000002 |
41.078000000000003 |
40.185000000000002 |
37.952500000000001 |
37.952500000000001 |
20.092500000000001 |
4.38 |
4.38 |
4.38 |
4.38 |
4.38 |
4.38 |
4.38 |
4.38 |
4.38 |
4.38 |
4.2923999999999998 |
7.008 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Multiple measurements of oxygen saturation in blood using ear or finger device |
150.30000000000001 |
94761 |
3.4985999999999997 |
147.29400000000001 |
135.27000000000001 |
120.99150000000002 |
100.40040000000002 |
96.642900000000012 |
147.29400000000001 |
135.27000000000001 |
145.791 |
135.27000000000001 |
142.785 |
145.791 |
108.21600000000001 |
105.21000000000001 |
147.29400000000001 |
132.26400000000001 |
145.791 |
144.28800000000001 |
135.27000000000001 |
147.29400000000001 |
135.27000000000001 |
138.27600000000001 |
135.27000000000001 |
127.75500000000001 |
127.75500000000001 |
67.635000000000005 |
3.57 |
3.57 |
3.57 |
3.57 |
3.57 |
3.57 |
3.57 |
3.57 |
3.57 |
3.57 |
3.4985999999999997 |
5.7119999999999997 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Immunologic analysis technique on serum |
278.55 |
86334 |
21.8932 |
272.97899999999998 |
250.69500000000002 |
224.23275000000001 |
186.07140000000001 |
179.10765000000001 |
272.97899999999998 |
250.69500000000002 |
270.19350000000003 |
250.69500000000002 |
264.6225 |
270.19350000000003 |
200.55600000000001 |
194.98499999999999 |
272.97899999999998 |
245.12400000000002 |
270.19350000000003 |
267.40800000000002 |
250.69500000000002 |
272.97899999999998 |
250.69500000000002 |
256.26600000000002 |
250.69500000000002 |
236.76750000000001 |
236.76750000000001 |
125.34750000000001 |
22.34 |
22.34 |
22.34 |
22.34 |
22.34 |
22.34 |
22.34 |
22.34 |
22.34 |
22.34 |
21.8932 |
35.744 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Application of electrical stimulation to 1 or more areas, unattended by physical therapist |
66.849999999999994 |
G0283/97014 |
12.4656 |
65.512999999999991 |
60.164999999999999 |
53.814250000000001 |
44.655799999999999 |
42.984549999999999 |
65.512999999999991 |
60.164999999999999 |
64.844499999999996 |
60.164999999999999 |
63.507499999999993 |
64.844499999999996 |
48.131999999999991 |
46.794999999999995 |
65.512999999999991 |
58.827999999999996 |
64.844499999999996 |
64.175999999999988 |
60.164999999999999 |
65.512999999999991 |
60.164999999999999 |
61.501999999999995 |
60.164999999999999 |
56.822499999999991 |
56.822499999999991 |
30.0825 |
12.72 |
12.72 |
12.72 |
12.72 |
12.72 |
12.72 |
12.72 |
12.72 |
12.72 |
12.72 |
12.4656 |
20.352000000000004 |
62.2545 |
61.0687 |
61.0687 |
62.2545 |
61.6616 |
|
Vancomycin (antibiotic) level |
276.14999999999998 |
80202 |
13.2692 |
270.62699999999995 |
248.535 |
222.30074999999999 |
184.4682 |
177.56444999999999 |
270.62699999999995 |
248.535 |
267.8655 |
248.535 |
262.34249999999997 |
267.8655 |
198.82799999999997 |
193.30499999999998 |
270.62699999999995 |
243.01199999999997 |
267.8655 |
265.10399999999998 |
248.535 |
270.62699999999995 |
248.535 |
254.05799999999999 |
248.535 |
234.72749999999996 |
234.72749999999996 |
124.2675 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.54 |
13.2692 |
21.664000000000001 |
46.861500000000007 |
45.968900000000005 |
45.968900000000005 |
46.861500000000007 |
46.415200000000006 |
|
Special stained specimen slides to examine tissue, initial procedure |
298.39999999999998 |
88342 |
107.15090000000001 |
292.43199999999996 |
268.56 |
240.21199999999999 |
199.3312 |
191.87119999999999 |
292.43199999999996 |
268.56 |
289.44799999999998 |
268.56 |
283.47999999999996 |
289.44799999999998 |
214.84799999999998 |
208.87999999999997 |
292.43199999999996 |
262.59199999999998 |
289.44799999999998 |
286.46399999999994 |
268.56 |
292.43199999999996 |
268.56 |
274.52799999999996 |
268.56 |
253.64 |
253.64 |
134.28 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
143.88 |
141.00239999999999 |
230.208 |
109.23150000000001 |
107.15090000000001 |
107.15090000000001 |
109.23150000000001 |
108.19120000000001 |
|
MRI scan brain |
3298.5 |
70551 |
217.54039999999998 |
3232.5299999999997 |
2968.65 |
2655.2925 |
2203.3980000000001 |
2120.9355 |
3232.5299999999997 |
2968.65 |
3199.5450000000001 |
2968.65 |
3133.5749999999998 |
3199.5450000000001 |
2374.92 |
2308.9499999999998 |
3232.5299999999997 |
2902.68 |
3199.5450000000001 |
3166.56 |
2968.65 |
3232.5299999999997 |
2968.65 |
3034.6200000000003 |
2968.65 |
2803.7249999999999 |
2803.7249999999999 |
1484.325 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
392.47950000000003 |
385.00370000000004 |
385.00370000000004 |
392.47950000000003 |
388.74160000000006 |
|
Vaccine for influenza administered into muscle |
25 |
90686 |
6.37 |
35.794500000000006 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
25 |
11.25 |
6.5 |
6.5 |
6.5 |
6.5 |
6.5 |
6.5 |
6.5 |
6.5 |
6.5 |
6.5 |
6.37 |
10.4 |
35.794500000000006 |
35.112700000000004 |
35.112700000000004 |
35.794500000000006 |
35.453600000000002 |
|
Ultrasound re-evaluation of pregnant uterus, per fetus |
985.45 |
76816 |
103.0078 |
965.74099999999999 |
886.90500000000009 |
793.28725000000009 |
658.28060000000005 |
633.64435000000003 |
965.74099999999999 |
886.90500000000009 |
955.88650000000007 |
886.90500000000009 |
936.17750000000001 |
955.88650000000007 |
709.524 |
689.81499999999994 |
965.74099999999999 |
867.19600000000003 |
955.88650000000007 |
946.03200000000004 |
886.90500000000009 |
965.74099999999999 |
886.90500000000009 |
906.61400000000003 |
886.90500000000009 |
837.63250000000005 |
837.63250000000005 |
443.45250000000004 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
318.48599999999999 |
312.4196 |
312.4196 |
318.48599999999999 |
315.45280000000002 |
|
Application of vein wound compression system lower leg below knee including ankle and foot |
401.95 |
29581 |
133.4564 |
393.911 |
361.755 |
323.56975 |
268.50260000000003 |
258.45384999999999 |
393.911 |
361.755 |
389.89149999999995 |
361.755 |
381.85249999999996 |
389.89149999999995 |
289.404 |
281.36499999999995 |
393.911 |
353.71600000000001 |
389.89149999999995 |
385.87199999999996 |
361.755 |
393.911 |
361.755 |
369.79399999999998 |
361.755 |
341.65749999999997 |
341.65749999999997 |
180.8775 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
133.4564 |
217.88800000000003 |
254.499 |
249.6514 |
249.6514 |
254.499 |
252.0752 |
|
Gammaglobulin (immune system protein) measurement |
137.80000000000001 |
82784 |
9.1140000000000008 |
135.04400000000001 |
124.02000000000001 |
110.92900000000002 |
92.05040000000001 |
88.605400000000003 |
135.04400000000001 |
124.02000000000001 |
133.666 |
124.02000000000001 |
130.91 |
133.666 |
99.216000000000008 |
96.460000000000008 |
135.04400000000001 |
121.26400000000001 |
133.666 |
132.28800000000001 |
124.02000000000001 |
135.04400000000001 |
124.02000000000001 |
126.77600000000001 |
124.02000000000001 |
117.13000000000001 |
117.13000000000001 |
62.010000000000005 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.3000000000000007 |
9.1140000000000008 |
14.880000000000003 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Hand X-ray, 3 views (unilateral) |
524.25 |
73130 |
76.479200000000006 |
513.76499999999999 |
471.82499999999999 |
422.02125000000001 |
350.19900000000001 |
337.09275000000002 |
513.76499999999999 |
471.82499999999999 |
508.52249999999998 |
471.82499999999999 |
498.03749999999997 |
508.52249999999998 |
377.46 |
366.97499999999997 |
513.76499999999999 |
461.34 |
508.52249999999998 |
503.28 |
471.82499999999999 |
513.76499999999999 |
471.82499999999999 |
482.31 |
471.82499999999999 |
445.61250000000001 |
445.61250000000001 |
235.91249999999999 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Hand X-ray, 3 views (bilateral) |
1048.5 |
73130 - 50 |
76.479200000000006 |
1027.53 |
943.65 |
844.04250000000002 |
700.39800000000002 |
674.18550000000005 |
1027.53 |
943.65 |
1017.045 |
943.65 |
996.07499999999993 |
1017.045 |
754.92 |
733.94999999999993 |
1027.53 |
922.68 |
1017.045 |
1006.56 |
943.65 |
1027.53 |
943.65 |
964.62 |
943.65 |
891.22500000000002 |
891.22500000000002 |
471.82499999999999 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Medication Assisted Treatment Clinic Visit |
224 |
99211 |
100.8 |
219.51999999999998 |
201.6 |
180.32000000000002 |
149.63200000000001 |
144.03200000000001 |
219.51999999999998 |
201.6 |
217.28 |
201.6 |
212.79999999999998 |
217.28 |
161.28 |
156.79999999999998 |
219.51999999999998 |
197.12 |
217.28 |
215.04 |
201.6 |
219.51999999999998 |
201.6 |
206.08 |
201.6 |
190.4 |
190.4 |
100.8 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
114.54 |
112.2492 |
183.26400000000001 |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Varies depending on diagnosis |
Thyroid hormone, T3 measurement |
344.1 |
84481 |
16.601200000000002 |
337.21800000000002 |
309.69000000000005 |
277.00050000000005 |
229.85880000000003 |
221.25630000000001 |
337.21800000000002 |
309.69000000000005 |
333.77699999999999 |
309.69000000000005 |
326.89499999999998 |
333.77699999999999 |
247.75200000000001 |
240.87 |
337.21800000000002 |
302.80800000000005 |
333.77699999999999 |
330.33600000000001 |
309.69000000000005 |
337.21800000000002 |
309.69000000000005 |
316.57200000000006 |
309.69000000000005 |
292.48500000000001 |
292.48500000000001 |
154.84500000000003 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.940000000000001 |
16.601200000000002 |
27.104000000000003 |
60.553500000000007 |
59.400100000000002 |
59.400100000000002 |
60.553500000000007 |
59.976800000000004 |
|
Calcium level |
109.85 |
82330 |
13.4064 |
107.65299999999999 |
98.864999999999995 |
88.429249999999996 |
73.379800000000003 |
70.63355 |
107.65299999999999 |
98.864999999999995 |
106.55449999999999 |
98.864999999999995 |
104.35749999999999 |
106.55449999999999 |
79.091999999999999 |
76.894999999999996 |
107.65299999999999 |
96.667999999999992 |
106.55449999999999 |
105.45599999999999 |
98.864999999999995 |
107.65299999999999 |
98.864999999999995 |
101.062 |
98.864999999999995 |
93.372499999999988 |
93.372499999999988 |
49.432499999999997 |
13.68 |
13.68 |
13.68 |
13.68 |
13.68 |
13.68 |
13.68 |
13.68 |
13.68 |
13.68 |
13.4064 |
21.888000000000002 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Application of ultrasound to 1 or more areas, each 15 minutes |
194.15 |
97035 |
13.798399999999999 |
190.267 |
174.73500000000001 |
156.29075 |
129.69220000000001 |
124.83845000000001 |
190.267 |
174.73500000000001 |
188.32550000000001 |
174.73500000000001 |
184.4425 |
188.32550000000001 |
139.78800000000001 |
135.905 |
190.267 |
170.852 |
188.32550000000001 |
186.38399999999999 |
174.73500000000001 |
190.267 |
174.73500000000001 |
178.61800000000002 |
174.73500000000001 |
165.0275 |
165.0275 |
87.367500000000007 |
14.08 |
14.08 |
14.08 |
14.08 |
14.08 |
14.08 |
14.08 |
14.08 |
14.08 |
14.08 |
13.798399999999999 |
22.528000000000002 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Hepatitis C Antibody screening |
341.2 |
G0472 |
45.423000000000002 |
334.37599999999998 |
307.08 |
274.666 |
227.92160000000001 |
219.39160000000001 |
334.37599999999998 |
307.08 |
330.964 |
307.08 |
324.14 |
330.964 |
245.66399999999999 |
238.83999999999997 |
334.37599999999998 |
300.25599999999997 |
330.964 |
327.55199999999996 |
307.08 |
334.37599999999998 |
307.08 |
313.904 |
307.08 |
290.02 |
290.02 |
153.54 |
46.35 |
46.35 |
46.35 |
46.35 |
46.35 |
46.35 |
46.35 |
46.35 |
46.35 |
46.35 |
45.423000000000002 |
74.160000000000011 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus |
1076.05 |
76801 |
103.0078 |
1054.529 |
968.44499999999994 |
866.22024999999996 |
718.80140000000006 |
691.90014999999994 |
1054.529 |
968.44499999999994 |
1043.7684999999999 |
968.44499999999994 |
1022.2474999999999 |
1043.7684999999999 |
774.75599999999997 |
753.2349999999999 |
1054.529 |
946.92399999999998 |
1043.7684999999999 |
1033.0079999999998 |
968.44499999999994 |
1054.529 |
968.44499999999994 |
989.96600000000001 |
968.44499999999994 |
914.64249999999993 |
914.64249999999993 |
484.22249999999997 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
318.48599999999999 |
312.4196 |
312.4196 |
318.48599999999999 |
315.45280000000002 |
|
Albumin (protein) level |
26.45 |
82040 |
4.851 |
25.920999999999999 |
23.805 |
21.292249999999999 |
17.668600000000001 |
17.007349999999999 |
25.920999999999999 |
23.805 |
25.656499999999998 |
23.805 |
25.127499999999998 |
25.656499999999998 |
19.044 |
18.514999999999997 |
25.920999999999999 |
23.276 |
25.656499999999998 |
25.391999999999999 |
23.805 |
25.920999999999999 |
23.805 |
24.334 |
23.805 |
22.482499999999998 |
22.482499999999998 |
11.9025 |
4.95 |
4.95 |
4.95 |
4.95 |
4.95 |
4.95 |
4.95 |
4.95 |
4.95 |
4.95 |
4.851 |
7.9200000000000008 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Foot X-ray, 3-views (unilateral) |
413.6 |
73630 |
76.479200000000006 |
405.32800000000003 |
372.24 |
332.94800000000004 |
276.28480000000002 |
265.94480000000004 |
405.32800000000003 |
372.24 |
401.19200000000001 |
372.24 |
392.92 |
401.19200000000001 |
297.79200000000003 |
289.52 |
405.32800000000003 |
363.96800000000002 |
401.19200000000001 |
397.05599999999998 |
372.24 |
405.32800000000003 |
372.24 |
380.51200000000006 |
372.24 |
351.56 |
351.56 |
186.12 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Foot X-ray, 3-views (bilateral) |
827.2 |
73630 - 50 |
76.479200000000006 |
810.65600000000006 |
744.48 |
665.89600000000007 |
552.56960000000004 |
531.88960000000009 |
810.65600000000006 |
744.48 |
802.38400000000001 |
744.48 |
785.84 |
802.38400000000001 |
595.58400000000006 |
579.04 |
810.65600000000006 |
727.93600000000004 |
802.38400000000001 |
794.11199999999997 |
744.48 |
810.65600000000006 |
744.48 |
761.02400000000011 |
744.48 |
703.12 |
|
372.24 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
X-ray of spine of neck, 2 or 3 views |
610.04999999999995 |
72040 |
76.479200000000006 |
597.84899999999993 |
549.04499999999996 |
491.09024999999997 |
407.51339999999999 |
392.26214999999996 |
597.84899999999993 |
549.04499999999996 |
591.74849999999992 |
549.04499999999996 |
579.5474999999999 |
591.74849999999992 |
439.23599999999993 |
427.03499999999997 |
597.84899999999993 |
536.84399999999994 |
591.74849999999992 |
585.64799999999991 |
549.04499999999996 |
597.84899999999993 |
549.04499999999996 |
561.24599999999998 |
549.04499999999996 |
518.5424999999999 |
518.5424999999999 |
274.52249999999998 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers |
882.6 |
93970 |
217.54039999999998 |
864.94799999999998 |
794.34 |
710.49300000000005 |
589.57680000000005 |
567.51179999999999 |
864.94799999999998 |
794.34 |
856.12199999999996 |
794.34 |
838.47 |
856.12199999999996 |
635.47199999999998 |
617.81999999999994 |
864.94799999999998 |
776.68799999999999 |
856.12199999999996 |
847.29599999999994 |
794.34 |
864.94799999999998 |
794.34 |
811.99200000000008 |
794.34 |
750.21 |
750.21 |
397.17 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
363.28950000000003 |
356.36970000000002 |
356.36970000000002 |
363.28950000000003 |
359.82960000000003 |
|
Immunologic analysis for detection of tumor antigen |
321.85000000000002 |
86304 |
20.393799999999999 |
315.41300000000001 |
289.66500000000002 |
259.08925000000005 |
214.99580000000003 |
206.94955000000002 |
315.41300000000001 |
289.66500000000002 |
312.19450000000001 |
289.66500000000002 |
305.75749999999999 |
312.19450000000001 |
231.732 |
225.29499999999999 |
315.41300000000001 |
283.22800000000001 |
312.19450000000001 |
308.976 |
289.66500000000002 |
315.41300000000001 |
289.66500000000002 |
296.10200000000003 |
289.66500000000002 |
273.57249999999999 |
273.57249999999999 |
144.83250000000001 |
20.81 |
20.81 |
20.81 |
20.81 |
20.81 |
20.81 |
20.81 |
20.81 |
20.81 |
20.81 |
20.393799999999999 |
33.295999999999999 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Analysis of substance using immunoassay technique |
243.15 |
83516 |
11.299399999999999 |
238.28700000000001 |
218.83500000000001 |
195.73575000000002 |
162.42420000000001 |
156.34545 |
238.28700000000001 |
218.83500000000001 |
235.85550000000001 |
218.83500000000001 |
230.99250000000001 |
235.85550000000001 |
175.06799999999998 |
170.20499999999998 |
238.28700000000001 |
213.97200000000001 |
235.85550000000001 |
233.42400000000001 |
218.83500000000001 |
238.28700000000001 |
218.83500000000001 |
223.69800000000001 |
218.83500000000001 |
206.67750000000001 |
206.67750000000001 |
109.4175 |
11.53 |
11.53 |
11.53 |
11.53 |
11.53 |
11.53 |
11.53 |
11.53 |
11.53 |
11.53 |
11.299399999999999 |
18.448 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Application of long leg splint (thigh to ankle or toes) |
670.05 |
29505 |
133.37470000000002 |
656.64899999999989 |
603.04499999999996 |
539.39025000000004 |
447.59339999999997 |
430.84215 |
656.64899999999989 |
603.04499999999996 |
649.94849999999997 |
603.04499999999996 |
636.5474999999999 |
649.94849999999997 |
482.43599999999992 |
469.03499999999991 |
656.64899999999989 |
589.64400000000001 |
649.94849999999997 |
643.24799999999993 |
603.04499999999996 |
656.64899999999989 |
603.04499999999996 |
616.44600000000003 |
603.04499999999996 |
569.5424999999999 |
569.5424999999999 |
301.52249999999998 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
136.18 |
133.4564 |
217.88800000000003 |
135.96450000000002 |
133.37470000000002 |
133.37470000000002 |
135.96450000000002 |
134.6696 |
|
Ultrasound of head and neck |
861.2 |
76536 |
103.0078 |
843.976 |
775.08 |
693.26600000000008 |
575.28160000000003 |
553.75160000000005 |
843.976 |
775.08 |
835.36400000000003 |
775.08 |
818.14 |
835.36400000000003 |
620.06399999999996 |
602.84 |
843.976 |
757.85599999999999 |
835.36400000000003 |
826.75200000000007 |
775.08 |
843.976 |
775.08 |
792.30400000000009 |
775.08 |
732.02 |
732.02 |
387.54 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Immunologic analysis for detection of organism |
347.2 |
87449 |
11.740400000000001 |
340.25599999999997 |
312.48 |
279.49599999999998 |
231.92959999999999 |
223.24959999999999 |
340.25599999999997 |
312.48 |
336.78399999999999 |
312.48 |
329.84 |
336.78399999999999 |
249.98399999999998 |
243.03999999999996 |
340.25599999999997 |
305.536 |
336.78399999999999 |
333.31199999999995 |
312.48 |
340.25599999999997 |
312.48 |
319.42399999999998 |
312.48 |
295.12 |
295.12 |
156.24 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.98 |
11.740400000000001 |
19.168000000000003 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Syphilis detection test |
43.55 |
86592 |
4.1845999999999997 |
67.79849999999999 |
39.195 |
35.057749999999999 |
29.0914 |
28.002649999999999 |
42.678999999999995 |
39.195 |
42.243499999999997 |
39.195 |
41.372499999999995 |
42.243499999999997 |
31.355999999999998 |
30.484999999999996 |
42.678999999999995 |
38.323999999999998 |
42.243499999999997 |
41.807999999999993 |
39.195 |
42.678999999999995 |
39.195 |
40.066000000000003 |
39.195 |
37.017499999999998 |
37.017499999999998 |
19.5975 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.2699999999999996 |
4.1845999999999997 |
6.8319999999999999 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Ultrasound of pregnant uterus, 1 or more fetus(es) |
985.45 |
76815 |
103.0078 |
965.74099999999999 |
886.90500000000009 |
793.28725000000009 |
658.28060000000005 |
633.64435000000003 |
965.74099999999999 |
886.90500000000009 |
955.88650000000007 |
886.90500000000009 |
936.17750000000001 |
955.88650000000007 |
709.524 |
689.81499999999994 |
965.74099999999999 |
867.19600000000003 |
955.88650000000007 |
946.03200000000004 |
886.90500000000009 |
965.74099999999999 |
886.90500000000009 |
906.61400000000003 |
886.90500000000009 |
837.63250000000005 |
837.63250000000005 |
443.45250000000004 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
318.48599999999999 |
312.4196 |
312.4196 |
318.48599999999999 |
315.45280000000002 |
|
Vaginal ultrasound of pregnant uterus |
712.55 |
76817 |
103.0078 |
698.29899999999998 |
641.29499999999996 |
573.60275000000001 |
475.98340000000002 |
458.16964999999999 |
698.29899999999998 |
641.29499999999996 |
691.17349999999999 |
641.29499999999996 |
676.9224999999999 |
691.17349999999999 |
513.03599999999994 |
498.78499999999991 |
698.29899999999998 |
627.04399999999998 |
691.17349999999999 |
684.04799999999989 |
641.29499999999996 |
698.29899999999998 |
641.29499999999996 |
655.54599999999994 |
641.29499999999996 |
605.6674999999999 |
605.6674999999999 |
320.64749999999998 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
318.48599999999999 |
312.4196 |
312.4196 |
318.48599999999999 |
315.45280000000002 |
|
Detection test by immunoassay technique for Hepatitis B surface antigen |
215.1 |
87340 |
10.1234 |
210.798 |
193.59 |
173.15550000000002 |
143.68680000000001 |
138.30930000000001 |
210.798 |
193.59 |
208.64699999999999 |
193.59 |
204.345 |
208.64699999999999 |
154.87199999999999 |
150.57 |
210.798 |
189.28799999999998 |
208.64699999999999 |
206.49599999999998 |
193.59 |
210.798 |
193.59 |
197.892 |
193.59 |
182.83499999999998 |
182.83499999999998 |
96.795000000000002 |
10.33 |
10.33 |
10.33 |
10.33 |
10.33 |
10.33 |
10.33 |
10.33 |
10.33 |
10.33 |
10.1234 |
16.528000000000002 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
Detection test by nucleic acid for herpes simplex virus, amplified probe technique |
571.54999999999995 |
87529 |
34.388200000000005 |
560.11899999999991 |
514.39499999999998 |
460.09775000000002 |
381.79539999999997 |
367.50664999999998 |
560.11899999999991 |
514.39499999999998 |
554.40349999999989 |
514.39499999999998 |
542.97249999999997 |
554.40349999999989 |
411.51599999999996 |
400.08499999999992 |
560.11899999999991 |
502.96399999999994 |
554.40349999999989 |
548.68799999999999 |
514.39499999999998 |
560.11899999999991 |
514.39499999999998 |
525.82600000000002 |
514.39499999999998 |
485.81749999999994 |
485.81749999999994 |
257.19749999999999 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
35.090000000000003 |
34.388200000000005 |
56.144000000000005 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Evaluation of physical therapy, high complexity |
286.05 |
97163 |
96.049800000000005 |
280.32900000000001 |
257.44499999999999 |
230.27025000000003 |
191.08140000000003 |
183.93015000000003 |
280.32900000000001 |
257.44499999999999 |
277.46850000000001 |
257.44499999999999 |
271.7475 |
277.46850000000001 |
205.95599999999999 |
200.23499999999999 |
280.32900000000001 |
251.72400000000002 |
277.46850000000001 |
274.608 |
257.44499999999999 |
280.32900000000001 |
257.44499999999999 |
263.166 |
257.44499999999999 |
243.14250000000001 |
243.14250000000001 |
128.7225 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
98.01 |
96.049800000000005 |
156.81600000000003 |
157.36350000000002 |
154.36610000000002 |
154.36610000000002 |
157.36350000000002 |
155.8648 |
|
Vaginal delivery |
5357.35 |
59409 |
2410.8075000000003 |
5250.2030000000004 |
4821.6150000000007 |
4312.6667500000003 |
3578.7098000000005 |
3444.7760500000004 |
5250.2030000000004 |
4821.6150000000007 |
5196.6295 |
4821.6150000000007 |
5089.4825000000001 |
5196.6295 |
3857.2919999999999 |
3750.145 |
5250.2030000000004 |
4714.4680000000008 |
5196.6295 |
5143.0560000000005 |
4821.6150000000007 |
5250.2030000000004 |
4821.6150000000007 |
4928.7620000000006 |
4821.6150000000007 |
4553.7475000000004 |
4553.7475000000004 |
2410.8075000000003 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2530.35 |
2479.7429999999999 |
4048.56 |
2533.8495000000003 |
2485.5857000000001 |
2485.5857000000001 |
2533.8495000000003 |
2509.7175999999999 |
|
Blood sodium level |
48.35 |
84295 |
4.7137999999999991 |
47.383000000000003 |
43.515000000000001 |
38.921750000000003 |
32.297800000000002 |
31.08905 |
47.383000000000003 |
43.515000000000001 |
46.899500000000003 |
43.515000000000001 |
45.932499999999997 |
46.899500000000003 |
34.811999999999998 |
33.844999999999999 |
47.383000000000003 |
42.548000000000002 |
46.899500000000003 |
46.415999999999997 |
43.515000000000001 |
47.383000000000003 |
43.515000000000001 |
44.482000000000006 |
43.515000000000001 |
41.097499999999997 |
41.097499999999997 |
21.7575 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.8099999999999996 |
4.7137999999999991 |
7.6959999999999997 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Analysis for antibody to Rubella (German measles virus) |
97 |
86762 |
14.1022 |
95.06 |
87.3 |
78.085000000000008 |
64.796000000000006 |
62.371000000000002 |
95.06 |
87.3 |
94.09 |
87.3 |
92.149999999999991 |
94.09 |
69.84 |
67.899999999999991 |
95.06 |
85.36 |
94.09 |
93.11999999999999 |
87.3 |
95.06 |
87.3 |
89.240000000000009 |
87.3 |
82.45 |
82.45 |
43.65 |
14.39 |
14.39 |
14.39 |
14.39 |
14.39 |
14.39 |
14.39 |
14.39 |
14.39 |
14.39 |
14.1022 |
23.024000000000001 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Glutamyltransferase (liver enzyme) level |
51.95 |
82977 |
7.056 |
50.911000000000001 |
46.755000000000003 |
41.819750000000006 |
34.702600000000004 |
33.403850000000006 |
50.911000000000001 |
46.755000000000003 |
50.391500000000001 |
46.755000000000003 |
49.352499999999999 |
50.391500000000001 |
37.404000000000003 |
36.365000000000002 |
50.911000000000001 |
45.716000000000001 |
50.391500000000001 |
49.872 |
46.755000000000003 |
50.911000000000001 |
46.755000000000003 |
47.794000000000004 |
46.755000000000003 |
44.157499999999999 |
44.157499999999999 |
23.377500000000001 |
7.2 |
7.2 |
7.2 |
7.2 |
7.2 |
7.2 |
7.2 |
7.2 |
7.2 |
7.2 |
7.056 |
11.520000000000001 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube |
4870.8500000000004 |
95811 |
869.51479999999992 |
4773.433 |
4383.7650000000003 |
3921.0342500000006 |
3253.7278000000006 |
3131.9565500000003 |
4773.433 |
4383.7650000000003 |
4724.7245000000003 |
4383.7650000000003 |
4627.3074999999999 |
4724.7245000000003 |
3507.0120000000002 |
3409.5950000000003 |
4773.433 |
4286.348 |
4724.7245000000003 |
4676.0160000000005 |
4383.7650000000003 |
4773.433 |
4383.7650000000003 |
4481.1820000000007 |
4383.7650000000003 |
4140.2224999999999 |
4140.2224999999999 |
2191.8825000000002 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
887.26 |
869.51479999999992 |
1419.616 |
1210.2615000000001 |
1187.2089000000001 |
1187.2089000000001 |
1210.2615000000001 |
1198.7352000000001 |
|
PHP 5+ Hrs/Day |
1200 |
H0015 |
231.56460000000001 |
1176 |
1080 |
966.00000000000011 |
801.6 |
771.6 |
1176 |
1080 |
1164 |
1080 |
1140 |
1164 |
864 |
840 |
1176 |
1056 |
1164 |
1152 |
1080 |
1176 |
1080 |
1104 |
1080 |
1020 |
1020 |
540 |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
236.06100000000001 |
231.56460000000001 |
231.56460000000001 |
236.06100000000001 |
233.81280000000001 |
236.06100000000001 |
Analysis for antibody to Rubeola (measles virus) |
242.3 |
86765 |
12.622400000000001 |
237.45400000000001 |
218.07000000000002 |
195.05150000000003 |
161.85640000000001 |
155.7989 |
237.45400000000001 |
218.07000000000002 |
235.03100000000001 |
218.07000000000002 |
230.185 |
235.03100000000001 |
174.45599999999999 |
169.60999999999999 |
237.45400000000001 |
213.22400000000002 |
235.03100000000001 |
232.608 |
218.07000000000002 |
237.45400000000001 |
218.07000000000002 |
222.91600000000003 |
218.07000000000002 |
205.95500000000001 |
205.95500000000001 |
109.03500000000001 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.622400000000001 |
20.608000000000004 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Rheumatoid factor level |
107.05 |
86431 |
5.5565999999999995 |
104.90899999999999 |
96.344999999999999 |
86.175250000000005 |
71.509399999999999 |
68.833150000000003 |
104.90899999999999 |
96.344999999999999 |
103.8385 |
96.344999999999999 |
101.69749999999999 |
103.8385 |
77.075999999999993 |
74.934999999999988 |
104.90899999999999 |
94.203999999999994 |
103.8385 |
102.76799999999999 |
96.344999999999999 |
104.90899999999999 |
96.344999999999999 |
98.486000000000004 |
96.344999999999999 |
90.992499999999993 |
90.992499999999993 |
48.172499999999999 |
5.67 |
5.67 |
5.67 |
5.67 |
5.67 |
5.67 |
5.67 |
5.67 |
5.67 |
5.67 |
5.5565999999999995 |
9.072000000000001 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Measurement of exhaled carbon dioxide gas |
202.9 |
94799 |
91.305000000000007 |
336.43050000000005 |
182.61 |
163.33450000000002 |
135.53720000000001 |
130.46469999999999 |
198.84200000000001 |
182.61 |
196.81299999999999 |
182.61 |
192.755 |
196.81299999999999 |
146.08799999999999 |
142.03 |
198.84200000000001 |
178.55199999999999 |
196.81299999999999 |
194.78399999999999 |
182.61 |
198.84200000000001 |
182.61 |
186.66800000000001 |
182.61 |
172.465 |
172.465 |
91.305000000000007 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
134.61000000000001 |
131.9178 |
215.37600000000003 |
336.43050000000005 |
330.02230000000003 |
330.02230000000003 |
336.43050000000005 |
333.22640000000001 |
|
Evaluation of occupational therapy, low complexity |
286.05 |
97165 |
93.247 |
280.32900000000001 |
257.44499999999999 |
230.27025000000003 |
191.08140000000003 |
183.93015000000003 |
280.32900000000001 |
257.44499999999999 |
277.46850000000001 |
257.44499999999999 |
271.7475 |
277.46850000000001 |
205.95599999999999 |
200.23499999999999 |
280.32900000000001 |
251.72400000000002 |
277.46850000000001 |
274.608 |
257.44499999999999 |
280.32900000000001 |
257.44499999999999 |
263.166 |
257.44499999999999 |
243.14250000000001 |
243.14250000000001 |
128.7225 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
95.15 |
93.247 |
152.24 |
143.62950000000001 |
140.8937 |
140.8937 |
143.62950000000001 |
142.26159999999999 |
|
Fetal non-stress test |
671.55 |
59025 |
161.0042 |
658.11899999999991 |
604.39499999999998 |
540.59775000000002 |
448.59539999999998 |
431.80664999999999 |
658.11899999999991 |
604.39499999999998 |
651.40349999999989 |
604.39499999999998 |
637.97249999999997 |
651.40349999999989 |
483.51599999999996 |
470.08499999999992 |
658.11899999999991 |
590.96399999999994 |
651.40349999999989 |
644.68799999999999 |
604.39499999999998 |
658.11899999999991 |
604.39499999999998 |
617.82600000000002 |
604.39499999999998 |
570.8175 |
570.8175 |
302.19749999999999 |
164.29 |
164.29 |
164.29 |
164.29 |
164.29 |
164.29 |
164.29 |
164.29 |
164.29 |
164.29 |
161.0042 |
262.86399999999998 |
301.59150000000005 |
295.84690000000001 |
295.84690000000001 |
301.59150000000005 |
298.7192 |
|
Carcinoembryonic antigen (CEA) protein level |
199.25 |
82378 |
18.5808 |
195.26499999999999 |
179.32500000000002 |
160.39625000000001 |
133.09900000000002 |
128.11775 |
195.26499999999999 |
179.32500000000002 |
193.27250000000001 |
179.32500000000002 |
189.28749999999999 |
193.27250000000001 |
143.46 |
139.47499999999999 |
195.26499999999999 |
175.34 |
193.27250000000001 |
191.28 |
179.32500000000002 |
195.26499999999999 |
179.32500000000002 |
183.31 |
179.32500000000002 |
169.36249999999998 |
169.36249999999998 |
89.662500000000009 |
18.96 |
18.96 |
18.96 |
18.96 |
18.96 |
18.96 |
18.96 |
18.96 |
18.96 |
18.96 |
18.5808 |
30.336000000000002 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
X-ray of pelvis, 1 or 2 views |
379.75 |
72170 |
103.0078 |
372.15499999999997 |
341.77500000000003 |
305.69875000000002 |
253.673 |
244.17925 |
372.15499999999997 |
341.77500000000003 |
368.35750000000002 |
341.77500000000003 |
360.76249999999999 |
368.35750000000002 |
273.42 |
265.82499999999999 |
372.15499999999997 |
334.18 |
368.35750000000002 |
364.56 |
341.77500000000003 |
372.15499999999997 |
341.77500000000003 |
349.37 |
341.77500000000003 |
322.78749999999997 |
322.78749999999997 |
170.88750000000002 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Nuclear medicine study with CT imaging skull base to mid-thigh |
9027.4 |
78815 |
1297.2232000000001 |
8846.851999999999 |
8124.66 |
7267.0569999999998 |
6030.3032000000003 |
5804.6181999999999 |
8846.851999999999 |
8124.66 |
8756.5779999999995 |
8124.66 |
8576.0299999999988 |
8756.5779999999995 |
6499.7279999999992 |
6319.1799999999994 |
8846.851999999999 |
7944.1120000000001 |
8756.5779999999995 |
8666.3040000000001 |
8124.66 |
8846.851999999999 |
8124.66 |
8305.2080000000005 |
8124.66 |
7673.2899999999991 |
7673.2899999999991 |
4062.33 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1427.94 |
1399.3812 |
2284.7040000000002 |
1322.412 |
1297.2232000000001 |
1297.2232000000001 |
1322.412 |
1309.8176000000001 |
|
X-ray of middle spine, 3 views |
646 |
72072 |
103.0078 |
633.08000000000004 |
581.4 |
520.03000000000009 |
431.52800000000002 |
415.37799999999999 |
633.08000000000004 |
581.4 |
626.62 |
581.4 |
613.69999999999993 |
626.62 |
465.12 |
452.2 |
633.08000000000004 |
568.48 |
626.62 |
620.16 |
581.4 |
633.08000000000004 |
581.4 |
594.32000000000005 |
581.4 |
549.1 |
549.1 |
290.7 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Calcium level |
56.35 |
82310 |
5.0568 |
55.222999999999999 |
50.715000000000003 |
45.361750000000001 |
37.641800000000003 |
36.233049999999999 |
55.222999999999999 |
50.715000000000003 |
54.659500000000001 |
50.715000000000003 |
53.532499999999999 |
54.659500000000001 |
40.572000000000003 |
39.445 |
55.222999999999999 |
49.588000000000001 |
54.659500000000001 |
54.095999999999997 |
50.715000000000003 |
55.222999999999999 |
50.715000000000003 |
51.842000000000006 |
50.715000000000003 |
47.897500000000001 |
47.897500000000001 |
25.357500000000002 |
5.16 |
5.16 |
5.16 |
5.16 |
5.16 |
5.16 |
5.16 |
5.16 |
5.16 |
5.16 |
5.0568 |
8.2560000000000002 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Protein measurement, serum |
137.69999999999999 |
84165 |
10.5252 |
134.946 |
123.92999999999999 |
110.8485 |
91.983599999999996 |
88.5411 |
134.946 |
123.92999999999999 |
133.56899999999999 |
123.92999999999999 |
130.81499999999997 |
133.56899999999999 |
99.143999999999991 |
96.389999999999986 |
134.946 |
121.17599999999999 |
133.56899999999999 |
132.19199999999998 |
123.92999999999999 |
134.946 |
123.92999999999999 |
126.684 |
123.92999999999999 |
117.04499999999999 |
117.04499999999999 |
61.964999999999996 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.74 |
10.5252 |
17.184000000000001 |
41.580000000000005 |
40.788000000000004 |
40.788000000000004 |
41.580000000000005 |
41.184000000000005 |
|
Ultrasound of pelvis (non-obstetrical) |
825.1 |
76857 |
103.0078 |
808.59799999999996 |
742.59 |
664.20550000000003 |
551.16680000000008 |
530.53930000000003 |
808.59799999999996 |
742.59 |
800.34699999999998 |
742.59 |
783.84500000000003 |
800.34699999999998 |
594.072 |
577.56999999999994 |
808.59799999999996 |
726.08800000000008 |
800.34699999999998 |
792.096 |
742.59 |
808.59799999999996 |
742.59 |
759.0920000000001 |
742.59 |
701.33500000000004 |
701.33500000000004 |
371.29500000000002 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck |
874.15 |
93880 |
217.54039999999998 |
856.66699999999992 |
786.73500000000001 |
703.69074999999998 |
583.93219999999997 |
562.07844999999998 |
856.66699999999992 |
786.73500000000001 |
847.92549999999994 |
786.73500000000001 |
830.4425 |
847.92549999999994 |
629.38799999999992 |
611.90499999999997 |
856.66699999999992 |
769.25199999999995 |
847.92549999999994 |
839.18399999999997 |
786.73500000000001 |
856.66699999999992 |
786.73500000000001 |
804.21799999999996 |
786.73500000000001 |
743.02749999999992 |
743.02749999999992 |
393.36750000000001 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Elbow X-ray, 3 views (unilateral) |
549.25 |
73080 |
76.479200000000006 |
538.26499999999999 |
494.32499999999999 |
442.14625000000001 |
366.899 |
353.16775000000001 |
538.26499999999999 |
494.32499999999999 |
532.77250000000004 |
494.32499999999999 |
521.78750000000002 |
532.77250000000004 |
395.46 |
384.47499999999997 |
538.26499999999999 |
483.34 |
532.77250000000004 |
527.28 |
494.32499999999999 |
538.26499999999999 |
494.32499999999999 |
505.31 |
494.32499999999999 |
466.86250000000001 |
466.86250000000001 |
247.16249999999999 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Elbow X-ray, 3 views (bilateral) |
1098.5 |
73080 - 50 |
76.479200000000006 |
1076.53 |
988.65 |
884.29250000000002 |
733.798 |
706.33550000000002 |
1076.53 |
988.65 |
1065.5450000000001 |
988.65 |
1043.575 |
1065.5450000000001 |
790.92 |
768.94999999999993 |
1076.53 |
966.68 |
1065.5450000000001 |
1054.56 |
988.65 |
1076.53 |
988.65 |
1010.62 |
988.65 |
933.72500000000002 |
933.72500000000002 |
494.32499999999999 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Hip only X-ray, 2 views |
491.6 |
73502 |
76.479200000000006 |
481.76800000000003 |
442.44000000000005 |
395.73800000000006 |
328.38880000000006 |
316.09880000000004 |
481.76800000000003 |
442.44000000000005 |
476.85200000000003 |
442.44000000000005 |
467.02 |
476.85200000000003 |
353.952 |
344.12 |
481.76800000000003 |
432.608 |
476.85200000000003 |
471.93599999999998 |
442.44000000000005 |
481.76800000000003 |
442.44000000000005 |
452.27200000000005 |
442.44000000000005 |
417.86 |
417.86 |
221.22000000000003 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Hip only X-ray, 2 views (bilateral) |
983.2 |
73502 |
114.7188 |
963.53600000000006 |
884.88000000000011 |
791.47600000000011 |
656.77760000000012 |
632.19760000000008 |
963.53600000000006 |
884.88000000000011 |
953.70400000000006 |
884.88000000000011 |
934.04 |
953.70400000000006 |
707.904 |
688.24 |
963.53600000000006 |
865.21600000000001 |
953.70400000000006 |
943.87199999999996 |
884.88000000000011 |
963.53600000000006 |
884.88000000000011 |
904.5440000000001 |
884.88000000000011 |
835.72 |
835.72 |
442.44000000000005 |
117.06 |
117.06 |
117.06 |
117.06 |
117.06 |
117.06 |
117.06 |
117.06 |
117.06 |
117.06 |
114.7188 |
187.29600000000002 |
147.90300000000002 |
145.08580000000001 |
145.08580000000001 |
147.90300000000002 |
146.49440000000001 |
|
Detection test by nucleic acid for Hepatitis C virus, quantification |
300.14999999999998 |
87522 |
41.983200000000004 |
294.14699999999999 |
270.13499999999999 |
241.62074999999999 |
200.50020000000001 |
192.99644999999998 |
294.14699999999999 |
270.13499999999999 |
291.14549999999997 |
270.13499999999999 |
285.14249999999998 |
291.14549999999997 |
216.10799999999998 |
210.10499999999996 |
294.14699999999999 |
264.13200000000001 |
291.14549999999997 |
288.14399999999995 |
270.13499999999999 |
294.14699999999999 |
270.13499999999999 |
276.13799999999998 |
270.13499999999999 |
255.12749999999997 |
255.12749999999997 |
135.0675 |
42.84 |
42.84 |
42.84 |
42.84 |
42.84 |
42.84 |
42.84 |
42.84 |
42.84 |
42.84 |
41.983200000000004 |
68.544000000000011 |
95.948999999999998 |
94.121399999999994 |
94.121399999999994 |
95.948999999999998 |
95.035200000000003 |
|
Ultrasound, pelvic (nonobstetric) |
1115.55 |
76856 |
103.0078 |
1093.239 |
1003.995 |
898.01774999999998 |
745.18740000000003 |
717.29864999999995 |
1093.239 |
1003.995 |
1082.0835 |
1003.995 |
1059.7724999999998 |
1082.0835 |
803.19599999999991 |
780.88499999999988 |
1093.239 |
981.68399999999997 |
1082.0835 |
1070.9279999999999 |
1003.995 |
1093.239 |
1003.995 |
1026.306 |
1003.995 |
948.21749999999997 |
948.21749999999997 |
501.9975 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
105.11 |
103.0078 |
168.17600000000002 |
363.28950000000003 |
356.36970000000002 |
356.36970000000002 |
363.28950000000003 |
359.82960000000003 |
|
Diagnostic mammogram, tomosynthesis used |
44.95 |
77062 |
20.227500000000003 |
70.01400000000001 |
40.455000000000005 |
36.184750000000001 |
30.026600000000002 |
28.902850000000001 |
44.051000000000002 |
40.455000000000005 |
43.601500000000001 |
40.455000000000005 |
42.702500000000001 |
43.601500000000001 |
32.364000000000004 |
31.465 |
44.051000000000002 |
39.556000000000004 |
43.601500000000001 |
43.152000000000001 |
40.455000000000005 |
44.051000000000002 |
40.455000000000005 |
41.354000000000006 |
40.455000000000005 |
38.207500000000003 |
38.207500000000003 |
20.227500000000003 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
23.26 |
22.794800000000002 |
37.216000000000001 |
70.01400000000001 |
68.680400000000006 |
68.680400000000006 |
70.01400000000001 |
69.347200000000015 |
|
Ultrasound Breast, limited |
516.5 |
76642 |
76.479200000000006 |
506.17 |
464.85 |
415.78250000000003 |
345.02199999999999 |
332.10950000000003 |
506.17 |
464.85 |
501.005 |
464.85 |
490.67499999999995 |
501.005 |
371.88 |
361.54999999999995 |
506.17 |
454.52 |
501.005 |
495.84 |
464.85 |
506.17 |
464.85 |
475.18 |
464.85 |
439.02499999999998 |
439.02499999999998 |
232.42500000000001 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
78.040000000000006 |
76.479200000000006 |
124.86400000000002 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Ultrasound Breast, limited (bilateral) |
1033 |
76642 - 50 |
226.09530000000001 |
1012.34 |
929.7 |
831.56500000000005 |
690.04399999999998 |
664.21900000000005 |
1012.34 |
929.7 |
1002.01 |
929.7 |
981.34999999999991 |
1002.01 |
743.76 |
723.09999999999991 |
1012.34 |
909.04 |
1002.01 |
991.68 |
929.7 |
1012.34 |
929.7 |
950.36 |
929.7 |
878.05 |
878.05 |
464.85 |
0 |
0 |
230.4855 |
226.09530000000001 |
226.09530000000001 |
230.4855 |
228.29040000000001 |
|
Vaccine for influenza for injection into muscle |
67 |
90662 |
17.0716 |
65.66 |
60.300000000000004 |
53.935000000000002 |
44.756 |
43.081000000000003 |
65.66 |
60.300000000000004 |
64.989999999999995 |
60.300000000000004 |
63.65 |
64.989999999999995 |
48.239999999999995 |
46.9 |
65.66 |
58.96 |
64.989999999999995 |
64.319999999999993 |
60.300000000000004 |
65.66 |
60.300000000000004 |
61.64 |
60.300000000000004 |
56.949999999999996 |
56.949999999999996 |
30.150000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.420000000000002 |
17.0716 |
27.872000000000003 |
35.794500000000006 |
35.112700000000004 |
35.112700000000004 |
35.794500000000006 |
35.453600000000002 |
|
Analysis for antibody to varicella-zoster virus (chicken pox) |
145.9 |
86787 |
12.622400000000001 |
142.982 |
131.31 |
117.44950000000001 |
97.461200000000005 |
93.813700000000011 |
142.982 |
131.31 |
141.523 |
131.31 |
138.60499999999999 |
141.523 |
105.048 |
102.13 |
142.982 |
128.392 |
141.523 |
140.06399999999999 |
131.31 |
142.982 |
131.31 |
134.22800000000001 |
131.31 |
124.015 |
124.015 |
65.655000000000001 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.88 |
12.622400000000001 |
20.608000000000004 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Triglycerides level |
65.849999999999994 |
84478 |
5.6252000000000004 |
64.532999999999987 |
59.264999999999993 |
53.009250000000002 |
43.9878 |
42.341549999999998 |
64.532999999999987 |
59.264999999999993 |
63.874499999999991 |
59.264999999999993 |
62.55749999999999 |
63.874499999999991 |
47.411999999999992 |
46.094999999999992 |
64.532999999999987 |
57.947999999999993 |
63.874499999999991 |
63.215999999999994 |
59.264999999999993 |
64.532999999999987 |
59.264999999999993 |
60.582000000000001 |
59.264999999999993 |
55.972499999999997 |
55.972499999999997 |
29.632499999999997 |
5.74 |
5.74 |
5.74 |
5.74 |
5.74 |
5.74 |
5.74 |
5.74 |
5.74 |
5.74 |
5.6252000000000004 |
9.1840000000000011 |
25.283999999999999 |
24.802399999999999 |
24.802399999999999 |
25.283999999999999 |
25.043199999999999 |
|
Application of mechanical traction to 1 or more areas |
155.94999999999999 |
97012 |
14.2296 |
152.83099999999999 |
140.35499999999999 |
125.53975 |
104.1746 |
100.27584999999999 |
152.83099999999999 |
140.35499999999999 |
151.27149999999997 |
140.35499999999999 |
148.15249999999997 |
151.27149999999997 |
112.28399999999999 |
109.16499999999999 |
152.83099999999999 |
137.23599999999999 |
151.27149999999997 |
149.71199999999999 |
140.35499999999999 |
152.83099999999999 |
140.35499999999999 |
143.47399999999999 |
140.35499999999999 |
132.55749999999998 |
132.55749999999998 |
70.177499999999995 |
14.52 |
14.52 |
14.52 |
14.52 |
14.52 |
14.52 |
14.52 |
14.52 |
14.52 |
14.52 |
14.2296 |
23.231999999999999 |
62.2545 |
61.0687 |
61.0687 |
62.2545 |
61.6616 |
|
Ultrasound study of arteries of both arms and legs |
585.29999999999995 |
93922 |
105.83019999999999 |
573.59399999999994 |
526.77 |
471.16649999999998 |
390.98039999999997 |
376.34789999999998 |
573.59399999999994 |
526.77 |
567.74099999999999 |
526.77 |
556.03499999999997 |
567.74099999999999 |
421.41599999999994 |
409.70999999999992 |
573.59399999999994 |
515.06399999999996 |
567.74099999999999 |
561.88799999999992 |
526.77 |
573.59399999999994 |
526.77 |
538.476 |
526.77 |
497.50499999999994 |
497.50499999999994 |
263.38499999999999 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
107.99 |
105.83019999999999 |
172.78399999999999 |
261.01949999999999 |
256.04770000000002 |
256.04770000000002 |
261.01949999999999 |
258.53360000000004 |
|
Screening test for mononucleosis (mono) |
105.75 |
86308 |
5.0763999999999996 |
103.63500000000001 |
95.174999999999997 |
85.128750000000011 |
70.641000000000005 |
67.997250000000008 |
103.63500000000001 |
95.174999999999997 |
102.5775 |
95.174999999999997 |
100.46249999999999 |
102.5775 |
76.14 |
74.024999999999991 |
103.63500000000001 |
93.06 |
102.5775 |
101.52 |
95.174999999999997 |
103.63500000000001 |
95.174999999999997 |
97.29 |
95.174999999999997 |
89.887500000000003 |
89.887500000000003 |
47.587499999999999 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.18 |
5.0763999999999996 |
8.2880000000000003 |
67.79849999999999 |
66.507099999999994 |
66.507099999999994 |
67.79849999999999 |
67.152799999999999 |
|
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection |
18739.099999999999 |
93458 |
2458.9190000000003 |
18364.317999999999 |
16865.189999999999 |
15084.9755 |
12517.718800000001 |
12049.2413 |
18364.317999999999 |
16865.189999999999 |
18176.927 |
16865.189999999999 |
17802.144999999997 |
18176.927 |
13492.151999999998 |
13117.369999999999 |
18364.317999999999 |
16490.407999999999 |
18176.927 |
17989.535999999996 |
16865.189999999999 |
18364.317999999999 |
16865.189999999999 |
17239.971999999998 |
16865.189999999999 |
15928.234999999999 |
15928.234999999999 |
8432.5949999999993 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2796.39 |
2740.4621999999999 |
4474.2240000000002 |
2506.6650000000004 |
2458.9190000000003 |
2458.9190000000003 |
2506.6650000000004 |
2482.7920000000004 |
|
Identification of organisms by genetic analysis |
622.65 |
87149 |
19.649000000000001 |
610.197 |
560.38499999999999 |
501.23325 |
415.93020000000001 |
400.36394999999999 |
610.197 |
560.38499999999999 |
603.97050000000002 |
560.38499999999999 |
591.51749999999993 |
603.97050000000002 |
448.30799999999999 |
435.85499999999996 |
610.197 |
547.93200000000002 |
603.97050000000002 |
597.74399999999991 |
560.38499999999999 |
610.197 |
560.38499999999999 |
572.83799999999997 |
560.38499999999999 |
529.25249999999994 |
529.25249999999994 |
280.1925 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
20.05 |
19.649000000000001 |
32.080000000000005 |
46.6935 |
45.804099999999998 |
45.804099999999998 |
46.6935 |
46.248800000000003 |
|
MRI scan of upper spinal canal |
3298.5 |
72141 |
217.54039999999998 |
3232.5299999999997 |
2968.65 |
2655.2925 |
2203.3980000000001 |
2120.9355 |
3232.5299999999997 |
2968.65 |
3199.5450000000001 |
2968.65 |
3133.5749999999998 |
3199.5450000000001 |
2374.92 |
2308.9499999999998 |
3232.5299999999997 |
2902.68 |
3199.5450000000001 |
3166.56 |
2968.65 |
3232.5299999999997 |
2968.65 |
3034.6200000000003 |
2968.65 |
2803.7249999999999 |
2803.7249999999999 |
1484.325 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
221.98 |
217.54039999999998 |
355.16800000000001 |
392.47950000000003 |
385.00370000000004 |
385.00370000000004 |
392.47950000000003 |
388.74160000000006 |
|
Injections of trigger points in 1 or 2 muscles |
1323.36 |
20552 |
246.88159999999999 |
1296.8927999999999 |
1191.0239999999999 |
1065.3047999999999 |
884.00447999999994 |
850.92048 |
1296.8927999999999 |
1191.0239999999999 |
1283.6591999999998 |
1191.0239999999999 |
1257.1919999999998 |
1283.6591999999998 |
952.81919999999991 |
926.35199999999986 |
1296.8927999999999 |
1164.5567999999998 |
1283.6591999999998 |
1270.4255999999998 |
1191.0239999999999 |
1296.8927999999999 |
1191.0239999999999 |
1217.4911999999999 |
1191.0239999999999 |
1124.856 |
1124.856 |
595.51199999999994 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
246.88159999999999 |
403.072 |
311.16750000000002 |
305.24050000000005 |
305.24050000000005 |
311.16750000000002 |
308.20400000000001 |
|
Pharmacy/drugs administered |
82.47 |
0250/0636 |
37.111499999999999 |
80.820599999999999 |
74.222999999999999 |
66.388350000000003 |
55.089960000000005 |
53.028210000000001 |
80.820599999999999 |
74.222999999999999 |
79.995899999999992 |
74.222999999999999 |
78.346499999999992 |
79.995899999999992 |
59.378399999999999 |
57.728999999999992 |
80.820599999999999 |
72.573599999999999 |
79.995899999999992 |
79.171199999999999 |
74.222999999999999 |
80.820599999999999 |
74.222999999999999 |
75.872399999999999 |
74.222999999999999 |
70.099499999999992 |
70.099499999999992 |
37.111499999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Injections of trigger points in 3 or more muscles |
1970.22 |
20553 |
246.88159999999999 |
1930.8155999999999 |
1773.1980000000001 |
1586.0271 |
1316.1069600000001 |
1266.8514600000001 |
1930.8155999999999 |
1773.1980000000001 |
1911.1134 |
1773.1980000000001 |
1871.7089999999998 |
1911.1134 |
1418.5583999999999 |
1379.154 |
1930.8155999999999 |
1733.7936 |
1911.1134 |
1891.4112 |
1773.1980000000001 |
1930.8155999999999 |
1773.1980000000001 |
1812.6024000000002 |
1773.1980000000001 |
1674.6869999999999 |
1674.6869999999999 |
886.59900000000005 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
251.92 |
246.88159999999999 |
403.072 |
311.16750000000002 |
305.24050000000005 |
305.24050000000005 |
311.16750000000002 |
308.20400000000001 |
|
Pharmacy/drugs administered |
82.47 |
0250/0636 |
37.111499999999999 |
80.820599999999999 |
74.222999999999999 |
66.388350000000003 |
55.089960000000005 |
53.028210000000001 |
80.820599999999999 |
74.222999999999999 |
79.995899999999992 |
74.222999999999999 |
78.346499999999992 |
79.995899999999992 |
59.378399999999999 |
57.728999999999992 |
80.820599999999999 |
72.573599999999999 |
79.995899999999992 |
79.171199999999999 |
74.222999999999999 |
80.820599999999999 |
74.222999999999999 |
75.872399999999999 |
74.222999999999999 |
70.099499999999992 |
70.099499999999992 |
37.111499999999999 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes |
175.43 |
12011 |
78.9435 |
277.10399999999998 |
157.887 |
141.22115000000002 |
117.18724000000002 |
112.80149 |
171.92140000000001 |
157.887 |
170.1671 |
157.887 |
166.6585 |
170.1671 |
126.3096 |
122.801 |
171.92140000000001 |
154.3784 |
170.1671 |
168.4128 |
157.887 |
171.92140000000001 |
157.887 |
161.3956 |
157.887 |
149.1155 |
149.1155 |
78.9435 |
173.19 |
173.19 |
173.19 |
173.19 |
173.19 |
173.19 |
173.19 |
173.19 |
173.19 |
173.19 |
169.72620000000001 |
277.10399999999998 |
251.9265 |
247.12790000000001 |
247.12790000000001 |
251.9265 |
249.52720000000002 |
|
Supplies |
902.06 |
0270-0278 |
405.92699999999996 |
884.01879999999994 |
811.85399999999993 |
726.15830000000005 |
602.57608000000005 |
580.02458000000001 |
884.01879999999994 |
811.85399999999993 |
874.99819999999988 |
811.85399999999993 |
856.95699999999988 |
874.99819999999988 |
649.4831999999999 |
631.44199999999989 |
884.01879999999994 |
793.81279999999992 |
874.99819999999988 |
865.97759999999994 |
811.85399999999993 |
884.01879999999994 |
811.85399999999993 |
829.89519999999993 |
811.85399999999993 |
766.75099999999998 |
766.75099999999998 |
405.92699999999996 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan of blood vessels in chest with contrast |
4315.3500000000004 |
71275 |
168.78539999999998 |
4229.0430000000006 |
3883.8150000000005 |
3473.8567500000004 |
2882.6538000000005 |
2774.7700500000001 |
4229.0430000000006 |
3883.8150000000005 |
4185.8895000000002 |
3883.8150000000005 |
4099.5825000000004 |
4185.8895000000002 |
3107.0520000000001 |
3020.7449999999999 |
4229.0430000000006 |
3797.5080000000003 |
4185.8895000000002 |
4142.7359999999999 |
3883.8150000000005 |
4229.0430000000006 |
3883.8150000000005 |
3970.1220000000003 |
3883.8150000000005 |
3668.0475000000001 |
3668.0475000000001 |
1941.9075000000003 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
509.96400000000006 |
500.25040000000001 |
500.25040000000001 |
509.96400000000006 |
505.10720000000003 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan chest with contrast |
2632.6 |
71260 |
168.78539999999998 |
2579.9479999999999 |
2369.34 |
2119.2429999999999 |
1758.5768 |
1692.7618 |
2579.9479999999999 |
2369.34 |
2553.6219999999998 |
2369.34 |
2500.9699999999998 |
2553.6219999999998 |
1895.4719999999998 |
1842.8199999999997 |
2579.9479999999999 |
2316.6880000000001 |
2553.6219999999998 |
2527.2959999999998 |
2369.34 |
2579.9479999999999 |
2369.34 |
2421.9920000000002 |
2369.34 |
2237.71 |
2237.71 |
1184.67 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
511.31850000000003 |
501.57910000000004 |
501.57910000000004 |
511.31850000000003 |
506.44880000000006 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan of abdominal and pelvic blood vessels with contrast |
7096 |
74174 |
347.98819999999995 |
6954.08 |
6386.4000000000005 |
5712.2800000000007 |
4740.1280000000006 |
4562.7280000000001 |
6954.08 |
6386.4000000000005 |
6883.12 |
6386.4000000000005 |
6741.2 |
6883.12 |
5109.12 |
4967.2 |
6954.08 |
6244.4800000000005 |
6883.12 |
6812.16 |
6386.4000000000005 |
6954.08 |
6386.4000000000005 |
6528.3200000000006 |
6386.4000000000005 |
6031.5999999999995 |
6031.5999999999995 |
3193.2000000000003 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
355.09 |
347.98819999999995 |
568.14400000000001 |
509.96400000000006 |
500.25040000000001 |
500.25040000000001 |
509.96400000000006 |
505.10720000000003 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Injections of upper or middle spine facet joint using imaging guidance |
2020.05 |
64490 |
777.47320000000002 |
1979.6489999999999 |
1818.0450000000001 |
1626.1402500000002 |
1349.3934000000002 |
1298.8921499999999 |
1979.6489999999999 |
1818.0450000000001 |
1959.4485 |
1818.0450000000001 |
1919.0474999999999 |
1959.4485 |
1454.4359999999999 |
1414.0349999999999 |
1979.6489999999999 |
1777.644 |
1959.4485 |
1939.2479999999998 |
1818.0450000000001 |
1979.6489999999999 |
1818.0450000000001 |
1858.4460000000001 |
1818.0450000000001 |
1717.0425 |
1717.0425 |
909.02250000000004 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
793.34 |
777.47320000000002 |
1269.3440000000001 |
952.41300000000001 |
934.27179999999998 |
934.27179999999998 |
952.41300000000001 |
943.3424 |
|
second level (List separately in addition to code for primary procedure) |
943.08 |
64491 |
424.38600000000002 |
924.21839999999997 |
848.77200000000005 |
759.1794000000001 |
629.97744000000012 |
606.40044 |
924.21839999999997 |
848.77200000000005 |
914.7876 |
848.77200000000005 |
895.92600000000004 |
914.7876 |
679.01760000000002 |
660.15599999999995 |
924.21839999999997 |
829.9104000000001 |
914.7876 |
905.35680000000002 |
848.77200000000005 |
924.21839999999997 |
848.77200000000005 |
867.63360000000011 |
848.77200000000005 |
801.61800000000005 |
801.61800000000005 |
424.38600000000002 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Pharmacy/drugs administered |
240.62 |
0250/0636 |
108.27900000000001 |
235.80760000000001 |
216.55800000000002 |
193.69910000000002 |
160.73416 |
154.71866 |
235.80760000000001 |
216.55800000000002 |
233.4014 |
216.55800000000002 |
228.589 |
233.4014 |
173.24639999999999 |
168.434 |
235.80760000000001 |
211.7456 |
233.4014 |
230.99519999999998 |
216.55800000000002 |
235.80760000000001 |
216.55800000000002 |
221.37040000000002 |
216.55800000000002 |
204.52699999999999 |
204.52699999999999 |
108.27900000000001 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
Supplies |
70.23 |
0270-0278 |
31.603500000000004 |
68.825400000000002 |
63.207000000000008 |
56.535150000000009 |
46.913640000000008 |
45.157890000000002 |
68.825400000000002 |
63.207000000000008 |
68.123100000000008 |
63.207000000000008 |
66.718500000000006 |
68.123100000000008 |
50.565600000000003 |
49.161000000000001 |
68.825400000000002 |
61.802400000000006 |
68.123100000000008 |
67.4208 |
63.207000000000008 |
68.825400000000002 |
63.207000000000008 |
64.61160000000001 |
63.207000000000008 |
59.695500000000003 |
59.695500000000003 |
31.603500000000004 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan of neck blood vessels with contrast |
4067.75 |
70498 |
168.78539999999998 |
3986.395 |
3660.9749999999999 |
3274.5387500000002 |
2717.2570000000001 |
2615.5632500000002 |
3986.395 |
3660.9749999999999 |
3945.7174999999997 |
3660.9749999999999 |
3864.3624999999997 |
3945.7174999999997 |
2928.7799999999997 |
2847.4249999999997 |
3986.395 |
3579.62 |
3945.7174999999997 |
3905.04 |
3660.9749999999999 |
3986.395 |
3660.9749999999999 |
3742.3300000000004 |
3660.9749999999999 |
3457.5875000000001 |
3457.5875000000001 |
1830.4875 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
509.96400000000006 |
500.25040000000001 |
500.25040000000001 |
509.96400000000006 |
505.10720000000003 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
CT scan of blood vessel of head with contrast |
3331.7 |
70496 |
168.78539999999998 |
3265.0659999999998 |
2998.5299999999997 |
2682.0185000000001 |
2225.5756000000001 |
2142.2831000000001 |
3265.0659999999998 |
2998.5299999999997 |
3231.7489999999998 |
2998.5299999999997 |
3165.1149999999998 |
3231.7489999999998 |
2398.8239999999996 |
2332.1899999999996 |
3265.0659999999998 |
2931.8959999999997 |
3231.7489999999998 |
3198.4319999999998 |
2998.5299999999997 |
3265.0659999999998 |
2998.5299999999997 |
3065.1639999999998 |
2998.5299999999997 |
2831.9449999999997 |
2831.9449999999997 |
1499.2649999999999 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
172.23 |
168.78539999999998 |
275.56799999999998 |
509.96400000000006 |
500.25040000000001 |
500.25040000000001 |
509.96400000000006 |
505.10720000000003 |
|
Contrast material |
283.70999999999998 |
Q9967 |
127.6695 |
278.03579999999999 |
255.339 |
228.38655 |
189.51828 |
182.42552999999998 |
278.03579999999999 |
255.339 |
275.19869999999997 |
255.339 |
269.52449999999999 |
275.19869999999997 |
204.27119999999996 |
198.59699999999998 |
278.03579999999999 |
249.66479999999999 |
275.19869999999997 |
272.36159999999995 |
255.339 |
278.03579999999999 |
255.339 |
261.01319999999998 |
255.339 |
241.15349999999998 |
241.15349999999998 |
127.6695 |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
Packaged |
|
600
600
1
1
3
3
0
3
1
2
0
0
0
False
False