/data															
/row/code_description	/row/code_type	/row/code	/row/de_identified_maximum_negotiated_charge	/row/de_identified_maximum_negotiated_charge/#agg	/row/de_identified_minimum_negotiated_charge	/row/de_identified_minimum_negotiated_charge/#agg	/row/discounted_cash_price	/row/discounted_cash_price/#agg	/row/gross_charge	/row/gross_charge/#agg	/row/patient_class	/row/payer_specific_negotiated_charge	/row/payer_specific_negotiated_charge/#agg	/row/payer	/row/plan_type
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	aetna	ppo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	aetna	epo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	aetna	hmo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	aetna	pos
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1732.38	1732.38	aetna	ppo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1732.38	1732.38	aetna	epo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1732.38	1732.38	aetna	hmo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1732.38	1732.38	aetna	pos
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	325.48	325.48	aetna	ppo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	325.48	325.48	aetna	epo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	325.48	325.48	aetna	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	325.48	325.48	aetna	pos
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	739.85	739.85	aetna	ppo
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	739.85	739.85	aetna	epo
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	739.85	739.85	aetna	hmo
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	739.85	739.85	aetna	pos
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	1406.03	1406.03	aetna	ppo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	1406.03	1406.03	aetna	epo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	1406.03	1406.03	aetna	hmo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	1406.03	1406.03	aetna	pos
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	903.1	903.1	aetna	ppo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	903.1	903.1	aetna	epo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	903.1	903.1	aetna	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	903.1	903.1	aetna	pos
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1995.04	1995.04	aetna	ppo
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1995.04	1995.04	aetna	epo
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1995.04	1995.04	aetna	hmo
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1995.04	1995.04	aetna	pos
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2177.79	2177.79	aetna	ppo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2177.79	2177.79	aetna	epo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2177.79	2177.79	aetna	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2177.79	2177.79	aetna	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1138.95	1138.95	aetna	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1138.95	1138.95	aetna	epo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1138.95	1138.95	aetna	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1138.95	1138.95	aetna	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	23.3	23.3	aetna	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	23.3	23.3	aetna	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	23.3	23.3	aetna	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	23.3	23.3	aetna	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	825.72	825.72	aetna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	825.72	825.72	aetna	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	825.72	825.72	aetna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	825.72	825.72	aetna	pos
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	14191.44	14191.44	aetna	ppo
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	14191.44	14191.44	aetna	epo
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	14191.44	14191.44	aetna	hmo
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	14191.44	14191.44	aetna	pos
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	50.06	50.06	aetna	ppo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	50.06	50.06	aetna	epo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	50.06	50.06	aetna	hmo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	50.06	50.06	aetna	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	22.94	22.94	aetna	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	22.94	22.94	aetna	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	22.94	22.94	aetna	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	22.94	22.94	aetna	pos
"kcentra, per i.u."	cpt	C9132	4893.99	4893.99	1444.99	1444.99	25616.82	25616.82	21347.35	21347.35	O	1444.99	1444.99	aetna	ppo
"kcentra, per i.u."	cpt	C9132	4893.99	4893.99	1444.99	1444.99	25616.82	25616.82	21347.35	21347.35	O	1444.99	1444.99	aetna	epo
"kcentra, per i.u."	cpt	C9132	4893.99	4893.99	1444.99	1444.99	25616.82	25616.82	21347.35	21347.35	O	1444.99	1444.99	aetna	hmo
"kcentra, per i.u."	cpt	C9132	4893.99	4893.99	1444.99	1444.99	25616.82	25616.82	21347.35	21347.35	O	1444.99	1444.99	aetna	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1971.24	1971.24	aetna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1971.24	1971.24	aetna	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1971.24	1971.24	aetna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1971.24	1971.24	aetna	pos
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	663.49	663.49	aetna	ppo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	663.49	663.49	aetna	epo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	663.49	663.49	aetna	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	663.49	663.49	aetna	pos
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	63.7	63.7	aetna	ppo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	63.7	63.7	aetna	epo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	63.7	63.7	aetna	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	63.7	63.7	aetna	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1743.68	1743.68	aetna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1743.68	1743.68	aetna	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1743.68	1743.68	aetna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1743.68	1743.68	aetna	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	1516.11	1516.11	aetna	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	1516.11	1516.11	aetna	epo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	1516.11	1516.11	aetna	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	1516.11	1516.11	aetna	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.29	70.29	aetna	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.29	70.29	aetna	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.29	70.29	aetna	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.29	70.29	aetna	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	aetna	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	aetna	epo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	aetna	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	aetna	pos
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	87.99	87.99	aetna	ppo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	87.99	87.99	aetna	epo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	87.99	87.99	aetna	hmo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	87.99	87.99	aetna	pos
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	83.8	83.8	aetna	ppo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	83.8	83.8	aetna	epo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	83.8	83.8	aetna	hmo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	83.8	83.8	aetna	pos
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	46.48	46.48	aetna	ppo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	46.48	46.48	aetna	epo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	46.48	46.48	aetna	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	46.48	46.48	aetna	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	1464.23	1464.23	aetna	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	1464.23	1464.23	aetna	epo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	1464.23	1464.23	aetna	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	1464.23	1464.23	aetna	pos
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	aetna	ppo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	aetna	epo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	aetna	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	aetna	pos
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	9490.45	9490.45	aetna	ppo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	9490.45	9490.45	aetna	epo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	9490.45	9490.45	aetna	hmo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	9490.45	9490.45	aetna	pos
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1995.04	1995.04	aetna	ppo
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1995.04	1995.04	aetna	epo
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1995.04	1995.04	aetna	hmo
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1995.04	1995.04	aetna	pos
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	671.68	671.68	aetna	ppo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	671.68	671.68	aetna	epo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	671.68	671.68	aetna	hmo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	671.68	671.68	aetna	pos
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	ppo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	epo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	pos
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	ppo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	epo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	620.75	620.75	aetna	pos
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1995.04	1995.04	aetna	ppo
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1995.04	1995.04	aetna	epo
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1995.04	1995.04	aetna	hmo
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1995.04	1995.04	aetna	pos
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	9214.1	9214.1	aetna	ppo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	9214.1	9214.1	aetna	epo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	9214.1	9214.1	aetna	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	9214.1	9214.1	aetna	pos
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7205.71	7205.71	aetna	ppo
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7205.71	7205.71	aetna	epo
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7205.71	7205.71	aetna	hmo
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7205.71	7205.71	aetna	pos
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	1807.46	1807.46	aetna	ppo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	1807.46	1807.46	aetna	epo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	1807.46	1807.46	aetna	hmo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	1807.46	1807.46	aetna	pos
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1264.62	1264.62	aetna	ppo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1264.62	1264.62	aetna	epo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1264.62	1264.62	aetna	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1264.62	1264.62	aetna	pos
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	2410.83	2410.83	aetna	ppo
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	2410.83	2410.83	aetna	epo
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	2410.83	2410.83	aetna	hmo
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	2410.83	2410.83	aetna	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	aetna	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	aetna	epo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	aetna	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	aetna	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1127.01	1127.01	aetna	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1127.01	1127.01	aetna	epo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1127.01	1127.01	aetna	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1127.01	1127.01	aetna	pos
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	620.75	620.75	aetna	ppo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	620.75	620.75	aetna	epo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	620.75	620.75	aetna	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	620.75	620.75	aetna	pos
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	249.2	249.2	aetna	ppo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	249.2	249.2	aetna	epo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	249.2	249.2	aetna	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	249.2	249.2	aetna	pos
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1958.83	1958.83	aetna	ppo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1958.83	1958.83	aetna	epo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1958.83	1958.83	aetna	hmo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1958.83	1958.83	aetna	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	105.94	105.94	aetna	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	105.94	105.94	aetna	epo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	105.94	105.94	aetna	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	105.94	105.94	aetna	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	385.25	385.25	aetna	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	385.25	385.25	aetna	epo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	385.25	385.25	aetna	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	385.25	385.25	aetna	pos
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14156.17	14156.17	aetna	ppo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14156.17	14156.17	aetna	epo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14156.17	14156.17	aetna	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14156.17	14156.17	aetna	pos
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	643.93	643.93	aetna	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	643.93	643.93	aetna	epo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	643.93	643.93	aetna	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	643.93	643.93	aetna	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	579.75	579.75	aetna	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	579.75	579.75	aetna	epo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	579.75	579.75	aetna	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	579.75	579.75	aetna	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	573.24	573.24	aetna	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	573.24	573.24	aetna	epo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	573.24	573.24	aetna	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	573.24	573.24	aetna	pos
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	aetna	ppo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	aetna	epo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	aetna	hmo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	aetna	pos
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	9490.45	9490.45	aetna	ppo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	9490.45	9490.45	aetna	epo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	9490.45	9490.45	aetna	hmo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	9490.45	9490.45	aetna	pos
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	aetna	ppo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	aetna	epo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	aetna	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	aetna	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8619.47	8619.47	aetna	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8619.47	8619.47	aetna	epo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8619.47	8619.47	aetna	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8619.47	8619.47	aetna	pos
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14120.9	14120.9	aetna	ppo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14120.9	14120.9	aetna	epo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14120.9	14120.9	aetna	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14120.9	14120.9	aetna	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11450.77	11450.77	aetna	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11450.77	11450.77	aetna	epo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11450.77	11450.77	aetna	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11450.77	11450.77	aetna	pos
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	14120.9	14120.9	aetna	ppo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	14120.9	14120.9	aetna	epo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	14120.9	14120.9	aetna	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	14120.9	14120.9	aetna	pos
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	4282.09	4282.09	aetna	ppo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	4282.09	4282.09	aetna	epo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	4282.09	4282.09	aetna	hmo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	4282.09	4282.09	aetna	pos
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	160.63	160.63	aetna	ppo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	160.63	160.63	aetna	epo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	160.63	160.63	aetna	hmo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	160.63	160.63	aetna	pos
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	14156.17	14156.17	aetna	ppo
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	14156.17	14156.17	aetna	epo
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	14156.17	14156.17	aetna	hmo
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	14156.17	14156.17	aetna	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	377.12	377.12	aetna	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	377.12	377.12	aetna	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	377.12	377.12	aetna	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	377.12	377.12	aetna	pos
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	1493.86	1493.86	aetna	ppo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	1493.86	1493.86	aetna	epo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	1493.86	1493.86	aetna	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	1493.86	1493.86	aetna	pos
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	2147.64	2147.64	aetna	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	2147.64	2147.64	aetna	epo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	2147.64	2147.64	aetna	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	2147.64	2147.64	aetna	pos
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	737.44	737.44	aetna	ppo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	737.44	737.44	aetna	epo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	737.44	737.44	aetna	hmo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	737.44	737.44	aetna	pos
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	aetna	ppo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	aetna	epo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	aetna	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	aetna	pos
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	1218.97	1218.97	aetna	ppo
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	1218.97	1218.97	aetna	epo
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	1218.97	1218.97	aetna	hmo
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	1218.97	1218.97	aetna	pos
vinblastine sulfate inj	cpt	J9360	10076.53	10076.53	758.2	758.2	5234.28	5234.28	4361.9	4361.9	O	10076.53	10076.53	aetna	ppo
vinblastine sulfate inj	cpt	J9360	10076.53	10076.53	758.2	758.2	5234.28	5234.28	4361.9	4361.9	O	10076.53	10076.53	aetna	epo
vinblastine sulfate inj	cpt	J9360	10076.53	10076.53	758.2	758.2	5234.28	5234.28	4361.9	4361.9	O	10076.53	10076.53	aetna	hmo
vinblastine sulfate inj	cpt	J9360	10076.53	10076.53	758.2	758.2	5234.28	5234.28	4361.9	4361.9	O	10076.53	10076.53	aetna	pos
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	430.19	430.19	aetna	ppo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	430.19	430.19	aetna	epo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	430.19	430.19	aetna	hmo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	430.19	430.19	aetna	pos
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	9249.37	9249.37	741.72	741.72	37090.75	37090.75	30908.96	30908.96	O	9249.37	9249.37	aetna	ppo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	9249.37	9249.37	741.72	741.72	37090.75	37090.75	30908.96	30908.96	O	9249.37	9249.37	aetna	epo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	9249.37	9249.37	741.72	741.72	37090.75	37090.75	30908.96	30908.96	O	9249.37	9249.37	aetna	hmo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	9249.37	9249.37	741.72	741.72	37090.75	37090.75	30908.96	30908.96	O	9249.37	9249.37	aetna	pos
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	aetna	ppo
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	aetna	epo
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	aetna	hmo
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	aetna	pos
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	aetna	ppo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	aetna	epo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	aetna	hmo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	aetna	pos
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	4307.3	4307.3	aetna	ppo
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	4307.3	4307.3	aetna	epo
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	4307.3	4307.3	aetna	hmo
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	4307.3	4307.3	aetna	pos
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1297.13	1297.13	aetna	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1297.13	1297.13	aetna	epo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1297.13	1297.13	aetna	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1297.13	1297.13	aetna	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1180.24	1180.24	aetna	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1180.24	1180.24	aetna	epo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1180.24	1180.24	aetna	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1180.24	1180.24	aetna	pos
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1156.19	1156.19	aetna	ppo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1156.19	1156.19	aetna	epo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1156.19	1156.19	aetna	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1156.19	1156.19	aetna	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	14191.44	14191.44	aetna	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	14191.44	14191.44	aetna	epo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	14191.44	14191.44	aetna	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	14191.44	14191.44	aetna	pos
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	9214.1	9214.1	aetna	ppo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	9214.1	9214.1	aetna	epo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	9214.1	9214.1	aetna	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	9214.1	9214.1	aetna	pos
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	7408.69	7408.69	aetna	ppo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	7408.69	7408.69	aetna	epo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	7408.69	7408.69	aetna	hmo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	7408.69	7408.69	aetna	pos
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	220.14	220.14	aetna	ppo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	220.14	220.14	aetna	epo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	220.14	220.14	aetna	hmo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	220.14	220.14	aetna	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	998.76	998.76	aetna	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	998.76	998.76	aetna	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	998.76	998.76	aetna	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	998.76	998.76	aetna	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4124.09	4124.09	aetna	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4124.09	4124.09	aetna	epo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4124.09	4124.09	aetna	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4124.09	4124.09	aetna	pos
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	347.84	347.84	aetna	ppo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	347.84	347.84	aetna	epo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	347.84	347.84	aetna	hmo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	347.84	347.84	aetna	pos
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	2547.88	2547.88	aetna	ppo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	2547.88	2547.88	aetna	epo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	2547.88	2547.88	aetna	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	2547.88	2547.88	aetna	pos
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2995.71	2995.71	aetna	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2995.71	2995.71	aetna	epo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2995.71	2995.71	aetna	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2995.71	2995.71	aetna	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	aetna	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	aetna	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	aetna	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	aetna	pos
"conn tiss, non-human"	cpt	C1763	10542.6	10542.6	9490.45	9490.45	54305.62	54305.62	45254.68	45254.68	O	9490.45	9490.45	aetna	ppo
"conn tiss, non-human"	cpt	C1763	10542.6	10542.6	9490.45	9490.45	54305.62	54305.62	45254.68	45254.68	O	9490.45	9490.45	aetna	epo
"conn tiss, non-human"	cpt	C1763	10542.6	10542.6	9490.45	9490.45	54305.62	54305.62	45254.68	45254.68	O	9490.45	9490.45	aetna	hmo
"conn tiss, non-human"	cpt	C1763	10542.6	10542.6	9490.45	9490.45	54305.62	54305.62	45254.68	45254.68	O	9490.45	9490.45	aetna	pos
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	aetna	ppo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	aetna	epo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	aetna	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	aetna	pos
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	4307.3	4307.3	aetna	ppo
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	4307.3	4307.3	aetna	epo
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	4307.3	4307.3	aetna	hmo
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	4307.3	4307.3	aetna	pos
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	819.35	819.35	aetna	ppo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	819.35	819.35	aetna	epo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	819.35	819.35	aetna	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	819.35	819.35	aetna	pos
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.32	206.32	aetna	ppo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.32	206.32	aetna	epo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.32	206.32	aetna	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.32	206.32	aetna	pos
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9778.82	9778.82	aetna	ppo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9778.82	9778.82	aetna	epo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9778.82	9778.82	aetna	hmo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9778.82	9778.82	aetna	pos
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	1862.34	1862.34	aetna	ppo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	1862.34	1862.34	aetna	epo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	1862.34	1862.34	aetna	hmo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	1862.34	1862.34	aetna	pos
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	ppo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	epo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	pos
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	1541.69	1541.69	aetna	ppo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	1541.69	1541.69	aetna	epo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	1541.69	1541.69	aetna	hmo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	1541.69	1541.69	aetna	pos
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	ppo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	epo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	274.98	274.98	aetna	pos
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	1541.69	1541.69	aetna	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	1541.69	1541.69	aetna	epo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	1541.69	1541.69	aetna	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	1541.69	1541.69	aetna	pos
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	aetna	ppo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	aetna	epo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	aetna	hmo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	aetna	pos
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	aetna	ppo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	aetna	epo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	aetna	hmo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	aetna	pos
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip	cpt	27043	8313.56	8313.56	8313.56	8313.56	17877.54	17877.54	14897.95	14897.95	O	8313.56	8313.56	aetna	ppo
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip	cpt	27043	8313.56	8313.56	8313.56	8313.56	17877.54	17877.54	14897.95	14897.95	O	8313.56	8313.56	aetna	epo
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip	cpt	27043	8313.56	8313.56	8313.56	8313.56	17877.54	17877.54	14897.95	14897.95	O	8313.56	8313.56	aetna	hmo
Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip	cpt	27043	8313.56	8313.56	8313.56	8313.56	17877.54	17877.54	14897.95	14897.95	O	8313.56	8313.56	aetna	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	aetna	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	aetna	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	aetna	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	aetna	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1958.83	1958.83	aetna	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1958.83	1958.83	aetna	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1958.83	1958.83	aetna	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1958.83	1958.83	aetna	pos
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3131.05	3131.05	aetna	ppo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3131.05	3131.05	aetna	epo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3131.05	3131.05	aetna	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3131.05	3131.05	aetna	pos
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	264.87	264.87	aetna	ppo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	264.87	264.87	aetna	epo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	264.87	264.87	aetna	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	264.87	264.87	aetna	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.48	8.48	aetna	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.48	8.48	aetna	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.48	8.48	aetna	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.48	8.48	aetna	pos
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14120.9	14120.9	aetna	ppo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14120.9	14120.9	aetna	epo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14120.9	14120.9	aetna	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14120.9	14120.9	aetna	pos
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	95.08	95.08	aetna	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	95.08	95.08	aetna	epo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	95.08	95.08	aetna	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	95.08	95.08	aetna	pos
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	ppo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	epo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	hmo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	294.34	294.34	aetna	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	294.34	294.34	aetna	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	294.34	294.34	aetna	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	294.34	294.34	aetna	pos
"aicd, single chamber"	cpt	C1722	30118.22	30118.22	28054.74	28054.74	104567.21	104567.21	87139.34	87139.34	O	30118.22	30118.22	aetna	ppo
"aicd, single chamber"	cpt	C1722	30118.22	30118.22	28054.74	28054.74	104567.21	104567.21	87139.34	87139.34	O	30118.22	30118.22	aetna	epo
"aicd, single chamber"	cpt	C1722	30118.22	30118.22	28054.74	28054.74	104567.21	104567.21	87139.34	87139.34	O	30118.22	30118.22	aetna	hmo
"aicd, single chamber"	cpt	C1722	30118.22	30118.22	28054.74	28054.74	104567.21	104567.21	87139.34	87139.34	O	30118.22	30118.22	aetna	pos
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	14120.9	14120.9	aetna	ppo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	14120.9	14120.9	aetna	epo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	14120.9	14120.9	aetna	hmo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	14120.9	14120.9	aetna	pos
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	aetna	ppo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	aetna	epo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	aetna	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	aetna	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.59	1914.59	aetna	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.59	1914.59	aetna	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.59	1914.59	aetna	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.59	1914.59	aetna	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	aetna	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	aetna	epo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	aetna	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	aetna	pos
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1732.38	1732.38	aetna	ppo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1732.38	1732.38	aetna	epo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1732.38	1732.38	aetna	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1732.38	1732.38	aetna	pos
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	23772.44	23772.44	aetna	ppo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	23772.44	23772.44	aetna	epo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	23772.44	23772.44	aetna	hmo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	23772.44	23772.44	aetna	pos
"Ultrasound evaluation of heart blood vessel or graft, each additional vessel"	cpt	92979	14120.9	14120.9	172.42	172.42	114856.13	114856.13	95713.44	95713.44	O	14120.9	14120.9	aetna	ppo
"Ultrasound evaluation of heart blood vessel or graft, each additional vessel"	cpt	92979	14120.9	14120.9	172.42	172.42	114856.13	114856.13	95713.44	95713.44	O	14120.9	14120.9	aetna	epo
"Ultrasound evaluation of heart blood vessel or graft, each additional vessel"	cpt	92979	14120.9	14120.9	172.42	172.42	114856.13	114856.13	95713.44	95713.44	O	14120.9	14120.9	aetna	hmo
"Ultrasound evaluation of heart blood vessel or graft, each additional vessel"	cpt	92979	14120.9	14120.9	172.42	172.42	114856.13	114856.13	95713.44	95713.44	O	14120.9	14120.9	aetna	pos
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	14120.9	14120.9	aetna	ppo
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	14120.9	14120.9	aetna	epo
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	14120.9	14120.9	aetna	hmo
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	14120.9	14120.9	aetna	pos
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	aetna	ppo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	aetna	epo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	aetna	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	aetna	pos
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	636.24	636.24	aetna	ppo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	636.24	636.24	aetna	epo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	636.24	636.24	aetna	hmo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	636.24	636.24	aetna	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	aetna	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	aetna	epo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	aetna	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	aetna	pos
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	7333.25	7333.25	aetna	ppo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	7333.25	7333.25	aetna	epo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	7333.25	7333.25	aetna	hmo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	7333.25	7333.25	aetna	pos
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	5149.04	5149.04	aetna	ppo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	5149.04	5149.04	aetna	epo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	5149.04	5149.04	aetna	hmo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	5149.04	5149.04	aetna	pos
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	428.12	428.12	aetna	ppo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	428.12	428.12	aetna	epo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	428.12	428.12	aetna	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	428.12	428.12	aetna	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	182.62	182.62	aetna	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	182.62	182.62	aetna	epo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	182.62	182.62	aetna	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	182.62	182.62	aetna	pos
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	883.06	883.06	aetna	ppo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	883.06	883.06	aetna	epo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	883.06	883.06	aetna	hmo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	883.06	883.06	aetna	pos
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	643.93	643.93	aetna	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	643.93	643.93	aetna	epo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	643.93	643.93	aetna	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	643.93	643.93	aetna	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	260.79	260.79	aetna	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	260.79	260.79	aetna	epo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	260.79	260.79	aetna	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	260.79	260.79	aetna	pos
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9490.45	9490.45	aetna	ppo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9490.45	9490.45	aetna	epo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9490.45	9490.45	aetna	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9490.45	9490.45	aetna	pos
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	14191.44	14191.44	aetna	ppo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	14191.44	14191.44	aetna	epo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	14191.44	14191.44	aetna	hmo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	14191.44	14191.44	aetna	pos
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	1971.24	1971.24	aetna	ppo
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	1971.24	1971.24	aetna	epo
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	1971.24	1971.24	aetna	hmo
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	1971.24	1971.24	aetna	pos
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1444.99	1444.99	aetna	ppo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1444.99	1444.99	aetna	epo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1444.99	1444.99	aetna	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1444.99	1444.99	aetna	pos
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	643.93	643.93	aetna	ppo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	643.93	643.93	aetna	epo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	643.93	643.93	aetna	hmo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	643.93	643.93	aetna	pos
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	595.36	595.36	aetna	ppo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	595.36	595.36	aetna	epo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	595.36	595.36	aetna	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	595.36	595.36	aetna	pos
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	14120.9	14120.9	aetna	ppo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	14120.9	14120.9	aetna	epo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	14120.9	14120.9	aetna	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	14120.9	14120.9	aetna	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	aetna	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	aetna	epo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	aetna	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	aetna	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	182.62	182.62	aetna	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	182.62	182.62	aetna	epo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	182.62	182.62	aetna	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	182.62	182.62	aetna	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	167.19	167.19	aetna	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	167.19	167.19	aetna	epo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	167.19	167.19	aetna	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	167.19	167.19	aetna	pos
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7737.17	7737.17	aetna	ppo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7737.17	7737.17	aetna	epo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7737.17	7737.17	aetna	hmo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7737.17	7737.17	aetna	pos
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	aetna	ppo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	aetna	epo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	aetna	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	aetna	pos
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	175.74	175.74	aetna	ppo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	175.74	175.74	aetna	epo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	175.74	175.74	aetna	hmo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	175.74	175.74	aetna	pos
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	222.64	222.64	aetna	ppo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	222.64	222.64	aetna	epo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	222.64	222.64	aetna	hmo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	222.64	222.64	aetna	pos
foam drg <=16 sq in w/border	cpt	A6212	102.66	102.66	102.66	102.66	4253.94	4253.94	3544.95	3544.95	O	102.66	102.66	aetna	ppo
foam drg <=16 sq in w/border	cpt	A6212	102.66	102.66	102.66	102.66	4253.94	4253.94	3544.95	3544.95	O	102.66	102.66	aetna	epo
foam drg <=16 sq in w/border	cpt	A6212	102.66	102.66	102.66	102.66	4253.94	4253.94	3544.95	3544.95	O	102.66	102.66	aetna	hmo
foam drg <=16 sq in w/border	cpt	A6212	102.66	102.66	102.66	102.66	4253.94	4253.94	3544.95	3544.95	O	102.66	102.66	aetna	pos
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	64.43	64.43	aetna	ppo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	64.43	64.43	aetna	epo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	64.43	64.43	aetna	hmo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	64.43	64.43	aetna	pos
"X-ray of chest, minimum of 4 views"	cpt	71048	235.15	235.15	22.57	22.57	478.27	478.27	398.56	398.56	O	235.15	235.15	aetna	ppo
"X-ray of chest, minimum of 4 views"	cpt	71048	235.15	235.15	22.57	22.57	478.27	478.27	398.56	398.56	O	235.15	235.15	aetna	epo
"X-ray of chest, minimum of 4 views"	cpt	71048	235.15	235.15	22.57	22.57	478.27	478.27	398.56	398.56	O	235.15	235.15	aetna	hmo
"X-ray of chest, minimum of 4 views"	cpt	71048	235.15	235.15	22.57	22.57	478.27	478.27	398.56	398.56	O	235.15	235.15	aetna	pos
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	63.17	63.17	aetna	ppo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	63.17	63.17	aetna	epo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	63.17	63.17	aetna	hmo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	63.17	63.17	aetna	pos
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	213.26	213.26	aetna	ppo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	213.26	213.26	aetna	epo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	213.26	213.26	aetna	hmo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	213.26	213.26	aetna	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	aetna	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	aetna	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	aetna	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	aetna	pos
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	1958.83	1958.83	aetna	ppo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	1958.83	1958.83	aetna	epo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	1958.83	1958.83	aetna	hmo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	1958.83	1958.83	aetna	pos
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	519.73	519.73	aetna	ppo
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	519.73	519.73	aetna	epo
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	519.73	519.73	aetna	hmo
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	519.73	519.73	aetna	pos
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	4294.7	4294.7	aetna	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	4294.7	4294.7	aetna	epo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	4294.7	4294.7	aetna	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	4294.7	4294.7	aetna	pos
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	138.14	138.14	aetna	ppo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	138.14	138.14	aetna	epo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	138.14	138.14	aetna	hmo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	138.14	138.14	aetna	pos
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	188.87	188.87	aetna	ppo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	188.87	188.87	aetna	epo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	188.87	188.87	aetna	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	188.87	188.87	aetna	pos
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	65.7	65.7	aetna	ppo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	65.7	65.7	aetna	epo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	65.7	65.7	aetna	hmo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	65.7	65.7	aetna	pos
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	112.57	112.57	aetna	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	112.57	112.57	aetna	epo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	112.57	112.57	aetna	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	112.57	112.57	aetna	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	237.89	237.89	aetna	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	237.89	237.89	aetna	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	237.89	237.89	aetna	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	237.89	237.89	aetna	pos
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	1541.11	1541.11	aetna	ppo
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	1541.11	1541.11	aetna	epo
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	1541.11	1541.11	aetna	hmo
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	1541.11	1541.11	aetna	pos
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	429.12	429.12	aetna	ppo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	429.12	429.12	aetna	epo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	429.12	429.12	aetna	hmo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	429.12	429.12	aetna	pos
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	aetna	ppo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	aetna	epo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	aetna	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	aetna	pos
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	1365.87	1365.87	aetna	ppo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	1365.87	1365.87	aetna	epo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	1365.87	1365.87	aetna	hmo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	1365.87	1365.87	aetna	pos
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	8300.35	8300.35	aetna	ppo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	8300.35	8300.35	aetna	epo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	8300.35	8300.35	aetna	hmo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	8300.35	8300.35	aetna	pos
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	832.09	832.09	aetna	ppo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	832.09	832.09	aetna	epo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	832.09	832.09	aetna	hmo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	832.09	832.09	aetna	pos
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	52.53	52.53	aetna	ppo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	52.53	52.53	aetna	epo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	52.53	52.53	aetna	hmo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	52.53	52.53	aetna	pos
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	5741.42	5741.42	aetna	ppo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	5741.42	5741.42	aetna	epo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	5741.42	5741.42	aetna	hmo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	5741.42	5741.42	aetna	pos
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.16	58.16	aetna	ppo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.16	58.16	aetna	epo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.16	58.16	aetna	hmo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.16	58.16	aetna	pos
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	220.77	220.77	aetna	ppo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	220.77	220.77	aetna	epo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	220.77	220.77	aetna	hmo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	220.77	220.77	aetna	pos
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	97.4	97.4	aetna	ppo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	97.4	97.4	aetna	epo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	97.4	97.4	aetna	hmo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	97.4	97.4	aetna	pos
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	14238.66	14238.66	aetna	ppo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	14238.66	14238.66	aetna	epo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	14238.66	14238.66	aetna	hmo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	14238.66	14238.66	aetna	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	163.65	163.65	aetna	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	163.65	163.65	aetna	epo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	163.65	163.65	aetna	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	163.65	163.65	aetna	pos
Removal of fluid from chest cavity with imaging guidance	cpt	32555	908.54	908.54	15.04	15.04	4789.2	4789.2	3991	3991	O	908.54	908.54	aetna	ppo
Removal of fluid from chest cavity with imaging guidance	cpt	32555	908.54	908.54	15.04	15.04	4789.2	4789.2	3991	3991	O	908.54	908.54	aetna	epo
Removal of fluid from chest cavity with imaging guidance	cpt	32555	908.54	908.54	15.04	15.04	4789.2	4789.2	3991	3991	O	908.54	908.54	aetna	hmo
Removal of fluid from chest cavity with imaging guidance	cpt	32555	908.54	908.54	15.04	15.04	4789.2	4789.2	3991	3991	O	908.54	908.54	aetna	pos
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	44.89	44.89	aetna	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	44.89	44.89	aetna	epo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	44.89	44.89	aetna	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	44.89	44.89	aetna	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1423.7	1423.7	aetna	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1423.7	1423.7	aetna	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1423.7	1423.7	aetna	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1423.7	1423.7	aetna	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	799.4	799.4	aetna	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	799.4	799.4	aetna	epo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	799.4	799.4	aetna	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	799.4	799.4	aetna	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	19.88	19.88	aetna	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	19.88	19.88	aetna	epo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	19.88	19.88	aetna	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	19.88	19.88	aetna	pos
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	37.84	37.84	aetna	ppo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	37.84	37.84	aetna	epo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	37.84	37.84	aetna	hmo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	37.84	37.84	aetna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	29.83	29.83	aetna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	29.83	29.83	aetna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	29.83	29.83	aetna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	29.83	29.83	aetna	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	60.66	60.66	aetna	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	60.66	60.66	aetna	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	60.66	60.66	aetna	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	60.66	60.66	aetna	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	62.18	62.18	aetna	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	62.18	62.18	aetna	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	62.18	62.18	aetna	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	62.18	62.18	aetna	pos
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	1965.52	1965.52	aetna	ppo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	1965.52	1965.52	aetna	epo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	1965.52	1965.52	aetna	hmo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	1965.52	1965.52	aetna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	75.61	75.61	aetna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	75.61	75.61	aetna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	75.61	75.61	aetna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	75.61	75.61	aetna	pos
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	5479.02	5479.02	aetna	ppo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	5479.02	5479.02	aetna	epo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	5479.02	5479.02	aetna	hmo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	5479.02	5479.02	aetna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	47.09	47.09	aetna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	47.09	47.09	aetna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	47.09	47.09	aetna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	47.09	47.09	aetna	pos
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	10076.53	10076.53	aetna	ppo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	10076.53	10076.53	aetna	epo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	10076.53	10076.53	aetna	hmo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	10076.53	10076.53	aetna	pos
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	34.73	34.73	aetna	ppo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	34.73	34.73	aetna	epo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	34.73	34.73	aetna	hmo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	34.73	34.73	aetna	pos
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	58.44	58.44	aetna	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	58.44	58.44	aetna	epo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	58.44	58.44	aetna	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	58.44	58.44	aetna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	130.64	130.64	aetna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	130.64	130.64	aetna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	130.64	130.64	aetna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	130.64	130.64	aetna	pos
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1215.96	1215.96	aetna	ppo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1215.96	1215.96	aetna	epo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1215.96	1215.96	aetna	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1215.96	1215.96	aetna	pos
Ultrasound and monitoring of heart of fetus	cpt	76818	456.54	456.54	99.29	99.29	928.56	928.56	773.8	773.8	O	456.54	456.54	aetna	ppo
Ultrasound and monitoring of heart of fetus	cpt	76818	456.54	456.54	99.29	99.29	928.56	928.56	773.8	773.8	O	456.54	456.54	aetna	epo
Ultrasound and monitoring of heart of fetus	cpt	76818	456.54	456.54	99.29	99.29	928.56	928.56	773.8	773.8	O	456.54	456.54	aetna	hmo
Ultrasound and monitoring of heart of fetus	cpt	76818	456.54	456.54	99.29	99.29	928.56	928.56	773.8	773.8	O	456.54	456.54	aetna	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	175.33	175.33	aetna	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	175.33	175.33	aetna	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	175.33	175.33	aetna	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	175.33	175.33	aetna	pos
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	323.96	323.96	aetna	ppo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	323.96	323.96	aetna	epo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	323.96	323.96	aetna	hmo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	323.96	323.96	aetna	pos
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	940.6	940.6	aetna	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	940.6	940.6	aetna	epo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	940.6	940.6	aetna	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	940.6	940.6	aetna	pos
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	211.27	211.27	aetna	ppo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	211.27	211.27	aetna	epo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	211.27	211.27	aetna	hmo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	211.27	211.27	aetna	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	63.79	63.79	aetna	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	63.79	63.79	aetna	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	63.79	63.79	aetna	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	63.79	63.79	aetna	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	234.68	234.68	14.94	14.94	274.75	274.75	228.96	228.96	E	139.43	139.43	aetna	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	234.68	234.68	14.94	14.94	274.75	274.75	228.96	228.96	E	139.43	139.43	aetna	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	234.68	234.68	14.94	14.94	274.75	274.75	228.96	228.96	E	139.43	139.43	aetna	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	234.68	234.68	14.94	14.94	274.75	274.75	228.96	228.96	E	139.43	139.43	aetna	pos
"Detection test by nucleic acid for HIV-1 virus, amplified probe technique"	cpt	87535	218.19	218.19	31.21	31.21	429.94	429.94	358.28	358.28	O	218.19	218.19	aetna	ppo
"Detection test by nucleic acid for HIV-1 virus, amplified probe technique"	cpt	87535	218.19	218.19	31.21	31.21	429.94	429.94	358.28	358.28	O	218.19	218.19	aetna	epo
"Detection test by nucleic acid for HIV-1 virus, amplified probe technique"	cpt	87535	218.19	218.19	31.21	31.21	429.94	429.94	358.28	358.28	O	218.19	218.19	aetna	hmo
"Detection test by nucleic acid for HIV-1 virus, amplified probe technique"	cpt	87535	218.19	218.19	31.21	31.21	429.94	429.94	358.28	358.28	O	218.19	218.19	aetna	pos
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	1541.69	1541.69	aetna	ppo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	1541.69	1541.69	aetna	epo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	1541.69	1541.69	aetna	hmo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	1541.69	1541.69	aetna	pos
levofloxacin injection	cpt	J1956	2485.45	2485.45	941.32	941.32	14500.13	14500.13	12083.44	12083.44	E	1995.04	1995.04	aetna	ppo
levofloxacin injection	cpt	J1956	2485.45	2485.45	941.32	941.32	14500.13	14500.13	12083.44	12083.44	E	1995.04	1995.04	aetna	epo
levofloxacin injection	cpt	J1956	2485.45	2485.45	941.32	941.32	14500.13	14500.13	12083.44	12083.44	E	1995.04	1995.04	aetna	hmo
levofloxacin injection	cpt	J1956	2485.45	2485.45	941.32	941.32	14500.13	14500.13	12083.44	12083.44	E	1995.04	1995.04	aetna	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	pos
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	75.51	75.51	aetna	ppo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	75.51	75.51	aetna	epo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	75.51	75.51	aetna	hmo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	75.51	75.51	aetna	pos
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	201.38	201.38	aetna	ppo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	201.38	201.38	aetna	epo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	201.38	201.38	aetna	hmo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	201.38	201.38	aetna	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	7.32	7.32	aetna	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	7.32	7.32	aetna	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	7.32	7.32	aetna	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	7.32	7.32	aetna	pos
levetiracetam injection	cpt	J1953	1444.99	1444.99	943.3	943.3	6504.31	6504.31	5420.26	5420.26	O	1444.99	1444.99	aetna	ppo
levetiracetam injection	cpt	J1953	1444.99	1444.99	943.3	943.3	6504.31	6504.31	5420.26	5420.26	O	1444.99	1444.99	aetna	epo
levetiracetam injection	cpt	J1953	1444.99	1444.99	943.3	943.3	6504.31	6504.31	5420.26	5420.26	O	1444.99	1444.99	aetna	hmo
levetiracetam injection	cpt	J1953	1444.99	1444.99	943.3	943.3	6504.31	6504.31	5420.26	5420.26	O	1444.99	1444.99	aetna	pos
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	aetna	ppo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	aetna	epo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	aetna	hmo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	aetna	pos
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1855.69	1855.69	aetna	ppo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1855.69	1855.69	aetna	epo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1855.69	1855.69	aetna	hmo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1855.69	1855.69	aetna	pos
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	130.4	130.4	aetna	ppo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	130.4	130.4	aetna	epo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	130.4	130.4	aetna	hmo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	130.4	130.4	aetna	pos
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	9490.45	9490.45	aetna	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	9490.45	9490.45	aetna	epo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	9490.45	9490.45	aetna	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	9490.45	9490.45	aetna	pos
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	424.02	424.02	aetna	ppo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	424.02	424.02	aetna	epo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	424.02	424.02	aetna	hmo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	424.02	424.02	aetna	pos
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	181.37	181.37	aetna	ppo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	181.37	181.37	aetna	epo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	181.37	181.37	aetna	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	181.37	181.37	aetna	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	aetna	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	aetna	epo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	aetna	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	aetna	pos
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	228.98	228.98	aetna	ppo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	228.98	228.98	aetna	epo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	228.98	228.98	aetna	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	228.98	228.98	aetna	pos
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	aetna	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	aetna	epo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	aetna	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	aetna	pos
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	883.44	883.44	aetna	ppo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	883.44	883.44	aetna	epo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	883.44	883.44	aetna	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	883.44	883.44	aetna	pos
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	aetna	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	aetna	epo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	aetna	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	aetna	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	97.56	97.56	aetna	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	97.56	97.56	aetna	epo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	97.56	97.56	aetna	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	97.56	97.56	aetna	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	78.23	78.23	aetna	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.91	8.91	aetna	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.91	8.91	aetna	epo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.91	8.91	aetna	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.91	8.91	aetna	pos
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	640.71	640.71	aetna	ppo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	640.71	640.71	aetna	epo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	640.71	640.71	aetna	hmo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	640.71	640.71	aetna	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	178.68	178.68	aetna	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	178.68	178.68	aetna	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	178.68	178.68	aetna	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	178.68	178.68	aetna	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	96.59	96.59	aetna	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	96.59	96.59	aetna	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	96.59	96.59	aetna	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	96.59	96.59	aetna	pos
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	23.15	23.15	aetna	ppo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	23.15	23.15	aetna	epo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	23.15	23.15	aetna	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	23.15	23.15	aetna	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	143.14	143.14	aetna	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	143.14	143.14	aetna	epo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	143.14	143.14	aetna	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	143.14	143.14	aetna	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	57.04	57.04	aetna	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	58.47	58.47	aetna	pos
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	ppo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	epo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	59.66	59.66	aetna	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	59.66	59.66	aetna	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	59.66	59.66	aetna	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	59.66	59.66	aetna	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1952.13	1952.13	aetna	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1952.13	1952.13	aetna	epo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1952.13	1952.13	aetna	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1952.13	1952.13	aetna	pos
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	84.6	84.6	aetna	ppo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	84.6	84.6	aetna	epo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	84.6	84.6	aetna	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	84.6	84.6	aetna	pos
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area	cpt	52005	1569.38	1569.38	1500.24	1500.24	16097.6	16097.6	13414.67	13414.67	O	1541.69	1541.69	aetna	ppo
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area	cpt	52005	1569.38	1569.38	1500.24	1500.24	16097.6	16097.6	13414.67	13414.67	O	1541.69	1541.69	aetna	epo
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area	cpt	52005	1569.38	1569.38	1500.24	1500.24	16097.6	16097.6	13414.67	13414.67	O	1541.69	1541.69	aetna	hmo
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area	cpt	52005	1569.38	1569.38	1500.24	1500.24	16097.6	16097.6	13414.67	13414.67	O	1541.69	1541.69	aetna	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	aetna	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	aetna	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	aetna	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	aetna	pos
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	43.82	43.82	aetna	ppo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	43.82	43.82	aetna	epo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	43.82	43.82	aetna	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	43.82	43.82	aetna	pos
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	203.3	203.3	aetna	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	203.3	203.3	aetna	epo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	203.3	203.3	aetna	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	203.3	203.3	aetna	pos
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	4307.3	4307.3	aetna	ppo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	4307.3	4307.3	aetna	epo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	4307.3	4307.3	aetna	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	4307.3	4307.3	aetna	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	48.4	48.4	aetna	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	48.4	48.4	aetna	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	48.4	48.4	aetna	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	48.4	48.4	aetna	pos
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	ppo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	epo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	31.83	31.83	aetna	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	152.47	152.47	aetna	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	152.47	152.47	aetna	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	152.47	152.47	aetna	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	152.47	152.47	aetna	pos
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1070.3	1070.3	aetna	ppo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1070.3	1070.3	aetna	epo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1070.3	1070.3	aetna	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1070.3	1070.3	aetna	pos
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	5636.7	5636.7	aetna	ppo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	5636.7	5636.7	aetna	epo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	5636.7	5636.7	aetna	hmo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	5636.7	5636.7	aetna	pos
"Removal and replacement of defibrillator pulse generator, single wire (lead)"	cpt	33262	30118.22	30118.22	30118.22	30118.22	74112.78	74112.78	61760.65	61760.65	O	30118.22	30118.22	aetna	ppo
"Removal and replacement of defibrillator pulse generator, single wire (lead)"	cpt	33262	30118.22	30118.22	30118.22	30118.22	74112.78	74112.78	61760.65	61760.65	O	30118.22	30118.22	aetna	epo
"Removal and replacement of defibrillator pulse generator, single wire (lead)"	cpt	33262	30118.22	30118.22	30118.22	30118.22	74112.78	74112.78	61760.65	61760.65	O	30118.22	30118.22	aetna	hmo
"Removal and replacement of defibrillator pulse generator, single wire (lead)"	cpt	33262	30118.22	30118.22	30118.22	30118.22	74112.78	74112.78	61760.65	61760.65	O	30118.22	30118.22	aetna	pos
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	188.87	188.87	aetna	ppo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	188.87	188.87	aetna	epo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	188.87	188.87	aetna	hmo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	188.87	188.87	aetna	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	37.15	37.15	aetna	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	37.15	37.15	aetna	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	37.15	37.15	aetna	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	37.15	37.15	aetna	pos
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	ppo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	epo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	hmo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	pos
Tissue culture inoculation for virus isolation	cpt	87252	80.69	80.69	80.69	80.69	159	159	132.5	132.5	O	80.69	80.69	aetna	ppo
Tissue culture inoculation for virus isolation	cpt	87252	80.69	80.69	80.69	80.69	159	159	132.5	132.5	O	80.69	80.69	aetna	epo
Tissue culture inoculation for virus isolation	cpt	87252	80.69	80.69	80.69	80.69	159	159	132.5	132.5	O	80.69	80.69	aetna	hmo
Tissue culture inoculation for virus isolation	cpt	87252	80.69	80.69	80.69	80.69	159	159	132.5	132.5	O	80.69	80.69	aetna	pos
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	133.21	133.21	aetna	ppo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	133.21	133.21	aetna	epo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	133.21	133.21	aetna	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	133.21	133.21	aetna	pos
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.52	4.52	aetna	ppo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.52	4.52	aetna	epo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.52	4.52	aetna	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.52	4.52	aetna	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.9	8.9	aetna	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.9	8.9	aetna	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.9	8.9	aetna	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.9	8.9	aetna	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	138.27	138.27	aetna	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	138.27	138.27	aetna	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	138.27	138.27	aetna	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	138.27	138.27	aetna	pos
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	362.22	362.22	aetna	ppo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	362.22	362.22	aetna	epo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	362.22	362.22	aetna	hmo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	362.22	362.22	aetna	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	47.15	47.15	aetna	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	47.15	47.15	aetna	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	47.15	47.15	aetna	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	47.15	47.15	aetna	pos
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	1952.13	1952.13	aetna	ppo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	1952.13	1952.13	aetna	epo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	1952.13	1952.13	aetna	hmo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	1952.13	1952.13	aetna	pos
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	ppo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	epo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	65.67	65.67	aetna	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	155.75	155.75	aetna	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	155.75	155.75	aetna	epo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	155.75	155.75	aetna	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	155.75	155.75	aetna	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.33	5.33	aetna	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.33	5.33	aetna	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.33	5.33	aetna	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.33	5.33	aetna	pos
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1089.98	1089.98	aetna	ppo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1089.98	1089.98	aetna	epo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1089.98	1089.98	aetna	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1089.98	1089.98	aetna	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	19.39	19.39	aetna	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	19.39	19.39	aetna	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	19.39	19.39	aetna	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	19.39	19.39	aetna	pos
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	205.76	205.76	aetna	ppo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	205.76	205.76	aetna	epo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	205.76	205.76	aetna	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	205.76	205.76	aetna	pos
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.9	8.9	aetna	ppo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.9	8.9	aetna	epo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.9	8.9	aetna	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.9	8.9	aetna	pos
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	1753.5	1753.5	aetna	ppo
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	1753.5	1753.5	aetna	epo
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	1753.5	1753.5	aetna	hmo
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	1753.5	1753.5	aetna	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	38.15	38.15	aetna	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	38.15	38.15	aetna	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	38.15	38.15	aetna	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	38.15	38.15	aetna	pos
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	1398.23	1398.23	aetna	ppo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	1398.23	1398.23	aetna	epo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	1398.23	1398.23	aetna	hmo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	1398.23	1398.23	aetna	pos
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	aetna	ppo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	aetna	epo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	aetna	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	aetna	pos
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2510.82	2510.82	aetna	ppo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2510.82	2510.82	aetna	epo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2510.82	2510.82	aetna	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2510.82	2510.82	aetna	pos
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	126.33	126.33	aetna	ppo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	126.33	126.33	aetna	epo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	126.33	126.33	aetna	hmo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	126.33	126.33	aetna	pos
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	205.76	205.76	aetna	ppo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	205.76	205.76	aetna	epo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	205.76	205.76	aetna	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	205.76	205.76	aetna	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.32	8.32	aetna	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.32	8.32	aetna	epo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.32	8.32	aetna	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.32	8.32	aetna	pos
"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone"	cpt	52317	7585.06	7585.06	2652.67	2652.67	15861.14	15861.14	13217.62	13217.62	O	7585.06	7585.06	aetna	ppo
"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone"	cpt	52317	7585.06	7585.06	2652.67	2652.67	15861.14	15861.14	13217.62	13217.62	O	7585.06	7585.06	aetna	epo
"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone"	cpt	52317	7585.06	7585.06	2652.67	2652.67	15861.14	15861.14	13217.62	13217.62	O	7585.06	7585.06	aetna	hmo
"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone"	cpt	52317	7585.06	7585.06	2652.67	2652.67	15861.14	15861.14	13217.62	13217.62	O	7585.06	7585.06	aetna	pos
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	28.34	28.34	aetna	ppo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	28.34	28.34	aetna	epo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	28.34	28.34	aetna	hmo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	28.34	28.34	aetna	pos
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	10.02	10.02	aetna	ppo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	10.02	10.02	aetna	epo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	10.02	10.02	aetna	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	10.02	10.02	aetna	pos
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	6054.77	6054.77	aetna	ppo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	6054.77	6054.77	aetna	epo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	6054.77	6054.77	aetna	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	6054.77	6054.77	aetna	pos
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	2507.56	2507.56	aetna	ppo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	2507.56	2507.56	aetna	epo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	2507.56	2507.56	aetna	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	2507.56	2507.56	aetna	pos
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	10655.83	10655.83	aetna	ppo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	10655.83	10655.83	aetna	epo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	10655.83	10655.83	aetna	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	10655.83	10655.83	aetna	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	327.93	327.93	aetna	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	327.93	327.93	aetna	epo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	327.93	327.93	aetna	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	327.93	327.93	aetna	pos
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	9.12	9.12	aetna	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	9.12	9.12	aetna	epo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	9.12	9.12	aetna	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	9.12	9.12	aetna	pos
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	ppo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	epo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	111.02	111.02	aetna	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	111.02	111.02	aetna	epo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	111.02	111.02	aetna	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	111.02	111.02	aetna	pos
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1514.71	1514.71	aetna	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1514.71	1514.71	aetna	epo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1514.71	1514.71	aetna	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1514.71	1514.71	aetna	pos
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	445.42	445.42	aetna	ppo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	445.42	445.42	aetna	epo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	445.42	445.42	aetna	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	445.42	445.42	aetna	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	51461.98	51461.98	aetna	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	51461.98	51461.98	aetna	epo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	51461.98	51461.98	aetna	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	51461.98	51461.98	aetna	pos
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	42.46	42.46	aetna	ppo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	42.46	42.46	aetna	epo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	42.46	42.46	aetna	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	42.46	42.46	aetna	pos
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1716.51	1716.51	aetna	ppo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1716.51	1716.51	aetna	epo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1716.51	1716.51	aetna	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1716.51	1716.51	aetna	pos
Bacterial blood culture	cpt	87040	233.73	233.73	9.18	9.18	280.48	280.48	233.73	233.73	E	132.37	132.37	aetna	ppo
Bacterial blood culture	cpt	87040	233.73	233.73	9.18	9.18	280.48	280.48	233.73	233.73	E	132.37	132.37	aetna	epo
Bacterial blood culture	cpt	87040	233.73	233.73	9.18	9.18	280.48	280.48	233.73	233.73	E	132.37	132.37	aetna	hmo
Bacterial blood culture	cpt	87040	233.73	233.73	9.18	9.18	280.48	280.48	233.73	233.73	E	132.37	132.37	aetna	pos
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	293.35	293.35	aetna	ppo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	293.35	293.35	aetna	epo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	293.35	293.35	aetna	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	293.35	293.35	aetna	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2282.87	2282.87	aetna	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2282.87	2282.87	aetna	epo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2282.87	2282.87	aetna	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2282.87	2282.87	aetna	pos
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	ppo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	epo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	pos
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	1995.04	1995.04	aetna	ppo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	1995.04	1995.04	aetna	epo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	1995.04	1995.04	aetna	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	1995.04	1995.04	aetna	pos
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	127.12	127.12	aetna	ppo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	127.12	127.12	aetna	epo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	127.12	127.12	aetna	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	127.12	127.12	aetna	pos
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	606.52	606.52	aetna	ppo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	606.52	606.52	aetna	epo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	606.52	606.52	aetna	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	606.52	606.52	aetna	pos
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	127.12	127.12	aetna	ppo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	127.12	127.12	aetna	epo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	127.12	127.12	aetna	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	127.12	127.12	aetna	pos
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	46.62	46.62	aetna	ppo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	46.62	46.62	aetna	epo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	46.62	46.62	aetna	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	46.62	46.62	aetna	pos
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	aetna	ppo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	aetna	epo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	aetna	hmo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	aetna	pos
"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips"	cpt	11643	1215.96	1215.96	1215.96	1215.96	15226.31	15226.31	12688.59	12688.59	O	1215.96	1215.96	aetna	ppo
"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips"	cpt	11643	1215.96	1215.96	1215.96	1215.96	15226.31	15226.31	12688.59	12688.59	O	1215.96	1215.96	aetna	epo
"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips"	cpt	11643	1215.96	1215.96	1215.96	1215.96	15226.31	15226.31	12688.59	12688.59	O	1215.96	1215.96	aetna	hmo
"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips"	cpt	11643	1215.96	1215.96	1215.96	1215.96	15226.31	15226.31	12688.59	12688.59	O	1215.96	1215.96	aetna	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5464.01	5464.01	aetna	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5464.01	5464.01	aetna	epo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5464.01	5464.01	aetna	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5464.01	5464.01	aetna	pos
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	29.61	29.61	aetna	ppo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	29.61	29.61	aetna	epo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	29.61	29.61	aetna	hmo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	29.61	29.61	aetna	pos
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	23772.44	23772.44	aetna	ppo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	23772.44	23772.44	aetna	epo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	23772.44	23772.44	aetna	hmo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	23772.44	23772.44	aetna	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	70.26	70.26	aetna	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	70.26	70.26	aetna	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	70.26	70.26	aetna	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	70.26	70.26	aetna	pos
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	472.57	472.57	aetna	ppo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	472.57	472.57	aetna	epo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	472.57	472.57	aetna	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	472.57	472.57	aetna	pos
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	732.06	732.06	214.42	214.42	5787.49	5787.49	4822.91	4822.91	E	732.06	732.06	aetna	ppo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	732.06	732.06	214.42	214.42	5787.49	5787.49	4822.91	4822.91	E	732.06	732.06	aetna	epo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	732.06	732.06	214.42	214.42	5787.49	5787.49	4822.91	4822.91	E	732.06	732.06	aetna	hmo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	732.06	732.06	214.42	214.42	5787.49	5787.49	4822.91	4822.91	E	732.06	732.06	aetna	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	96.59	96.59	aetna	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	96.59	96.59	aetna	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	96.59	96.59	aetna	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	96.59	96.59	aetna	pos
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1444.99	1444.99	aetna	ppo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1444.99	1444.99	aetna	epo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1444.99	1444.99	aetna	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1444.99	1444.99	aetna	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	175.74	175.74	aetna	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	175.74	175.74	aetna	epo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	175.74	175.74	aetna	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	175.74	175.74	aetna	pos
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	987.77	987.77	aetna	ppo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	987.77	987.77	aetna	epo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	987.77	987.77	aetna	hmo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	987.77	987.77	aetna	pos
"injection, daratumumab 10 mg"	cpt	J9145	8563.88	8563.88	5143.64	5143.64	15330.14	15330.14	12775.12	12775.12	O	5143.64	5143.64	aetna	ppo
"injection, daratumumab 10 mg"	cpt	J9145	8563.88	8563.88	5143.64	5143.64	15330.14	15330.14	12775.12	12775.12	O	5143.64	5143.64	aetna	epo
"injection, daratumumab 10 mg"	cpt	J9145	8563.88	8563.88	5143.64	5143.64	15330.14	15330.14	12775.12	12775.12	O	5143.64	5143.64	aetna	hmo
"injection, daratumumab 10 mg"	cpt	J9145	8563.88	8563.88	5143.64	5143.64	15330.14	15330.14	12775.12	12775.12	O	5143.64	5143.64	aetna	pos
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	51.87	51.87	aetna	ppo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	51.87	51.87	aetna	epo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	51.87	51.87	aetna	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	51.87	51.87	aetna	pos
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	43.82	43.82	aetna	ppo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	43.82	43.82	aetna	epo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	43.82	43.82	aetna	hmo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	43.82	43.82	aetna	pos
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	ppo
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	epo
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	hmo
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	876.81	876.81	aetna	pos
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	61.97	61.97	aetna	ppo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	61.97	61.97	aetna	epo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	61.97	61.97	aetna	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	61.97	61.97	aetna	pos
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	154.28	154.28	aetna	ppo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	154.28	154.28	aetna	epo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	154.28	154.28	aetna	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	154.28	154.28	aetna	pos
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	1139.9	1139.9	aetna	ppo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	1139.9	1139.9	aetna	epo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	1139.9	1139.9	aetna	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	1139.9	1139.9	aetna	pos
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	2415.43	2415.43	aetna	ppo
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	2415.43	2415.43	aetna	epo
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	2415.43	2415.43	aetna	hmo
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	2415.43	2415.43	aetna	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	401.04	401.04	aetna	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	401.04	401.04	aetna	epo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	401.04	401.04	aetna	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	401.04	401.04	aetna	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	36.24	36.24	aetna	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	36.24	36.24	aetna	epo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	36.24	36.24	aetna	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	36.24	36.24	aetna	pos
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	652.29	652.29	aetna	ppo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	652.29	652.29	aetna	epo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	652.29	652.29	aetna	hmo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	652.29	652.29	aetna	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	421.52	421.52	aetna	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	421.52	421.52	aetna	epo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	421.52	421.52	aetna	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	421.52	421.52	aetna	pos
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	aetna	ppo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	aetna	epo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	aetna	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	aetna	pos
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	29.05	29.05	aetna	ppo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	29.05	29.05	aetna	epo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	29.05	29.05	aetna	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	29.05	29.05	aetna	pos
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	832.09	832.09	aetna	ppo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	832.09	832.09	aetna	epo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	832.09	832.09	aetna	hmo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	832.09	832.09	aetna	pos
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	83.27	83.27	aetna	ppo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	83.27	83.27	aetna	epo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	83.27	83.27	aetna	hmo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	83.27	83.27	aetna	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1952.13	1952.13	aetna	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1952.13	1952.13	aetna	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1952.13	1952.13	aetna	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1952.13	1952.13	aetna	pos
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	449.64	449.64	aetna	ppo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	449.64	449.64	aetna	epo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	449.64	449.64	aetna	hmo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	449.64	449.64	aetna	pos
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	23772.44	23772.44	aetna	ppo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	23772.44	23772.44	aetna	epo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	23772.44	23772.44	aetna	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	23772.44	23772.44	aetna	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	319.86	319.86	aetna	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	319.86	319.86	aetna	epo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	319.86	319.86	aetna	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	319.86	319.86	aetna	pos
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	83.27	83.27	aetna	ppo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	83.27	83.27	aetna	epo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	83.27	83.27	aetna	hmo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	83.27	83.27	aetna	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	1103.29	1103.29	aetna	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	1103.29	1103.29	aetna	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	1103.29	1103.29	aetna	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	1103.29	1103.29	aetna	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	763.93	763.93	aetna	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	763.93	763.93	aetna	epo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	763.93	763.93	aetna	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	763.93	763.93	aetna	pos
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	924.13	924.13	aetna	ppo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	924.13	924.13	aetna	epo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	924.13	924.13	aetna	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	924.13	924.13	aetna	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	1093.21	1093.21	aetna	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	1093.21	1093.21	aetna	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	1093.21	1093.21	aetna	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	1093.21	1093.21	aetna	pos
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	27.36	27.36	aetna	ppo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	27.36	27.36	aetna	epo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	27.36	27.36	aetna	hmo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	27.36	27.36	aetna	pos
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	58.16	58.16	aetna	ppo
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	58.16	58.16	aetna	epo
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	58.16	58.16	aetna	hmo
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	58.16	58.16	aetna	pos
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	51.64	51.64	aetna	ppo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	51.64	51.64	aetna	epo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	51.64	51.64	aetna	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	51.64	51.64	aetna	pos
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1548.35	1548.35	aetna	ppo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1548.35	1548.35	aetna	epo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1548.35	1548.35	aetna	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1548.35	1548.35	aetna	pos
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1034.56	1034.56	aetna	ppo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1034.56	1034.56	aetna	epo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1034.56	1034.56	aetna	hmo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1034.56	1034.56	aetna	pos
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7082.15	7082.15	aetna	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7082.15	7082.15	aetna	epo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7082.15	7082.15	aetna	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7082.15	7082.15	aetna	pos
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1023.76	1023.76	aetna	ppo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1023.76	1023.76	aetna	epo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1023.76	1023.76	aetna	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1023.76	1023.76	aetna	pos
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	481.19	481.19	aetna	ppo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	481.19	481.19	aetna	epo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	481.19	481.19	aetna	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	481.19	481.19	aetna	pos
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1452.58	1452.58	aetna	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1452.58	1452.58	aetna	epo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1452.58	1452.58	aetna	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1452.58	1452.58	aetna	pos
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1971.24	1971.24	aetna	ppo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1971.24	1971.24	aetna	epo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1971.24	1971.24	aetna	hmo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1971.24	1971.24	aetna	pos
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	68.59	68.59	aetna	ppo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	68.59	68.59	aetna	epo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	68.59	68.59	aetna	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	68.59	68.59	aetna	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1284.26	1284.26	aetna	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1284.26	1284.26	aetna	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1284.26	1284.26	aetna	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1284.26	1284.26	aetna	pos
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	48.72	48.72	aetna	ppo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	48.72	48.72	aetna	epo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	48.72	48.72	aetna	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	48.72	48.72	aetna	pos
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	2003.41	2003.41	aetna	ppo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	2003.41	2003.41	aetna	epo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	2003.41	2003.41	aetna	hmo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	2003.41	2003.41	aetna	pos
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6713.46	6713.46	aetna	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6713.46	6713.46	aetna	epo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6713.46	6713.46	aetna	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6713.46	6713.46	aetna	pos
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	20.87	20.87	aetna	ppo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	20.87	20.87	aetna	epo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	20.87	20.87	aetna	hmo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	20.87	20.87	aetna	pos
Creation of sling around bladder canal (urethra) to control leakage	cpt	57288	9490.45	9490.45	3784.07	3784.07	31149.61	31149.61	25958.01	25958.01	O	9490.45	9490.45	aetna	ppo
Creation of sling around bladder canal (urethra) to control leakage	cpt	57288	9490.45	9490.45	3784.07	3784.07	31149.61	31149.61	25958.01	25958.01	O	9490.45	9490.45	aetna	epo
Creation of sling around bladder canal (urethra) to control leakage	cpt	57288	9490.45	9490.45	3784.07	3784.07	31149.61	31149.61	25958.01	25958.01	O	9490.45	9490.45	aetna	hmo
Creation of sling around bladder canal (urethra) to control leakage	cpt	57288	9490.45	9490.45	3784.07	3784.07	31149.61	31149.61	25958.01	25958.01	O	9490.45	9490.45	aetna	pos
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	325.21	325.21	aetna	ppo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	325.21	325.21	aetna	epo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	325.21	325.21	aetna	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	325.21	325.21	aetna	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4284.01	4284.01	aetna	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4284.01	4284.01	aetna	epo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4284.01	4284.01	aetna	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4284.01	4284.01	aetna	pos
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	13.89	13.89	aetna	ppo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	13.89	13.89	aetna	epo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	13.89	13.89	aetna	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	13.89	13.89	aetna	pos
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	5479.02	5479.02	aetna	ppo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	5479.02	5479.02	aetna	epo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	5479.02	5479.02	aetna	hmo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	5479.02	5479.02	aetna	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	aetna	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	aetna	epo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	aetna	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	aetna	pos
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1300.21	1300.21	aetna	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1300.21	1300.21	aetna	epo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1300.21	1300.21	aetna	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1300.21	1300.21	aetna	pos
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	7851.31	7851.31	aetna	ppo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	7851.31	7851.31	aetna	epo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	7851.31	7851.31	aetna	hmo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	7851.31	7851.31	aetna	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	27.75	27.75	aetna	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	27.75	27.75	aetna	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	27.75	27.75	aetna	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	27.75	27.75	aetna	pos
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	165.81	165.81	aetna	ppo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	165.81	165.81	aetna	epo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	165.81	165.81	aetna	hmo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	165.81	165.81	aetna	pos
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	10076.53	10076.53	aetna	ppo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	10076.53	10076.53	aetna	epo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	10076.53	10076.53	aetna	hmo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	10076.53	10076.53	aetna	pos
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	21.95	21.95	aetna	ppo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	21.95	21.95	aetna	epo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	21.95	21.95	aetna	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	21.95	21.95	aetna	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	70.04	70.04	aetna	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	70.04	70.04	aetna	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	70.04	70.04	aetna	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	70.04	70.04	aetna	pos
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	191.72	191.72	aetna	ppo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	191.72	191.72	aetna	epo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	191.72	191.72	aetna	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	191.72	191.72	aetna	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1705.53	1705.53	aetna	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1705.53	1705.53	aetna	epo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1705.53	1705.53	aetna	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1705.53	1705.53	aetna	pos
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	4861.41	4861.41	aetna	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	4861.41	4861.41	aetna	epo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	4861.41	4861.41	aetna	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	4861.41	4861.41	aetna	pos
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	87.56	87.56	aetna	ppo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	87.56	87.56	aetna	epo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	87.56	87.56	aetna	hmo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	87.56	87.56	aetna	pos
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	aetna	ppo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	aetna	epo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	aetna	hmo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	aetna	pos
Acute hepatitis panel	cpt	80074	224.77	224.77	42.37	42.37	457.15	457.15	380.96	380.96	E	224.77	224.77	aetna	ppo
Acute hepatitis panel	cpt	80074	224.77	224.77	42.37	42.37	457.15	457.15	380.96	380.96	E	224.77	224.77	aetna	epo
Acute hepatitis panel	cpt	80074	224.77	224.77	42.37	42.37	457.15	457.15	380.96	380.96	E	224.77	224.77	aetna	hmo
Acute hepatitis panel	cpt	80074	224.77	224.77	42.37	42.37	457.15	457.15	380.96	380.96	E	224.77	224.77	aetna	pos
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1215.96	1215.96	aetna	ppo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1215.96	1215.96	aetna	epo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1215.96	1215.96	aetna	hmo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1215.96	1215.96	aetna	pos
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	17.91	17.91	aetna	ppo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	17.91	17.91	aetna	epo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	17.91	17.91	aetna	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	17.91	17.91	aetna	pos
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	481	481	aetna	ppo
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	481	481	aetna	epo
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	481	481	aetna	hmo
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	481	481	aetna	pos
"T cell count and ratio, including ratio"	cpt	86360	120.72	120.72	41.79	41.79	237.86	237.86	198.22	198.22	O	120.72	120.72	aetna	ppo
"T cell count and ratio, including ratio"	cpt	86360	120.72	120.72	41.79	41.79	237.86	237.86	198.22	198.22	O	120.72	120.72	aetna	epo
"T cell count and ratio, including ratio"	cpt	86360	120.72	120.72	41.79	41.79	237.86	237.86	198.22	198.22	O	120.72	120.72	aetna	hmo
"T cell count and ratio, including ratio"	cpt	86360	120.72	120.72	41.79	41.79	237.86	237.86	198.22	198.22	O	120.72	120.72	aetna	pos
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	aetna	ppo
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	aetna	epo
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	aetna	hmo
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	aetna	pos
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	aetna	ppo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	aetna	epo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	aetna	hmo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	aetna	pos
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	113.38	113.38	aetna	ppo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	113.38	113.38	aetna	epo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	113.38	113.38	aetna	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	113.38	113.38	aetna	pos
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	ppo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	epo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	hmo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	aetna	pos
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	1952.13	1952.13	aetna	ppo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	1952.13	1952.13	aetna	epo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	1952.13	1952.13	aetna	hmo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	1952.13	1952.13	aetna	pos
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	2442.48	2442.48	aetna	ppo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	2442.48	2442.48	aetna	epo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	2442.48	2442.48	aetna	hmo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	2442.48	2442.48	aetna	pos
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	120.08	120.08	aetna	ppo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	120.08	120.08	aetna	epo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	120.08	120.08	aetna	hmo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	120.08	120.08	aetna	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5949.32	5949.32	aetna	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5949.32	5949.32	aetna	epo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5949.32	5949.32	aetna	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5949.32	5949.32	aetna	pos
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	1034.56	1034.56	aetna	ppo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	1034.56	1034.56	aetna	epo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	1034.56	1034.56	aetna	hmo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	1034.56	1034.56	aetna	pos
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	7851.31	7851.31	aetna	ppo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	7851.31	7851.31	aetna	epo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	7851.31	7851.31	aetna	hmo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	7851.31	7851.31	aetna	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	aetna	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	aetna	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	aetna	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	aetna	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	138.14	138.14	aetna	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	138.14	138.14	aetna	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	138.14	138.14	aetna	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	138.14	138.14	aetna	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	138.14	138.14	aetna	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	138.14	138.14	aetna	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	138.14	138.14	aetna	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	138.14	138.14	aetna	pos
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	aetna	ppo
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	aetna	epo
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	aetna	hmo
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	aetna	pos
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	8253.63	8253.63	aetna	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	8253.63	8253.63	aetna	epo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	8253.63	8253.63	aetna	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	8253.63	8253.63	aetna	pos
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1127.79	1127.79	aetna	ppo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1127.79	1127.79	aetna	epo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1127.79	1127.79	aetna	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1127.79	1127.79	aetna	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	146.55	146.55	aetna	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	146.55	146.55	aetna	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	146.55	146.55	aetna	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	146.55	146.55	aetna	pos
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	165.81	165.81	aetna	ppo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	165.81	165.81	aetna	epo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	165.81	165.81	aetna	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	165.81	165.81	aetna	pos
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	20.41	20.41	aetna	ppo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	20.41	20.41	aetna	epo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	20.41	20.41	aetna	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	20.41	20.41	aetna	pos
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	586.4	586.4	aetna	ppo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	586.4	586.4	aetna	epo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	586.4	586.4	aetna	hmo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	586.4	586.4	aetna	pos
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	720.46	720.46	aetna	ppo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	720.46	720.46	aetna	epo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	720.46	720.46	aetna	hmo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	720.46	720.46	aetna	pos
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	1971.24	1971.24	aetna	ppo
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	1971.24	1971.24	aetna	epo
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	1971.24	1971.24	aetna	hmo
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	1971.24	1971.24	aetna	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	20.46	20.46	aetna	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	20.46	20.46	aetna	epo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	20.46	20.46	aetna	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	20.46	20.46	aetna	pos
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	aetna	ppo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	aetna	epo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	aetna	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	aetna	pos
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1995.04	1995.04	aetna	ppo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1995.04	1995.04	aetna	epo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1995.04	1995.04	aetna	hmo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1995.04	1995.04	aetna	pos
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	552.04	552.04	aetna	ppo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	552.04	552.04	aetna	epo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	552.04	552.04	aetna	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	552.04	552.04	aetna	pos
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	59.04	59.04	aetna	ppo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	59.04	59.04	aetna	epo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	59.04	59.04	aetna	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	59.04	59.04	aetna	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	293.31	293.31	aetna	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	293.31	293.31	aetna	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	293.31	293.31	aetna	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	293.31	293.31	aetna	pos
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	14238.66	14238.66	aetna	ppo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	14238.66	14238.66	aetna	epo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	14238.66	14238.66	aetna	hmo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	14238.66	14238.66	aetna	pos
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1444.99	1444.99	aetna	ppo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1444.99	1444.99	aetna	epo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1444.99	1444.99	aetna	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1444.99	1444.99	aetna	pos
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	28603.68	28603.68	aetna	ppo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	28603.68	28603.68	aetna	epo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	28603.68	28603.68	aetna	hmo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	28603.68	28603.68	aetna	pos
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	21.89	21.89	aetna	ppo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	21.89	21.89	aetna	epo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	21.89	21.89	aetna	hmo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	21.89	21.89	aetna	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	278.85	278.85	aetna	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	278.85	278.85	aetna	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	278.85	278.85	aetna	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	278.85	278.85	aetna	pos
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	8300.35	8300.35	aetna	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	8300.35	8300.35	aetna	epo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	8300.35	8300.35	aetna	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	8300.35	8300.35	aetna	pos
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	2100.38	2100.38	aetna	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	2100.38	2100.38	aetna	epo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	2100.38	2100.38	aetna	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	2100.38	2100.38	aetna	pos
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	6054.77	6054.77	aetna	ppo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	6054.77	6054.77	aetna	epo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	6054.77	6054.77	aetna	hmo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	6054.77	6054.77	aetna	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	20.64	20.64	aetna	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	20.64	20.64	aetna	epo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	20.64	20.64	aetna	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	20.64	20.64	aetna	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1788.91	1788.91	aetna	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1788.91	1788.91	aetna	epo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1788.91	1788.91	aetna	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1788.91	1788.91	aetna	pos
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	164.17	164.17	aetna	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	164.17	164.17	aetna	epo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	164.17	164.17	aetna	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	164.17	164.17	aetna	pos
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	5906.23	5906.23	aetna	ppo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	5906.23	5906.23	aetna	epo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	5906.23	5906.23	aetna	hmo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	5906.23	5906.23	aetna	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1952.13	1952.13	aetna	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1952.13	1952.13	aetna	epo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1952.13	1952.13	aetna	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1952.13	1952.13	aetna	pos
Removal of skin and bone	cpt	11047	1215.96	1215.96	1196.5	1196.5	8686.8	8686.8	7239	7239	O	1215.96	1215.96	aetna	ppo
Removal of skin and bone	cpt	11047	1215.96	1215.96	1196.5	1196.5	8686.8	8686.8	7239	7239	O	1215.96	1215.96	aetna	epo
Removal of skin and bone	cpt	11047	1215.96	1215.96	1196.5	1196.5	8686.8	8686.8	7239	7239	O	1215.96	1215.96	aetna	hmo
Removal of skin and bone	cpt	11047	1215.96	1215.96	1196.5	1196.5	8686.8	8686.8	7239	7239	O	1215.96	1215.96	aetna	pos
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1344.99	1344.99	aetna	ppo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1344.99	1344.99	aetna	epo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1344.99	1344.99	aetna	hmo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1344.99	1344.99	aetna	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	474.8	474.8	aetna	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	474.8	474.8	aetna	epo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	474.8	474.8	aetna	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	474.8	474.8	aetna	pos
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	aetna	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	aetna	epo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	aetna	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	aetna	pos
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	639.16	639.16	aetna	ppo
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	639.16	639.16	aetna	epo
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	639.16	639.16	aetna	hmo
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	639.16	639.16	aetna	pos
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	347.84	347.84	aetna	ppo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	347.84	347.84	aetna	epo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	347.84	347.84	aetna	hmo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	347.84	347.84	aetna	pos
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	14120.9	14120.9	aetna	ppo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	14120.9	14120.9	aetna	epo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	14120.9	14120.9	aetna	hmo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	14120.9	14120.9	aetna	pos
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	122.58	122.58	aetna	ppo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	122.58	122.58	aetna	epo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	122.58	122.58	aetna	hmo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	122.58	122.58	aetna	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	9.99	9.99	aetna	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	9.99	9.99	aetna	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	9.99	9.99	aetna	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	9.99	9.99	aetna	pos
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	146.34	146.34	aetna	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	146.34	146.34	aetna	epo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	146.34	146.34	aetna	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	146.34	146.34	aetna	pos
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	14120.9	14120.9	aetna	ppo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	14120.9	14120.9	aetna	epo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	14120.9	14120.9	aetna	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	14120.9	14120.9	aetna	pos
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	79.71	79.71	aetna	ppo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	79.71	79.71	aetna	epo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	79.71	79.71	aetna	hmo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	79.71	79.71	aetna	pos
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	4285.93	4285.93	aetna	ppo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	4285.93	4285.93	aetna	epo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	4285.93	4285.93	aetna	hmo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	4285.93	4285.93	aetna	pos
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1995.04	1995.04	aetna	ppo
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1995.04	1995.04	aetna	epo
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1995.04	1995.04	aetna	hmo
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1995.04	1995.04	aetna	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	66.6	66.6	aetna	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	66.6	66.6	aetna	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	66.6	66.6	aetna	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	66.6	66.6	aetna	pos
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	174.49	174.49	aetna	ppo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	174.49	174.49	aetna	epo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	174.49	174.49	aetna	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	174.49	174.49	aetna	pos
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	112.65	112.65	aetna	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	112.65	112.65	aetna	epo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	112.65	112.65	aetna	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	112.65	112.65	aetna	pos
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	11158.76	11158.76	aetna	ppo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	11158.76	11158.76	aetna	epo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	11158.76	11158.76	aetna	hmo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	11158.76	11158.76	aetna	pos
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	419.46	419.46	aetna	ppo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	419.46	419.46	aetna	epo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	419.46	419.46	aetna	hmo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	419.46	419.46	aetna	pos
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	1927.71	1927.71	aetna	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	1927.71	1927.71	aetna	epo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	1927.71	1927.71	aetna	hmo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	1927.71	1927.71	aetna	pos
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	429.12	429.12	aetna	ppo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	429.12	429.12	aetna	epo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	429.12	429.12	aetna	hmo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	429.12	429.12	aetna	pos
hydralazine hcl injection	cpt	J0360	2136.63	2136.63	1934.02	1934.02	16012.49	16012.49	13343.74	13343.74	E	1952.13	1952.13	aetna	ppo
hydralazine hcl injection	cpt	J0360	2136.63	2136.63	1934.02	1934.02	16012.49	16012.49	13343.74	13343.74	E	1952.13	1952.13	aetna	epo
hydralazine hcl injection	cpt	J0360	2136.63	2136.63	1934.02	1934.02	16012.49	16012.49	13343.74	13343.74	E	1952.13	1952.13	aetna	hmo
hydralazine hcl injection	cpt	J0360	2136.63	2136.63	1934.02	1934.02	16012.49	16012.49	13343.74	13343.74	E	1952.13	1952.13	aetna	pos
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	48.6	48.6	aetna	ppo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	48.6	48.6	aetna	epo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	48.6	48.6	aetna	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	48.6	48.6	aetna	pos
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	9113.8	9113.8	aetna	ppo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	9113.8	9113.8	aetna	epo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	9113.8	9113.8	aetna	hmo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	9113.8	9113.8	aetna	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	178.85	178.85	aetna	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	178.85	178.85	aetna	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	178.85	178.85	aetna	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	178.85	178.85	aetna	pos
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	23.1	23.1	aetna	ppo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	23.1	23.1	aetna	epo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	23.1	23.1	aetna	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	23.1	23.1	aetna	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	9214.1	9214.1	aetna	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	9214.1	9214.1	aetna	epo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	9214.1	9214.1	aetna	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	9214.1	9214.1	aetna	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	174.49	174.49	aetna	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	174.49	174.49	aetna	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	174.49	174.49	aetna	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	174.49	174.49	aetna	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	35.65	35.65	aetna	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	35.65	35.65	aetna	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	35.65	35.65	aetna	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	35.65	35.65	aetna	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	14120.9	14120.9	aetna	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	14120.9	14120.9	aetna	epo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	14120.9	14120.9	aetna	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	14120.9	14120.9	aetna	pos
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	1218.97	1218.97	aetna	ppo
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	1218.97	1218.97	aetna	epo
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	1218.97	1218.97	aetna	hmo
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	1218.97	1218.97	aetna	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	74.62	74.62	aetna	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	74.62	74.62	aetna	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	74.62	74.62	aetna	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	74.62	74.62	aetna	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	aetna	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	aetna	epo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	aetna	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	aetna	pos
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	36.8	36.8	aetna	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	36.8	36.8	aetna	epo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	36.8	36.8	aetna	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	36.8	36.8	aetna	pos
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	376.97	376.97	aetna	ppo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	376.97	376.97	aetna	epo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	376.97	376.97	aetna	hmo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	376.97	376.97	aetna	pos
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3849.34	3849.34	aetna	ppo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3849.34	3849.34	aetna	epo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3849.34	3849.34	aetna	hmo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3849.34	3849.34	aetna	pos
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	96.83	96.83	aetna	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	96.83	96.83	aetna	epo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	96.83	96.83	aetna	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	96.83	96.83	aetna	pos
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	49.41	49.41	aetna	ppo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	49.41	49.41	aetna	epo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	49.41	49.41	aetna	hmo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	49.41	49.41	aetna	pos
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	aetna	ppo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	aetna	epo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	aetna	hmo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	aetna	pos
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	1431.27	1431.27	aetna	ppo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	1431.27	1431.27	aetna	epo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	1431.27	1431.27	aetna	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	1431.27	1431.27	aetna	pos
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	aetna	ppo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	aetna	epo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	aetna	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	aetna	pos
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	832.09	832.09	aetna	ppo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	832.09	832.09	aetna	epo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	832.09	832.09	aetna	hmo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	832.09	832.09	aetna	pos
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	412.37	412.37	aetna	ppo
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	412.37	412.37	aetna	epo
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	412.37	412.37	aetna	hmo
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	412.37	412.37	aetna	pos
adenosine inj 1mg	cpt	J0153	9249.37	9249.37	741.72	741.72	36285.3	36285.3	30237.75	30237.75	O	9249.37	9249.37	aetna	ppo
adenosine inj 1mg	cpt	J0153	9249.37	9249.37	741.72	741.72	36285.3	36285.3	30237.75	30237.75	O	9249.37	9249.37	aetna	epo
adenosine inj 1mg	cpt	J0153	9249.37	9249.37	741.72	741.72	36285.3	36285.3	30237.75	30237.75	O	9249.37	9249.37	aetna	hmo
adenosine inj 1mg	cpt	J0153	9249.37	9249.37	741.72	741.72	36285.3	36285.3	30237.75	30237.75	O	9249.37	9249.37	aetna	pos
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2073.24	2073.24	aetna	ppo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2073.24	2073.24	aetna	epo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2073.24	2073.24	aetna	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2073.24	2073.24	aetna	pos
inj potassium chloride	cpt	J3480	1971.24	1971.24	725.65	725.65	15041.03	15041.03	12534.19	12534.19	E	1971.24	1971.24	aetna	ppo
inj potassium chloride	cpt	J3480	1971.24	1971.24	725.65	725.65	15041.03	15041.03	12534.19	12534.19	E	1971.24	1971.24	aetna	epo
inj potassium chloride	cpt	J3480	1971.24	1971.24	725.65	725.65	15041.03	15041.03	12534.19	12534.19	E	1971.24	1971.24	aetna	hmo
inj potassium chloride	cpt	J3480	1971.24	1971.24	725.65	725.65	15041.03	15041.03	12534.19	12534.19	E	1971.24	1971.24	aetna	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	26.94	26.94	aetna	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	26.94	26.94	aetna	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	26.94	26.94	aetna	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	26.94	26.94	aetna	pos
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	832.09	832.09	aetna	ppo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	832.09	832.09	aetna	epo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	832.09	832.09	aetna	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	832.09	832.09	aetna	pos
"injection, inflectra"	cpt	Q5103	2203.17	2203.17	339.19	339.19	6911.71	6911.71	5759.76	5759.76	O	528.64	528.64	aetna	ppo
"injection, inflectra"	cpt	Q5103	2203.17	2203.17	339.19	339.19	6911.71	6911.71	5759.76	5759.76	O	528.64	528.64	aetna	epo
"injection, inflectra"	cpt	Q5103	2203.17	2203.17	339.19	339.19	6911.71	6911.71	5759.76	5759.76	O	528.64	528.64	aetna	hmo
"injection, inflectra"	cpt	Q5103	2203.17	2203.17	339.19	339.19	6911.71	6911.71	5759.76	5759.76	O	528.64	528.64	aetna	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	aetna	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	aetna	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	aetna	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	aetna	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2034.14	2034.14	aetna	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2034.14	2034.14	aetna	epo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2034.14	2034.14	aetna	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2034.14	2034.14	aetna	pos
Removal of fibrous nerve growth from between toes	cpt	28080	8922.19	8922.19	8922.19	8922.19	16737.58	16737.58	13947.98	13947.98	O	8922.19	8922.19	aetna	ppo
Removal of fibrous nerve growth from between toes	cpt	28080	8922.19	8922.19	8922.19	8922.19	16737.58	16737.58	13947.98	13947.98	O	8922.19	8922.19	aetna	epo
Removal of fibrous nerve growth from between toes	cpt	28080	8922.19	8922.19	8922.19	8922.19	16737.58	16737.58	13947.98	13947.98	O	8922.19	8922.19	aetna	hmo
Removal of fibrous nerve growth from between toes	cpt	28080	8922.19	8922.19	8922.19	8922.19	16737.58	16737.58	13947.98	13947.98	O	8922.19	8922.19	aetna	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	95.01	95.01	aetna	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	95.01	95.01	aetna	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	95.01	95.01	aetna	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	95.01	95.01	aetna	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	aetna	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	aetna	epo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	aetna	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	aetna	pos
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	ppo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	epo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	hmo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	683.74	683.74	aetna	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	3099.83	3099.83	aetna	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	3099.83	3099.83	aetna	epo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	3099.83	3099.83	aetna	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	3099.83	3099.83	aetna	pos
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	57.72	57.72	aetna	ppo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	57.72	57.72	aetna	epo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	57.72	57.72	aetna	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	57.72	57.72	aetna	pos
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	9206.32	9206.32	aetna	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	9206.32	9206.32	aetna	epo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	9206.32	9206.32	aetna	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	9206.32	9206.32	aetna	pos
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	875.33	875.33	aetna	ppo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	875.33	875.33	aetna	epo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	875.33	875.33	aetna	hmo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	875.33	875.33	aetna	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	aetna	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	aetna	epo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	aetna	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	aetna	pos
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	1336.81	1336.81	aetna	ppo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	1336.81	1336.81	aetna	epo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	1336.81	1336.81	aetna	hmo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	1336.81	1336.81	aetna	pos
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	1995.04	1995.04	aetna	ppo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	1995.04	1995.04	aetna	epo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	1995.04	1995.04	aetna	hmo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	1995.04	1995.04	aetna	pos
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	36.8	36.8	aetna	ppo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	36.8	36.8	aetna	epo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	36.8	36.8	aetna	hmo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	36.8	36.8	aetna	pos
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	aetna	ppo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	aetna	epo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	aetna	hmo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	aetna	pos
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	5.02	5.02	aetna	ppo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	5.02	5.02	aetna	epo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	5.02	5.02	aetna	hmo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	5.02	5.02	aetna	pos
vitamin k phytonadione inj	cpt	J3430	4902.1	4902.1	1444.99	1444.99	24968.99	24968.99	20807.49	20807.49	O	1444.99	1444.99	aetna	ppo
vitamin k phytonadione inj	cpt	J3430	4902.1	4902.1	1444.99	1444.99	24968.99	24968.99	20807.49	20807.49	O	1444.99	1444.99	aetna	epo
vitamin k phytonadione inj	cpt	J3430	4902.1	4902.1	1444.99	1444.99	24968.99	24968.99	20807.49	20807.49	O	1444.99	1444.99	aetna	hmo
vitamin k phytonadione inj	cpt	J3430	4902.1	4902.1	1444.99	1444.99	24968.99	24968.99	20807.49	20807.49	O	1444.99	1444.99	aetna	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1284	1284	aetna	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1284	1284	aetna	epo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1284	1284	aetna	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1284	1284	aetna	pos
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	213.15	213.15	aetna	ppo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	213.15	213.15	aetna	epo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	213.15	213.15	aetna	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	213.15	213.15	aetna	pos
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	1788.91	1788.91	aetna	ppo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	1788.91	1788.91	aetna	epo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	1788.91	1788.91	aetna	hmo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	1788.91	1788.91	aetna	pos
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1705.53	1705.53	aetna	ppo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1705.53	1705.53	aetna	epo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1705.53	1705.53	aetna	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1705.53	1705.53	aetna	pos
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	aetna	ppo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	aetna	epo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	aetna	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	aetna	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	27.89	27.89	aetna	pos
Insertion of stomach tube using an endoscope	cpt	43246	5239.84	5239.84	1368.64	1368.64	4972.94	4972.94	4144.12	4144.12	O	5239.84	5239.84	aetna	ppo
Insertion of stomach tube using an endoscope	cpt	43246	5239.84	5239.84	1368.64	1368.64	4972.94	4972.94	4144.12	4144.12	O	5239.84	5239.84	aetna	epo
Insertion of stomach tube using an endoscope	cpt	43246	5239.84	5239.84	1368.64	1368.64	4972.94	4972.94	4144.12	4144.12	O	5239.84	5239.84	aetna	hmo
Insertion of stomach tube using an endoscope	cpt	43246	5239.84	5239.84	1368.64	1368.64	4972.94	4972.94	4144.12	4144.12	O	5239.84	5239.84	aetna	pos
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1596.82	1596.82	aetna	ppo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1596.82	1596.82	aetna	epo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1596.82	1596.82	aetna	hmo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1596.82	1596.82	aetna	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	65.71	65.71	aetna	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	65.71	65.71	aetna	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	65.71	65.71	aetna	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	65.71	65.71	aetna	pos
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	744.67	744.67	aetna	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	744.67	744.67	aetna	epo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	744.67	744.67	aetna	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	744.67	744.67	aetna	pos
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	1969.96	1969.96	aetna	ppo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	1969.96	1969.96	aetna	epo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	1969.96	1969.96	aetna	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	1969.96	1969.96	aetna	pos
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	113.2	113.2	aetna	ppo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	113.2	113.2	aetna	epo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	113.2	113.2	aetna	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	113.2	113.2	aetna	pos
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	74.23	74.23	aetna	ppo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	74.23	74.23	aetna	epo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	74.23	74.23	aetna	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	74.23	74.23	aetna	pos
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	32.23	32.23	aetna	ppo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	32.23	32.23	aetna	epo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	32.23	32.23	aetna	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	32.23	32.23	aetna	pos
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2442.65	2442.65	aetna	ppo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2442.65	2442.65	aetna	epo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2442.65	2442.65	aetna	hmo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2442.65	2442.65	aetna	pos
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	3530.58	3530.58	aetna	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	3530.58	3530.58	aetna	epo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	3530.58	3530.58	aetna	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	3530.58	3530.58	aetna	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	97.44	97.44	aetna	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	97.44	97.44	aetna	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	97.44	97.44	aetna	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	97.44	97.44	aetna	pos
"X-ray of hip with pelvis, minimum of 4 views"	cpt	73503	97.4	97.4	97.4	97.4	361.2	361.2	301	301	O	97.4	97.4	aetna	ppo
"X-ray of hip with pelvis, minimum of 4 views"	cpt	73503	97.4	97.4	97.4	97.4	361.2	361.2	301	301	O	97.4	97.4	aetna	epo
"X-ray of hip with pelvis, minimum of 4 views"	cpt	73503	97.4	97.4	97.4	97.4	361.2	361.2	301	301	O	97.4	97.4	aetna	hmo
"X-ray of hip with pelvis, minimum of 4 views"	cpt	73503	97.4	97.4	97.4	97.4	361.2	361.2	301	301	O	97.4	97.4	aetna	pos
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	aetna	ppo
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	aetna	epo
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	aetna	hmo
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	aetna	pos
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	aetna	ppo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	aetna	epo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	aetna	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	aetna	pos
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	53.72	53.72	aetna	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	53.72	53.72	aetna	epo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	53.72	53.72	aetna	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	53.72	53.72	aetna	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1965.52	1965.52	aetna	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1965.52	1965.52	aetna	epo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1965.52	1965.52	aetna	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1965.52	1965.52	aetna	pos
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	606.52	606.52	aetna	ppo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	606.52	606.52	aetna	epo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	606.52	606.52	aetna	hmo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	606.52	606.52	aetna	pos
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	26.46	26.46	aetna	ppo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	26.46	26.46	aetna	epo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	26.46	26.46	aetna	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	26.46	26.46	aetna	pos
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	3530.58	3530.58	aetna	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	3530.58	3530.58	aetna	epo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	3530.58	3530.58	aetna	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	3530.58	3530.58	aetna	pos
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	aetna	ppo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	aetna	epo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	aetna	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	aetna	pos
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.62	5.62	aetna	ppo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.62	5.62	aetna	epo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.62	5.62	aetna	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.62	5.62	aetna	pos
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	972.92	972.92	aetna	ppo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	972.92	972.92	aetna	epo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	972.92	972.92	aetna	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	972.92	972.92	aetna	pos
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	8866.76	8866.76	aetna	ppo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	8866.76	8866.76	aetna	epo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	8866.76	8866.76	aetna	hmo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	8866.76	8866.76	aetna	pos
rbc leukoreduced irradiated	cpt	P9040	1936.52	1936.52	1753.5	1753.5	13153.74	13153.74	10961.45	10961.45	E	1753.5	1753.5	aetna	ppo
rbc leukoreduced irradiated	cpt	P9040	1936.52	1936.52	1753.5	1753.5	13153.74	13153.74	10961.45	10961.45	E	1753.5	1753.5	aetna	epo
rbc leukoreduced irradiated	cpt	P9040	1936.52	1936.52	1753.5	1753.5	13153.74	13153.74	10961.45	10961.45	E	1753.5	1753.5	aetna	hmo
rbc leukoreduced irradiated	cpt	P9040	1936.52	1936.52	1753.5	1753.5	13153.74	13153.74	10961.45	10961.45	E	1753.5	1753.5	aetna	pos
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	62.65	62.65	aetna	ppo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	62.65	62.65	aetna	epo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	62.65	62.65	aetna	hmo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	62.65	62.65	aetna	pos
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	3530.58	3530.58	aetna	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	3530.58	3530.58	aetna	epo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	3530.58	3530.58	aetna	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	3530.58	3530.58	aetna	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	aetna	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	aetna	epo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	aetna	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	aetna	pos
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	228.51	228.51	aetna	ppo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	228.51	228.51	aetna	epo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	228.51	228.51	aetna	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	228.51	228.51	aetna	pos
Carboxyhemoglobin (protein) level	cpt	82375	98.58	98.58	10.96	10.96	118.3	118.3	98.58	98.58	E	58.16	58.16	aetna	ppo
Carboxyhemoglobin (protein) level	cpt	82375	98.58	98.58	10.96	10.96	118.3	118.3	98.58	98.58	E	58.16	58.16	aetna	epo
Carboxyhemoglobin (protein) level	cpt	82375	98.58	98.58	10.96	10.96	118.3	118.3	98.58	98.58	E	58.16	58.16	aetna	hmo
Carboxyhemoglobin (protein) level	cpt	82375	98.58	98.58	10.96	10.96	118.3	118.3	98.58	98.58	E	58.16	58.16	aetna	pos
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70	70	aetna	ppo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70	70	aetna	epo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70	70	aetna	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70	70	aetna	pos
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5449	5449	aetna	ppo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5449	5449	aetna	epo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5449	5449	aetna	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5449	5449	aetna	pos
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	6054.77	6054.77	aetna	ppo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	6054.77	6054.77	aetna	epo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	6054.77	6054.77	aetna	hmo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	6054.77	6054.77	aetna	pos
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	163.85	163.85	aetna	ppo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	163.85	163.85	aetna	epo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	163.85	163.85	aetna	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	163.85	163.85	aetna	pos
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	36.9	36.9	aetna	ppo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	36.9	36.9	aetna	epo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	36.9	36.9	aetna	hmo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	36.9	36.9	aetna	pos
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	ppo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	epo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	hmo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	pos
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	347.84	347.84	aetna	ppo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	347.84	347.84	aetna	epo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	347.84	347.84	aetna	hmo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	347.84	347.84	aetna	pos
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	5449	5449	aetna	ppo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	5449	5449	aetna	epo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	5449	5449	aetna	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	5449	5449	aetna	pos
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	2668.43	2668.43	aetna	ppo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	2668.43	2668.43	aetna	epo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	2668.43	2668.43	aetna	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	2668.43	2668.43	aetna	pos
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	537.22	537.22	aetna	ppo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	537.22	537.22	aetna	epo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	537.22	537.22	aetna	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	537.22	537.22	aetna	pos
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	126.52	126.52	aetna	ppo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	126.52	126.52	aetna	epo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	126.52	126.52	aetna	hmo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	126.52	126.52	aetna	pos
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	ppo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	epo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	hmo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	39.38	39.38	aetna	pos
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	123.94	123.94	aetna	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	123.94	123.94	aetna	epo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	123.94	123.94	aetna	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	123.94	123.94	aetna	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	1052.17	1052.17	aetna	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	1052.17	1052.17	aetna	epo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	1052.17	1052.17	aetna	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	1052.17	1052.17	aetna	pos
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	aetna	ppo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	aetna	epo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	aetna	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	aetna	pos
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	4307.3	4307.3	aetna	ppo
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	4307.3	4307.3	aetna	epo
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	4307.3	4307.3	aetna	hmo
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	4307.3	4307.3	aetna	pos
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	6120.94	6120.94	aetna	ppo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	6120.94	6120.94	aetna	epo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	6120.94	6120.94	aetna	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	6120.94	6120.94	aetna	pos
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	9882.2	9882.2	aetna	ppo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	9882.2	9882.2	aetna	epo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	9882.2	9882.2	aetna	hmo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	9882.2	9882.2	aetna	pos
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	56.91	56.91	aetna	ppo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	56.91	56.91	aetna	epo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	56.91	56.91	aetna	hmo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	56.91	56.91	aetna	pos
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	14156.17	14156.17	aetna	ppo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	14156.17	14156.17	aetna	epo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	14156.17	14156.17	aetna	hmo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	14156.17	14156.17	aetna	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	aetna	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	aetna	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	aetna	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	aetna	pos
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	103.19	103.19	aetna	ppo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	103.19	103.19	aetna	epo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	103.19	103.19	aetna	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	103.19	103.19	aetna	pos
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1626.88	1626.88	aetna	ppo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1626.88	1626.88	aetna	epo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1626.88	1626.88	aetna	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1626.88	1626.88	aetna	pos
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1493.86	1493.86	aetna	ppo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1493.86	1493.86	aetna	epo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1493.86	1493.86	aetna	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1493.86	1493.86	aetna	pos
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	aetna	ppo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	aetna	epo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	aetna	hmo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	aetna	pos
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	720.46	720.46	aetna	ppo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	720.46	720.46	aetna	epo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	720.46	720.46	aetna	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	720.46	720.46	aetna	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	aetna	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	aetna	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	aetna	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	aetna	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	96.81	96.81	aetna	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	96.81	96.81	aetna	epo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	96.81	96.81	aetna	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	96.81	96.81	aetna	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	70.09	70.09	aetna	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	70.09	70.09	aetna	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	70.09	70.09	aetna	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	70.09	70.09	aetna	pos
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	7408.69	7408.69	aetna	ppo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	7408.69	7408.69	aetna	epo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	7408.69	7408.69	aetna	hmo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	7408.69	7408.69	aetna	pos
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1344.99	1344.99	aetna	ppo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1344.99	1344.99	aetna	epo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1344.99	1344.99	aetna	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1344.99	1344.99	aetna	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	aetna	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	aetna	epo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	aetna	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	aetna	pos
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	8300.35	8300.35	aetna	ppo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	8300.35	8300.35	aetna	epo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	8300.35	8300.35	aetna	hmo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	8300.35	8300.35	aetna	pos
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	7585.06	7585.06	aetna	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	7585.06	7585.06	aetna	epo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	7585.06	7585.06	aetna	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	7585.06	7585.06	aetna	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1437.97	1437.97	aetna	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1437.97	1437.97	aetna	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1437.97	1437.97	aetna	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1437.97	1437.97	aetna	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	27.03	27.03	aetna	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	27.03	27.03	aetna	epo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	27.03	27.03	aetna	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	27.03	27.03	aetna	pos
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	69.84	69.84	aetna	ppo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	69.84	69.84	aetna	epo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	69.84	69.84	aetna	hmo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	69.84	69.84	aetna	pos
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	125.08	125.08	aetna	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	125.08	125.08	aetna	epo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	125.08	125.08	aetna	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	125.08	125.08	aetna	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	16.21	16.21	aetna	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	16.21	16.21	aetna	epo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	16.21	16.21	aetna	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	16.21	16.21	aetna	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	85.88	85.88	aetna	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	85.88	85.88	aetna	epo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	85.88	85.88	aetna	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	85.88	85.88	aetna	pos
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	aetna	ppo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	aetna	epo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	aetna	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	aetna	pos
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	519.73	519.73	aetna	ppo
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	519.73	519.73	aetna	epo
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	519.73	519.73	aetna	hmo
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	519.73	519.73	aetna	pos
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	78.23	78.23	aetna	ppo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	78.23	78.23	aetna	epo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	78.23	78.23	aetna	hmo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	78.23	78.23	aetna	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4124.09	4124.09	aetna	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4124.09	4124.09	aetna	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4124.09	4124.09	aetna	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4124.09	4124.09	aetna	pos
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	28.3	28.3	aetna	ppo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	28.3	28.3	aetna	epo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	28.3	28.3	aetna	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	28.3	28.3	aetna	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	aetna	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	aetna	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	aetna	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	aetna	pos
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	60.04	60.04	aetna	ppo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	60.04	60.04	aetna	epo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	60.04	60.04	aetna	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	60.04	60.04	aetna	pos
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	aetna	ppo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	aetna	epo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	aetna	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	aetna	pos
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	133.84	133.84	aetna	ppo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	133.84	133.84	aetna	epo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	133.84	133.84	aetna	hmo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	133.84	133.84	aetna	pos
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	14191.44	14191.44	aetna	ppo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	14191.44	14191.44	aetna	epo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	14191.44	14191.44	aetna	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	14191.44	14191.44	aetna	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	4492.48	4492.48	aetna	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	4492.48	4492.48	aetna	epo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	4492.48	4492.48	aetna	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	4492.48	4492.48	aetna	pos
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	37.53	37.53	aetna	ppo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	37.53	37.53	aetna	epo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	37.53	37.53	aetna	hmo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	37.53	37.53	aetna	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	32.55	32.55	aetna	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	32.55	32.55	aetna	epo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	32.55	32.55	aetna	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	32.55	32.55	aetna	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	14238.66	14238.66	aetna	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	14238.66	14238.66	aetna	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	14238.66	14238.66	aetna	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	14238.66	14238.66	aetna	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	22.24	22.24	aetna	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	22.24	22.24	aetna	epo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	22.24	22.24	aetna	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	22.24	22.24	aetna	pos
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	44.65	44.65	aetna	ppo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	44.65	44.65	aetna	epo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	44.65	44.65	aetna	hmo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	44.65	44.65	aetna	pos
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	1971.24	1971.24	aetna	ppo
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	1971.24	1971.24	aetna	epo
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	1971.24	1971.24	aetna	hmo
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	1971.24	1971.24	aetna	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	aetna	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	aetna	epo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	aetna	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	aetna	pos
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	epo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	174.49	174.49	aetna	pos
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	27.2	27.2	aetna	ppo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	27.2	27.2	aetna	epo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	27.2	27.2	aetna	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	27.2	27.2	aetna	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1772.55	1772.55	aetna	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1772.55	1772.55	aetna	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1772.55	1772.55	aetna	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1772.55	1772.55	aetna	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	412.37	412.37	aetna	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	412.37	412.37	aetna	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	412.37	412.37	aetna	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	412.37	412.37	aetna	pos
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	669.04	669.04	aetna	ppo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	669.04	669.04	aetna	epo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	669.04	669.04	aetna	hmo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	669.04	669.04	aetna	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	40.65	40.65	aetna	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	40.65	40.65	aetna	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	40.65	40.65	aetna	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	40.65	40.65	aetna	pos
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	46.48	46.48	aetna	ppo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	46.48	46.48	aetna	epo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	46.48	46.48	aetna	hmo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	46.48	46.48	aetna	pos
perc d-e cor stent ather s	cpt	C9602	14120.9	14120.9	13993.77	13993.77	113173.32	113173.32	94311.1	94311.1	O	14120.9	14120.9	aetna	ppo
perc d-e cor stent ather s	cpt	C9602	14120.9	14120.9	13993.77	13993.77	113173.32	113173.32	94311.1	94311.1	O	14120.9	14120.9	aetna	epo
perc d-e cor stent ather s	cpt	C9602	14120.9	14120.9	13993.77	13993.77	113173.32	113173.32	94311.1	94311.1	O	14120.9	14120.9	aetna	hmo
perc d-e cor stent ather s	cpt	C9602	14120.9	14120.9	13993.77	13993.77	113173.32	113173.32	94311.1	94311.1	O	14120.9	14120.9	aetna	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	aetna	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	aetna	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	aetna	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	aetna	pos
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	5988.6	5988.6	aetna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	5988.6	5988.6	aetna	epo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	5988.6	5988.6	aetna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	5988.6	5988.6	aetna	pos
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	14238.66	14238.66	aetna	ppo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	14238.66	14238.66	aetna	epo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	14238.66	14238.66	aetna	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	14238.66	14238.66	aetna	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4124.09	4124.09	aetna	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4124.09	4124.09	aetna	epo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4124.09	4124.09	aetna	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4124.09	4124.09	aetna	pos
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	aetna	ppo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	aetna	epo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	aetna	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	aetna	pos
perc drug-el cor stent bran	cpt	C9601	14191.44	14191.44	11308.3	11308.3	114856.13	114856.13	95713.44	95713.44	O	14191.44	14191.44	aetna	ppo
perc drug-el cor stent bran	cpt	C9601	14191.44	14191.44	11308.3	11308.3	114856.13	114856.13	95713.44	95713.44	O	14191.44	14191.44	aetna	epo
perc drug-el cor stent bran	cpt	C9601	14191.44	14191.44	11308.3	11308.3	114856.13	114856.13	95713.44	95713.44	O	14191.44	14191.44	aetna	hmo
perc drug-el cor stent bran	cpt	C9601	14191.44	14191.44	11308.3	11308.3	114856.13	114856.13	95713.44	95713.44	O	14191.44	14191.44	aetna	pos
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	56.81	56.81	aetna	ppo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	56.81	56.81	aetna	epo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	56.81	56.81	aetna	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	56.81	56.81	aetna	pos
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	936.47	936.47	aetna	ppo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	936.47	936.47	aetna	epo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	936.47	936.47	aetna	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	936.47	936.47	aetna	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11154.03	11154.03	aetna medicare advantage	epo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11154.03	11154.03	aetna medicare advantage	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11154.03	11154.03	aetna medicare advantage	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11154.03	11154.03	aetna medicare advantage	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11154.03	11154.03	aetna medicare advantage	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11154.03	11154.03	aetna medicare advantage	hmo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	10523.15	10523.15	aetna medicare advantage	epo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	10523.15	10523.15	aetna medicare advantage	ppo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	10523.15	10523.15	aetna medicare advantage	pos
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	10523.15	10523.15	aetna medicare advantage	pos
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	10523.15	10523.15	aetna medicare advantage	ppo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	10523.15	10523.15	aetna medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	aetna medicare advantage	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	aetna medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	aetna medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	aetna medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	aetna medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	aetna medicare advantage	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	aetna medicare advantage	epo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	aetna medicare advantage	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	aetna medicare advantage	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	aetna medicare advantage	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	aetna medicare advantage	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	aetna medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	aetna medicare advantage	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	aetna medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	aetna medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	aetna medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	aetna medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	aetna medicare advantage	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	112.14	112.14	aetna medicare advantage	epo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	112.14	112.14	aetna medicare advantage	ppo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	112.14	112.14	aetna medicare advantage	pos
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	112.14	112.14	aetna medicare advantage	pos
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	112.14	112.14	aetna medicare advantage	ppo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	112.14	112.14	aetna medicare advantage	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1518.32	1518.32	aetna medicare advantage	epo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1518.32	1518.32	aetna medicare advantage	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1518.32	1518.32	aetna medicare advantage	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1518.32	1518.32	aetna medicare advantage	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1518.32	1518.32	aetna medicare advantage	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1518.32	1518.32	aetna medicare advantage	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	42685.48	42685.48	aetna medicare advantage	epo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	42685.48	42685.48	aetna medicare advantage	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	42685.48	42685.48	aetna medicare advantage	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	42685.48	42685.48	aetna medicare advantage	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	42685.48	42685.48	aetna medicare advantage	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	42685.48	42685.48	aetna medicare advantage	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.45	7.45	aetna medicare advantage	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.45	7.45	aetna medicare advantage	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.45	7.45	aetna medicare advantage	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.45	7.45	aetna medicare advantage	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.45	7.45	aetna medicare advantage	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.45	7.45	aetna medicare advantage	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	epo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	epo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1527.85	1527.85	aetna medicare advantage	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	aetna medicare advantage	epo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	aetna medicare advantage	ppo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	aetna medicare advantage	pos
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	aetna medicare advantage	pos
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	aetna medicare advantage	ppo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	aetna medicare advantage	hmo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6219.34	6219.34	aetna medicare advantage	epo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6219.34	6219.34	aetna medicare advantage	ppo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6219.34	6219.34	aetna medicare advantage	pos
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6219.34	6219.34	aetna medicare advantage	pos
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6219.34	6219.34	aetna medicare advantage	ppo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6219.34	6219.34	aetna medicare advantage	hmo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	21841.06	21841.06	aetna medicare advantage	epo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	21841.06	21841.06	aetna medicare advantage	ppo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	21841.06	21841.06	aetna medicare advantage	pos
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	21841.06	21841.06	aetna medicare advantage	pos
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	21841.06	21841.06	aetna medicare advantage	ppo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	21841.06	21841.06	aetna medicare advantage	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	aetna medicare advantage	epo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	aetna medicare advantage	ppo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	aetna medicare advantage	pos
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	aetna medicare advantage	pos
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	aetna medicare advantage	ppo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	aetna medicare advantage	hmo
skin ulcers with cc	ms-drg	593	7479.51	7479.51	3578.19	3578.19	23167.73	23167.73	19306.44	19306.44	I	7479.51	7479.51	aetna medicare advantage	epo
skin ulcers with cc	ms-drg	593	7479.51	7479.51	3578.19	3578.19	23167.73	23167.73	19306.44	19306.44	I	7479.51	7479.51	aetna medicare advantage	ppo
skin ulcers with cc	ms-drg	593	7479.51	7479.51	3578.19	3578.19	23167.73	23167.73	19306.44	19306.44	I	7479.51	7479.51	aetna medicare advantage	pos
skin ulcers with cc	ms-drg	593	7479.51	7479.51	3578.19	3578.19	23167.73	23167.73	19306.44	19306.44	I	7479.51	7479.51	aetna medicare advantage	pos
skin ulcers with cc	ms-drg	593	7479.51	7479.51	3578.19	3578.19	23167.73	23167.73	19306.44	19306.44	I	7479.51	7479.51	aetna medicare advantage	ppo
skin ulcers with cc	ms-drg	593	7479.51	7479.51	3578.19	3578.19	23167.73	23167.73	19306.44	19306.44	I	7479.51	7479.51	aetna medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	68.9	68.9	aetna medicare advantage	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	68.9	68.9	aetna medicare advantage	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	68.9	68.9	aetna medicare advantage	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	68.9	68.9	aetna medicare advantage	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	68.9	68.9	aetna medicare advantage	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	68.9	68.9	aetna medicare advantage	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	12260.28	12260.28	aetna medicare advantage	epo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	12260.28	12260.28	aetna medicare advantage	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	12260.28	12260.28	aetna medicare advantage	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	12260.28	12260.28	aetna medicare advantage	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	12260.28	12260.28	aetna medicare advantage	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	12260.28	12260.28	aetna medicare advantage	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11728.47	11728.47	aetna medicare advantage	epo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11728.47	11728.47	aetna medicare advantage	ppo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11728.47	11728.47	aetna medicare advantage	pos
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11728.47	11728.47	aetna medicare advantage	pos
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11728.47	11728.47	aetna medicare advantage	ppo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11728.47	11728.47	aetna medicare advantage	hmo
Removal of one knee cartilage using an endoscope	cpt	29881	7460.54	7460.54	2274.34	2274.34	20616.25	20616.25	17180.21	17180.21	O	7460.54	7460.54	bcbs	hmo
Removal of one knee cartilage using an endoscope	cpt	29881	7460.54	7460.54	2274.34	2274.34	20616.25	20616.25	17180.21	17180.21	O	7460.54	7460.54	bcbs	hmo
Removal of one knee cartilage using an endoscope	cpt	29881	7460.54	7460.54	2274.34	2274.34	20616.25	20616.25	17180.21	17180.21	O	7460.54	7460.54	bcbs	pos
Removal of one knee cartilage using an endoscope	cpt	29881	7460.54	7460.54	2274.34	2274.34	20616.25	20616.25	17180.21	17180.21	O	7460.54	7460.54	bcbs	ppo
Removal of one knee cartilage using an endoscope	cpt	29881	7460.54	7460.54	2274.34	2274.34	20616.25	20616.25	17180.21	17180.21	O	7460.54	7460.54	bcbs	epo
Shaving of shoulder bone using an endoscope	cpt	29826	12067.91	12067.91	2425.05	2425.05	31991.54	31991.54	26659.62	26659.62	O	12067.91	12067.91	bcbs	hmo
Shaving of shoulder bone using an endoscope	cpt	29826	12067.91	12067.91	2425.05	2425.05	31991.54	31991.54	26659.62	26659.62	O	12067.91	12067.91	bcbs	hmo
Shaving of shoulder bone using an endoscope	cpt	29826	12067.91	12067.91	2425.05	2425.05	31991.54	31991.54	26659.62	26659.62	O	12067.91	12067.91	bcbs	pos
Shaving of shoulder bone using an endoscope	cpt	29826	12067.91	12067.91	2425.05	2425.05	31991.54	31991.54	26659.62	26659.62	O	12067.91	12067.91	bcbs	ppo
Shaving of shoulder bone using an endoscope	cpt	29826	12067.91	12067.91	2425.05	2425.05	31991.54	31991.54	26659.62	26659.62	O	12067.91	12067.91	bcbs	epo
"Removal of 1 or more breast growth, open procedure"	cpt	19120	3225.81	3225.81	2571.39	2571.39	17570.48	17570.48	14642.07	14642.07	O	3225.81	3225.81	bcbs	hmo
"Removal of 1 or more breast growth, open procedure"	cpt	19120	3225.81	3225.81	2571.39	2571.39	17570.48	17570.48	14642.07	14642.07	O	3225.81	3225.81	bcbs	hmo
"Removal of 1 or more breast growth, open procedure"	cpt	19120	3225.81	3225.81	2571.39	2571.39	17570.48	17570.48	14642.07	14642.07	O	3225.81	3225.81	bcbs	pos
"Removal of 1 or more breast growth, open procedure"	cpt	19120	3225.81	3225.81	2571.39	2571.39	17570.48	17570.48	14642.07	14642.07	O	3225.81	3225.81	bcbs	ppo
"Removal of 1 or more breast growth, open procedure"	cpt	19120	3225.81	3225.81	2571.39	2571.39	17570.48	17570.48	14642.07	14642.07	O	3225.81	3225.81	bcbs	epo
CT scan of upper spine before and after contrast	cpt	72127	350.36	350.36	350.36	350.36	2892.9	2892.9	2410.75	2410.75	O	350.36	350.36	bcbs	hmo
CT scan of upper spine before and after contrast	cpt	72127	350.36	350.36	350.36	350.36	2892.9	2892.9	2410.75	2410.75	O	350.36	350.36	bcbs	hmo
CT scan of upper spine before and after contrast	cpt	72127	350.36	350.36	350.36	350.36	2892.9	2892.9	2410.75	2410.75	O	350.36	350.36	bcbs	pos
CT scan of upper spine before and after contrast	cpt	72127	350.36	350.36	350.36	350.36	2892.9	2892.9	2410.75	2410.75	O	350.36	350.36	bcbs	ppo
CT scan of upper spine before and after contrast	cpt	72127	350.36	350.36	350.36	350.36	2892.9	2892.9	2410.75	2410.75	O	350.36	350.36	bcbs	epo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	301.25	301.25	bcbs	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	301.25	301.25	bcbs	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	301.25	301.25	bcbs	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	301.25	301.25	bcbs	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	301.25	301.25	bcbs	epo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	208.15	208.15	bcbs	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	208.15	208.15	bcbs	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	208.15	208.15	bcbs	pos
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	208.15	208.15	bcbs	ppo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	208.15	208.15	bcbs	epo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	575.85	575.85	bcbs	hmo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	575.85	575.85	bcbs	hmo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	575.85	575.85	bcbs	pos
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	575.85	575.85	bcbs	ppo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	575.85	575.85	bcbs	epo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	197.59	197.59	bcbs	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	197.59	197.59	bcbs	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	197.59	197.59	bcbs	pos
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	197.59	197.59	bcbs	ppo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	197.59	197.59	bcbs	epo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	216.32	216.32	bcbs	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	216.32	216.32	bcbs	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	216.32	216.32	bcbs	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	216.32	216.32	bcbs	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	216.32	216.32	bcbs	epo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	229.19	229.19	bcbs	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	229.19	229.19	bcbs	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	229.19	229.19	bcbs	pos
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	229.19	229.19	bcbs	ppo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	229.19	229.19	bcbs	epo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	301.06	301.06	bcbs	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	301.06	301.06	bcbs	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	301.06	301.06	bcbs	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	301.06	301.06	bcbs	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	301.06	301.06	bcbs	epo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	634.34	634.34	bcbs	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	634.34	634.34	bcbs	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	634.34	634.34	bcbs	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	634.34	634.34	bcbs	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	634.34	634.34	bcbs	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	781.91	781.91	bcbs	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	781.91	781.91	bcbs	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	781.91	781.91	bcbs	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	781.91	781.91	bcbs	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	781.91	781.91	bcbs	epo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	pos
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	ppo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	epo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	pos
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	ppo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	epo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	860.61	860.61	bcbs	hmo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	860.61	860.61	bcbs	hmo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	860.61	860.61	bcbs	pos
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	860.61	860.61	bcbs	ppo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	860.61	860.61	bcbs	epo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	513.66	513.66	bcbs	hmo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	513.66	513.66	bcbs	hmo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	513.66	513.66	bcbs	pos
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	513.66	513.66	bcbs	ppo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	513.66	513.66	bcbs	epo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	pos
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	458.1	458.1	bcbs	epo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	73.01	73.01	bcbs	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	73.01	73.01	bcbs	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	73.01	73.01	bcbs	pos
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	73.01	73.01	bcbs	ppo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	73.01	73.01	bcbs	epo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	324.93	324.93	bcbs	hmo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	324.93	324.93	bcbs	hmo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	324.93	324.93	bcbs	pos
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	324.93	324.93	bcbs	ppo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	324.93	324.93	bcbs	epo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	765.83	765.83	bcbs	hmo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	765.83	765.83	bcbs	hmo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	765.83	765.83	bcbs	pos
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	765.83	765.83	bcbs	ppo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	765.83	765.83	bcbs	epo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	536.32	536.32	bcbs	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	536.32	536.32	bcbs	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	536.32	536.32	bcbs	pos
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	536.32	536.32	bcbs	ppo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	536.32	536.32	bcbs	epo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	419.53	419.53	bcbs	hmo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	419.53	419.53	bcbs	hmo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	419.53	419.53	bcbs	pos
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	419.53	419.53	bcbs	ppo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	419.53	419.53	bcbs	epo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	70.55	70.55	bcbs	hmo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	70.55	70.55	bcbs	hmo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	70.55	70.55	bcbs	pos
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	70.55	70.55	bcbs	ppo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	70.55	70.55	bcbs	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	14.68	14.68	bcbs	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	14.68	14.68	bcbs	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	14.68	14.68	bcbs	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	14.68	14.68	bcbs	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	14.68	14.68	bcbs	epo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	559.23	559.23	bcbs	hmo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	559.23	559.23	bcbs	hmo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	559.23	559.23	bcbs	pos
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	559.23	559.23	bcbs	ppo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	559.23	559.23	bcbs	epo
CT scan of pelvis before and after contrast	cpt	72194	500.98	500.98	500.98	500.98	2173.01	2173.01	1810.84	1810.84	O	500.98	500.98	bcbs	hmo
CT scan of pelvis before and after contrast	cpt	72194	500.98	500.98	500.98	500.98	2173.01	2173.01	1810.84	1810.84	O	500.98	500.98	bcbs	hmo
CT scan of pelvis before and after contrast	cpt	72194	500.98	500.98	500.98	500.98	2173.01	2173.01	1810.84	1810.84	O	500.98	500.98	bcbs	pos
CT scan of pelvis before and after contrast	cpt	72194	500.98	500.98	500.98	500.98	2173.01	2173.01	1810.84	1810.84	O	500.98	500.98	bcbs	ppo
CT scan of pelvis before and after contrast	cpt	72194	500.98	500.98	500.98	500.98	2173.01	2173.01	1810.84	1810.84	O	500.98	500.98	bcbs	epo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1449.9	1449.9	bcbs	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1449.9	1449.9	bcbs	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1449.9	1449.9	bcbs	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1449.9	1449.9	bcbs	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	1449.9	1449.9	bcbs	epo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	868.48	868.48	bcbs	hmo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	868.48	868.48	bcbs	hmo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	868.48	868.48	bcbs	pos
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	868.48	868.48	bcbs	ppo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	868.48	868.48	bcbs	epo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	1644.5	1644.5	bcbs	hmo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	1644.5	1644.5	bcbs	hmo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	1644.5	1644.5	bcbs	pos
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	1644.5	1644.5	bcbs	ppo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	1644.5	1644.5	bcbs	epo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	25.28	25.28	bcbs	hmo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	25.28	25.28	bcbs	hmo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	25.28	25.28	bcbs	pos
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	25.28	25.28	bcbs	ppo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	25.28	25.28	bcbs	epo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	104.38	104.38	18.36	18.36	244.22	244.22	203.52	203.52	O	104.38	104.38	bcbs	hmo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	104.38	104.38	18.36	18.36	244.22	244.22	203.52	203.52	O	104.38	104.38	bcbs	hmo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	104.38	104.38	18.36	18.36	244.22	244.22	203.52	203.52	O	104.38	104.38	bcbs	pos
"X-ray of pelvis, minimum of 2 views"	cpt	72220	104.38	104.38	18.36	18.36	244.22	244.22	203.52	203.52	O	104.38	104.38	bcbs	ppo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	104.38	104.38	18.36	18.36	244.22	244.22	203.52	203.52	O	104.38	104.38	bcbs	epo
X-ray of collar bone	cpt	73000	70.7	70.7	17.46	17.46	272.21	272.21	226.84	226.84	O	52.19	52.19	bcbs	hmo
X-ray of collar bone	cpt	73000	70.7	70.7	17.46	17.46	272.21	272.21	226.84	226.84	O	52.19	52.19	bcbs	hmo
X-ray of collar bone	cpt	73000	70.7	70.7	17.46	17.46	272.21	272.21	226.84	226.84	O	52.19	52.19	bcbs	pos
X-ray of collar bone	cpt	73000	70.7	70.7	17.46	17.46	272.21	272.21	226.84	226.84	O	52.19	52.19	bcbs	ppo
X-ray of collar bone	cpt	73000	70.7	70.7	17.46	17.46	272.21	272.21	226.84	226.84	O	52.19	52.19	bcbs	epo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	3411.24	3411.24	bcbs	hmo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	3411.24	3411.24	bcbs	hmo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	3411.24	3411.24	bcbs	pos
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	3411.24	3411.24	bcbs	ppo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	3411.24	3411.24	bcbs	epo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1686.21	1686.21	bcbs	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1686.21	1686.21	bcbs	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1686.21	1686.21	bcbs	pos
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1686.21	1686.21	bcbs	ppo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1686.21	1686.21	bcbs	epo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1180.35	1180.35	bcbs	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1180.35	1180.35	bcbs	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1180.35	1180.35	bcbs	pos
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1180.35	1180.35	bcbs	ppo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1180.35	1180.35	bcbs	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	85.38	85.38	bcbs	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	85.38	85.38	bcbs	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	85.38	85.38	bcbs	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	85.38	85.38	bcbs	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	85.38	85.38	bcbs	epo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	8816.24	8816.24	bcbs	hmo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	8816.24	8816.24	bcbs	hmo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	8816.24	8816.24	bcbs	pos
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	8816.24	8816.24	bcbs	ppo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	8816.24	8816.24	bcbs	epo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	380.33	380.33	bcbs	hmo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	380.33	380.33	bcbs	hmo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	380.33	380.33	bcbs	pos
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	380.33	380.33	bcbs	ppo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	380.33	380.33	bcbs	epo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	7608.35	7608.35	bcbs	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	7608.35	7608.35	bcbs	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	7608.35	7608.35	bcbs	pos
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	7608.35	7608.35	bcbs	ppo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	7608.35	7608.35	bcbs	epo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	3073.87	3073.87	bcbs	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	3073.87	3073.87	bcbs	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	3073.87	3073.87	bcbs	pos
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	3073.87	3073.87	bcbs	ppo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	3073.87	3073.87	bcbs	epo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	128.03	128.03	bcbs	hmo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	128.03	128.03	bcbs	hmo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	128.03	128.03	bcbs	pos
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	128.03	128.03	bcbs	ppo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	128.03	128.03	bcbs	epo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	1132.77	1132.77	1132.77	1132.77	7804.86	7804.86	6504.05	6504.05	O	1132.77	1132.77	bcbs	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	1132.77	1132.77	1132.77	1132.77	7804.86	7804.86	6504.05	6504.05	O	1132.77	1132.77	bcbs	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	1132.77	1132.77	1132.77	1132.77	7804.86	7804.86	6504.05	6504.05	O	1132.77	1132.77	bcbs	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	1132.77	1132.77	1132.77	1132.77	7804.86	7804.86	6504.05	6504.05	O	1132.77	1132.77	bcbs	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	1132.77	1132.77	1132.77	1132.77	7804.86	7804.86	6504.05	6504.05	O	1132.77	1132.77	bcbs	epo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	141.16	141.16	bcbs	hmo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	141.16	141.16	bcbs	hmo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	141.16	141.16	bcbs	pos
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	141.16	141.16	bcbs	ppo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	141.16	141.16	bcbs	epo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	1405.42	1405.42	bcbs	hmo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	1405.42	1405.42	bcbs	hmo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	1405.42	1405.42	bcbs	pos
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	1405.42	1405.42	bcbs	ppo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	1405.42	1405.42	bcbs	epo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	600.96	600.96	bcbs	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	600.96	600.96	bcbs	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	600.96	600.96	bcbs	pos
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	600.96	600.96	bcbs	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	600.96	600.96	bcbs	epo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	178.54	178.54	bcbs	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	178.54	178.54	bcbs	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	178.54	178.54	bcbs	pos
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	178.54	178.54	bcbs	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	178.54	178.54	bcbs	epo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	487.82	487.82	bcbs	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	487.82	487.82	bcbs	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	487.82	487.82	bcbs	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	487.82	487.82	bcbs	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	487.82	487.82	bcbs	epo
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	266.68	266.68	bcbs	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	266.68	266.68	bcbs	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	266.68	266.68	bcbs	pos
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	266.68	266.68	bcbs	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	266.68	266.68	bcbs	epo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	127.09	127.09	bcbs	hmo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	127.09	127.09	bcbs	hmo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	127.09	127.09	bcbs	pos
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	127.09	127.09	bcbs	ppo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	127.09	127.09	bcbs	epo
"Emergency department visit, self limited or minor problem"	cpt	99281	183.64	183.64	122.43	122.43	209.88	209.88	174.9	174.9	O	183.64	183.64	bcbs	hmo
"Emergency department visit, self limited or minor problem"	cpt	99281	183.64	183.64	122.43	122.43	209.88	209.88	174.9	174.9	O	183.64	183.64	bcbs	hmo
"Emergency department visit, self limited or minor problem"	cpt	99281	183.64	183.64	122.43	122.43	209.88	209.88	174.9	174.9	O	183.64	183.64	bcbs	pos
"Emergency department visit, self limited or minor problem"	cpt	99281	183.64	183.64	122.43	122.43	209.88	209.88	174.9	174.9	O	183.64	183.64	bcbs	ppo
"Emergency department visit, self limited or minor problem"	cpt	99281	183.64	183.64	122.43	122.43	209.88	209.88	174.9	174.9	O	183.64	183.64	bcbs	epo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	353.09	353.09	bcbs	hmo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	353.09	353.09	bcbs	hmo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	353.09	353.09	bcbs	pos
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	353.09	353.09	bcbs	ppo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	353.09	353.09	bcbs	epo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	249.31	249.31	bcbs	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	249.31	249.31	bcbs	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	249.31	249.31	bcbs	pos
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	249.31	249.31	bcbs	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	249.31	249.31	bcbs	epo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	66.73	66.73	bcbs	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	66.73	66.73	bcbs	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	66.73	66.73	bcbs	pos
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	66.73	66.73	bcbs	ppo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	66.73	66.73	bcbs	epo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	34.96	34.96	bcbs	hmo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	34.96	34.96	bcbs	hmo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	34.96	34.96	bcbs	pos
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	34.96	34.96	bcbs	ppo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	34.96	34.96	bcbs	epo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	245.53	245.53	bcbs	hmo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	245.53	245.53	bcbs	hmo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	245.53	245.53	bcbs	pos
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	245.53	245.53	bcbs	ppo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	245.53	245.53	bcbs	epo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	259.15	259.15	bcbs	hmo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	259.15	259.15	bcbs	hmo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	259.15	259.15	bcbs	pos
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	259.15	259.15	bcbs	ppo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	259.15	259.15	bcbs	epo
"New patient office or other outpatient visit, typically 20 minutes"	cpt	99202	452.31	452.31	82.86	82.86	1009.96	1009.96	841.63	841.63	O	452.31	452.31	bcbs	hmo
"New patient office or other outpatient visit, typically 20 minutes"	cpt	99202	452.31	452.31	82.86	82.86	1009.96	1009.96	841.63	841.63	O	452.31	452.31	bcbs	hmo
"New patient office or other outpatient visit, typically 20 minutes"	cpt	99202	452.31	452.31	82.86	82.86	1009.96	1009.96	841.63	841.63	O	452.31	452.31	bcbs	pos
"New patient office or other outpatient visit, typically 20 minutes"	cpt	99202	452.31	452.31	82.86	82.86	1009.96	1009.96	841.63	841.63	O	452.31	452.31	bcbs	ppo
"New patient office or other outpatient visit, typically 20 minutes"	cpt	99202	452.31	452.31	82.86	82.86	1009.96	1009.96	841.63	841.63	O	452.31	452.31	bcbs	epo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2411.79	2411.79	bcbs	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2411.79	2411.79	bcbs	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2411.79	2411.79	bcbs	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2411.79	2411.79	bcbs	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2411.79	2411.79	bcbs	epo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2411.79	2411.79	bcbs	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2411.79	2411.79	bcbs	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2411.79	2411.79	bcbs	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2411.79	2411.79	bcbs	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2411.79	2411.79	bcbs	epo
"Negative pressure wound therapy, surface area greater than 50 square centimeters, per session"	cpt	97606	556.91	556.91	402.19	402.19	3379.6	3379.6	2816.33	2816.33	O	556.91	556.91	bcbs	hmo
"Negative pressure wound therapy, surface area greater than 50 square centimeters, per session"	cpt	97606	556.91	556.91	402.19	402.19	3379.6	3379.6	2816.33	2816.33	O	556.91	556.91	bcbs	hmo
"Negative pressure wound therapy, surface area greater than 50 square centimeters, per session"	cpt	97606	556.91	556.91	402.19	402.19	3379.6	3379.6	2816.33	2816.33	O	556.91	556.91	bcbs	pos
"Negative pressure wound therapy, surface area greater than 50 square centimeters, per session"	cpt	97606	556.91	556.91	402.19	402.19	3379.6	3379.6	2816.33	2816.33	O	556.91	556.91	bcbs	ppo
"Negative pressure wound therapy, surface area greater than 50 square centimeters, per session"	cpt	97606	556.91	556.91	402.19	402.19	3379.6	3379.6	2816.33	2816.33	O	556.91	556.91	bcbs	epo
"Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session"	cpt	97605	7386.83	7386.83	283.05	283.05	1824.05	1824.05	1520.04	1520.04	O	7386.83	7386.83	bcbs	hmo
"Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session"	cpt	97605	7386.83	7386.83	283.05	283.05	1824.05	1824.05	1520.04	1520.04	O	7386.83	7386.83	bcbs	hmo
"Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session"	cpt	97605	7386.83	7386.83	283.05	283.05	1824.05	1824.05	1520.04	1520.04	O	7386.83	7386.83	bcbs	pos
"Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session"	cpt	97605	7386.83	7386.83	283.05	283.05	1824.05	1824.05	1520.04	1520.04	O	7386.83	7386.83	bcbs	ppo
"Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per session"	cpt	97605	7386.83	7386.83	283.05	283.05	1824.05	1824.05	1520.04	1520.04	O	7386.83	7386.83	bcbs	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	81.13	81.13	bcbs	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	81.13	81.13	bcbs	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	81.13	81.13	bcbs	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	81.13	81.13	bcbs	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	81.13	81.13	bcbs	epo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	964.3	964.3	bcbs	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	964.3	964.3	bcbs	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	964.3	964.3	bcbs	pos
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	964.3	964.3	bcbs	ppo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	964.3	964.3	bcbs	epo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	99.93	99.93	bcbs	hmo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	99.93	99.93	bcbs	hmo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	99.93	99.93	bcbs	pos
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	99.93	99.93	bcbs	ppo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	99.93	99.93	bcbs	epo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	1023.86	1023.86	bcbs	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	1023.86	1023.86	bcbs	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	1023.86	1023.86	bcbs	pos
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	1023.86	1023.86	bcbs	ppo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	1023.86	1023.86	bcbs	epo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	411.79	411.79	bcbs	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	411.79	411.79	bcbs	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	411.79	411.79	bcbs	pos
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	411.79	411.79	bcbs	ppo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	411.79	411.79	bcbs	epo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	64.2	64.2	bcbs	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	64.2	64.2	bcbs	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	64.2	64.2	bcbs	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	64.2	64.2	bcbs	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	64.2	64.2	bcbs	epo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	1195.36	1195.36	bcbs	hmo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	1195.36	1195.36	bcbs	hmo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	1195.36	1195.36	bcbs	pos
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	1195.36	1195.36	bcbs	ppo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	1195.36	1195.36	bcbs	epo
CT scan of arm with contrast	cpt	73201	332.86	332.86	272.35	272.35	1507.32	1507.32	1256.1	1256.1	O	272.35	272.35	bcbs	hmo
CT scan of arm with contrast	cpt	73201	332.86	332.86	272.35	272.35	1507.32	1507.32	1256.1	1256.1	O	272.35	272.35	bcbs	hmo
CT scan of arm with contrast	cpt	73201	332.86	332.86	272.35	272.35	1507.32	1507.32	1256.1	1256.1	O	272.35	272.35	bcbs	pos
CT scan of arm with contrast	cpt	73201	332.86	332.86	272.35	272.35	1507.32	1507.32	1256.1	1256.1	O	272.35	272.35	bcbs	ppo
CT scan of arm with contrast	cpt	73201	332.86	332.86	272.35	272.35	1507.32	1507.32	1256.1	1256.1	O	272.35	272.35	bcbs	epo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1017.53	1017.53	bcbs	hmo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1017.53	1017.53	bcbs	hmo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1017.53	1017.53	bcbs	pos
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1017.53	1017.53	bcbs	ppo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1017.53	1017.53	bcbs	epo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	107.4	107.4	bcbs	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	107.4	107.4	bcbs	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	107.4	107.4	bcbs	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	107.4	107.4	bcbs	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	107.4	107.4	bcbs	epo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	167.86	167.86	bcbs	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	167.86	167.86	bcbs	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	167.86	167.86	bcbs	pos
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	167.86	167.86	bcbs	ppo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	167.86	167.86	bcbs	epo
MRI scan of arm before and after contrast	cpt	73220	1199.98	1199.98	332.86	332.86	3107.5	3107.5	2589.58	2589.58	O	1199.98	1199.98	bcbs	hmo
MRI scan of arm before and after contrast	cpt	73220	1199.98	1199.98	332.86	332.86	3107.5	3107.5	2589.58	2589.58	O	1199.98	1199.98	bcbs	hmo
MRI scan of arm before and after contrast	cpt	73220	1199.98	1199.98	332.86	332.86	3107.5	3107.5	2589.58	2589.58	O	1199.98	1199.98	bcbs	pos
MRI scan of arm before and after contrast	cpt	73220	1199.98	1199.98	332.86	332.86	3107.5	3107.5	2589.58	2589.58	O	1199.98	1199.98	bcbs	ppo
MRI scan of arm before and after contrast	cpt	73220	1199.98	1199.98	332.86	332.86	3107.5	3107.5	2589.58	2589.58	O	1199.98	1199.98	bcbs	epo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	3298.14	3298.14	bcbs	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	3298.14	3298.14	bcbs	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	3298.14	3298.14	bcbs	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	3298.14	3298.14	bcbs	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	3298.14	3298.14	bcbs	epo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	517.17	517.17	bcbs	epo
"Self-care or home management training, each 15 minutes"	cpt	97535	680.1	680.1	137.83	137.83	2973.6	2973.6	2478	2478	O	400.83	400.83	bcbs	hmo
"Self-care or home management training, each 15 minutes"	cpt	97535	680.1	680.1	137.83	137.83	2973.6	2973.6	2478	2478	O	400.83	400.83	bcbs	hmo
"Self-care or home management training, each 15 minutes"	cpt	97535	680.1	680.1	137.83	137.83	2973.6	2973.6	2478	2478	O	400.83	400.83	bcbs	pos
"Self-care or home management training, each 15 minutes"	cpt	97535	680.1	680.1	137.83	137.83	2973.6	2973.6	2478	2478	O	400.83	400.83	bcbs	ppo
"Self-care or home management training, each 15 minutes"	cpt	97535	680.1	680.1	137.83	137.83	2973.6	2973.6	2478	2478	O	400.83	400.83	bcbs	epo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	1177.16	1177.16	bcbs	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	1177.16	1177.16	bcbs	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	1177.16	1177.16	bcbs	pos
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	1177.16	1177.16	bcbs	ppo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	1177.16	1177.16	bcbs	epo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	891.88	891.88	bcbs	hmo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	891.88	891.88	bcbs	hmo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	891.88	891.88	bcbs	pos
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	891.88	891.88	bcbs	ppo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	891.88	891.88	bcbs	epo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1692.18	1692.18	bcbs	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1692.18	1692.18	bcbs	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1692.18	1692.18	bcbs	pos
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1692.18	1692.18	bcbs	ppo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	1692.18	1692.18	bcbs	epo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1260.46	1260.46	bcbs	hmo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1260.46	1260.46	bcbs	hmo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1260.46	1260.46	bcbs	pos
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1260.46	1260.46	bcbs	ppo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	1260.46	1260.46	bcbs	epo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	61.44	61.44	bcbs	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	61.44	61.44	bcbs	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	61.44	61.44	bcbs	pos
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	61.44	61.44	bcbs	ppo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	61.44	61.44	bcbs	epo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3531.48	3531.48	bcbs	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3531.48	3531.48	bcbs	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3531.48	3531.48	bcbs	pos
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3531.48	3531.48	bcbs	ppo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3531.48	3531.48	bcbs	epo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	882.87	882.87	bcbs	hmo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	882.87	882.87	bcbs	hmo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	882.87	882.87	bcbs	pos
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	882.87	882.87	bcbs	ppo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	882.87	882.87	bcbs	epo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	2046.31	2046.31	bcbs	hmo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	2046.31	2046.31	bcbs	hmo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	2046.31	2046.31	bcbs	pos
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	2046.31	2046.31	bcbs	ppo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	2046.31	2046.31	bcbs	epo
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	102.22	102.22	bcbs	hmo
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	102.22	102.22	bcbs	hmo
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	102.22	102.22	bcbs	pos
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	102.22	102.22	bcbs	ppo
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	102.22	102.22	bcbs	epo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	1047.49	1047.49	bcbs	hmo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	1047.49	1047.49	bcbs	hmo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	1047.49	1047.49	bcbs	pos
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	1047.49	1047.49	bcbs	ppo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	1047.49	1047.49	bcbs	epo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	1181.4	1181.4	bcbs	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	1181.4	1181.4	bcbs	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	1181.4	1181.4	bcbs	pos
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	1181.4	1181.4	bcbs	ppo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	1181.4	1181.4	bcbs	epo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	epo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	117.36	117.36	bcbs	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	117.36	117.36	bcbs	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	117.36	117.36	bcbs	pos
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	117.36	117.36	bcbs	ppo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	117.36	117.36	bcbs	epo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	8152.79	8152.79	bcbs	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	8152.79	8152.79	bcbs	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	8152.79	8152.79	bcbs	pos
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	8152.79	8152.79	bcbs	ppo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	8152.79	8152.79	bcbs	epo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	97.85	97.85	bcbs	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	97.85	97.85	bcbs	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	97.85	97.85	bcbs	pos
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	97.85	97.85	bcbs	ppo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	97.85	97.85	bcbs	epo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	5901.94	5901.94	bcbs	hmo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	5901.94	5901.94	bcbs	hmo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	5901.94	5901.94	bcbs	pos
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	5901.94	5901.94	bcbs	ppo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	5901.94	5901.94	bcbs	epo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	1629.98	1629.98	bcbs	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	1629.98	1629.98	bcbs	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	1629.98	1629.98	bcbs	pos
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	1629.98	1629.98	bcbs	ppo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	1629.98	1629.98	bcbs	epo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	3867.45	3867.45	bcbs	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	3867.45	3867.45	bcbs	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	3867.45	3867.45	bcbs	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	3867.45	3867.45	bcbs	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	3867.45	3867.45	bcbs	epo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	61.44	61.44	bcbs	hmo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	61.44	61.44	bcbs	hmo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	61.44	61.44	bcbs	pos
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	61.44	61.44	bcbs	ppo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	61.44	61.44	bcbs	epo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	7924.91	7924.91	bcbs	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	7924.91	7924.91	bcbs	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	7924.91	7924.91	bcbs	pos
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	7924.91	7924.91	bcbs	ppo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	7924.91	7924.91	bcbs	epo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	5117.27	5117.27	bcbs	hmo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	5117.27	5117.27	bcbs	hmo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	5117.27	5117.27	bcbs	pos
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	5117.27	5117.27	bcbs	ppo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	5117.27	5117.27	bcbs	epo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	2537.15	2537.15	bcbs	hmo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	2537.15	2537.15	bcbs	hmo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	2537.15	2537.15	bcbs	pos
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	2537.15	2537.15	bcbs	ppo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	2537.15	2537.15	bcbs	epo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2435.76	2435.76	bcbs	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2435.76	2435.76	bcbs	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2435.76	2435.76	bcbs	pos
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2435.76	2435.76	bcbs	ppo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2435.76	2435.76	bcbs	epo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	61.44	61.44	bcbs	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	61.44	61.44	bcbs	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	61.44	61.44	bcbs	pos
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	61.44	61.44	bcbs	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	61.44	61.44	bcbs	epo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	4264.13	4264.13	bcbs	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	4264.13	4264.13	bcbs	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	4264.13	4264.13	bcbs	pos
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	4264.13	4264.13	bcbs	ppo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	4264.13	4264.13	bcbs	epo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	13222.87	13222.87	bcbs	hmo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	13222.87	13222.87	bcbs	hmo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	13222.87	13222.87	bcbs	pos
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	13222.87	13222.87	bcbs	ppo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	13222.87	13222.87	bcbs	epo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	102.67	102.67	bcbs	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	102.67	102.67	bcbs	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	102.67	102.67	bcbs	pos
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	102.67	102.67	bcbs	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	102.67	102.67	bcbs	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	1647.76	1647.76	bcbs	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	1647.76	1647.76	bcbs	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	1647.76	1647.76	bcbs	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	1647.76	1647.76	bcbs	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	1647.76	1647.76	bcbs	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	1781.26	1781.26	bcbs	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	1781.26	1781.26	bcbs	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	1781.26	1781.26	bcbs	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	1781.26	1781.26	bcbs	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	1781.26	1781.26	bcbs	epo
"X-ray of both knees, standing, front to back view"	cpt	73565	61.44	61.44	24.61	24.61	363.79	363.79	303.16	303.16	O	61.44	61.44	bcbs	hmo
"X-ray of both knees, standing, front to back view"	cpt	73565	61.44	61.44	24.61	24.61	363.79	363.79	303.16	303.16	O	61.44	61.44	bcbs	hmo
"X-ray of both knees, standing, front to back view"	cpt	73565	61.44	61.44	24.61	24.61	363.79	363.79	303.16	303.16	O	61.44	61.44	bcbs	pos
"X-ray of both knees, standing, front to back view"	cpt	73565	61.44	61.44	24.61	24.61	363.79	363.79	303.16	303.16	O	61.44	61.44	bcbs	ppo
"X-ray of both knees, standing, front to back view"	cpt	73565	61.44	61.44	24.61	24.61	363.79	363.79	303.16	303.16	O	61.44	61.44	bcbs	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1440.1	1440.1	bcbs	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1440.1	1440.1	bcbs	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1440.1	1440.1	bcbs	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1440.1	1440.1	bcbs	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1440.1	1440.1	bcbs	epo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	197.67	197.67	bcbs	hmo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	197.67	197.67	bcbs	hmo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	197.67	197.67	bcbs	pos
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	197.67	197.67	bcbs	ppo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	197.67	197.67	bcbs	epo
"X-ray of ankle, 2 views"	cpt	73600	70.7	70.7	19.45	19.45	272.21	272.21	226.84	226.84	O	46.08	46.08	bcbs	hmo
"X-ray of ankle, 2 views"	cpt	73600	70.7	70.7	19.45	19.45	272.21	272.21	226.84	226.84	O	46.08	46.08	bcbs	hmo
"X-ray of ankle, 2 views"	cpt	73600	70.7	70.7	19.45	19.45	272.21	272.21	226.84	226.84	O	46.08	46.08	bcbs	pos
"X-ray of ankle, 2 views"	cpt	73600	70.7	70.7	19.45	19.45	272.21	272.21	226.84	226.84	O	46.08	46.08	bcbs	ppo
"X-ray of ankle, 2 views"	cpt	73600	70.7	70.7	19.45	19.45	272.21	272.21	226.84	226.84	O	46.08	46.08	bcbs	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	659.59	659.59	bcbs	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	659.59	659.59	bcbs	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	659.59	659.59	bcbs	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	659.59	659.59	bcbs	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	659.59	659.59	bcbs	epo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	98.4	98.4	bcbs	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	98.4	98.4	bcbs	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	98.4	98.4	bcbs	pos
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	98.4	98.4	bcbs	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	98.4	98.4	bcbs	epo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	2009.92	2009.92	bcbs	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	2009.92	2009.92	bcbs	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	2009.92	2009.92	bcbs	pos
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	2009.92	2009.92	bcbs	ppo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	2009.92	2009.92	bcbs	epo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	41.17	41.17	bcbs	hmo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	41.17	41.17	bcbs	hmo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	41.17	41.17	bcbs	pos
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	41.17	41.17	bcbs	ppo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	41.17	41.17	bcbs	epo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	1366.77	1366.77	bcbs	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	1366.77	1366.77	bcbs	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	1366.77	1366.77	bcbs	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	1366.77	1366.77	bcbs	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	1366.77	1366.77	bcbs	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	588.86	588.86	bcbs	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	588.86	588.86	bcbs	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	588.86	588.86	bcbs	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	588.86	588.86	bcbs	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	588.86	588.86	bcbs	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	61.44	61.44	bcbs	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	61.44	61.44	bcbs	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	61.44	61.44	bcbs	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	61.44	61.44	bcbs	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	61.44	61.44	bcbs	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	1077.64	1077.64	bcbs	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	1077.64	1077.64	bcbs	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	1077.64	1077.64	bcbs	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	1077.64	1077.64	bcbs	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	1077.64	1077.64	bcbs	epo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	1106.07	1106.07	bcbs	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	1106.07	1106.07	bcbs	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	1106.07	1106.07	bcbs	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	1106.07	1106.07	bcbs	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	1106.07	1106.07	bcbs	epo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	61.44	61.44	bcbs	hmo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	61.44	61.44	bcbs	hmo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	61.44	61.44	bcbs	pos
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	61.44	61.44	bcbs	ppo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	61.44	61.44	bcbs	epo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	1179.83	1179.83	bcbs	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	1179.83	1179.83	bcbs	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	1179.83	1179.83	bcbs	pos
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	1179.83	1179.83	bcbs	ppo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	1179.83	1179.83	bcbs	epo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	60.64	60.64	bcbs	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	60.64	60.64	bcbs	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	60.64	60.64	bcbs	pos
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	60.64	60.64	bcbs	ppo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	60.64	60.64	bcbs	epo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1644.5	1644.5	bcbs	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1644.5	1644.5	bcbs	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1644.5	1644.5	bcbs	pos
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1644.5	1644.5	bcbs	ppo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1644.5	1644.5	bcbs	epo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	482.16	482.16	bcbs	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	482.16	482.16	bcbs	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	482.16	482.16	bcbs	pos
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	482.16	482.16	bcbs	ppo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	482.16	482.16	bcbs	epo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	1581.95	1581.95	bcbs	hmo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	1581.95	1581.95	bcbs	hmo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	1581.95	1581.95	bcbs	pos
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	1581.95	1581.95	bcbs	ppo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	1581.95	1581.95	bcbs	epo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	pos
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	ppo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	epo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	919.58	919.58	bcbs	hmo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	919.58	919.58	bcbs	hmo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	919.58	919.58	bcbs	pos
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	919.58	919.58	bcbs	ppo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	919.58	919.58	bcbs	epo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	678.84	678.84	bcbs	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	678.84	678.84	bcbs	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	678.84	678.84	bcbs	pos
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	678.84	678.84	bcbs	ppo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	678.84	678.84	bcbs	epo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	762.39	762.39	bcbs	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	762.39	762.39	bcbs	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	762.39	762.39	bcbs	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	762.39	762.39	bcbs	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	762.39	762.39	bcbs	epo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	294.32	294.32	bcbs	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	294.32	294.32	bcbs	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	294.32	294.32	bcbs	pos
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	294.32	294.32	bcbs	ppo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	294.32	294.32	bcbs	epo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	82.35	82.35	bcbs	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	82.35	82.35	bcbs	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	82.35	82.35	bcbs	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	82.35	82.35	bcbs	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	82.35	82.35	bcbs	epo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	273.8	273.8	bcbs	hmo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	273.8	273.8	bcbs	hmo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	273.8	273.8	bcbs	pos
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	273.8	273.8	bcbs	ppo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	273.8	273.8	bcbs	epo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	epo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	464.59	464.59	bcbs	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	464.59	464.59	bcbs	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	464.59	464.59	bcbs	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	464.59	464.59	bcbs	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	464.59	464.59	bcbs	epo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	61.44	61.44	bcbs	hmo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	61.44	61.44	bcbs	hmo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	61.44	61.44	bcbs	pos
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	61.44	61.44	bcbs	ppo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	61.44	61.44	bcbs	epo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	282.79	282.79	bcbs	hmo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	282.79	282.79	bcbs	hmo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	282.79	282.79	bcbs	pos
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	282.79	282.79	bcbs	ppo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	282.79	282.79	bcbs	epo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	359.62	359.62	bcbs	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	359.62	359.62	bcbs	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	359.62	359.62	bcbs	pos
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	359.62	359.62	bcbs	ppo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	359.62	359.62	bcbs	epo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	37.21	37.21	bcbs	hmo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	37.21	37.21	bcbs	hmo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	37.21	37.21	bcbs	pos
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	37.21	37.21	bcbs	ppo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	37.21	37.21	bcbs	epo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	hmo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	hmo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	pos
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	ppo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	359.62	359.62	bcbs	epo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	592.16	592.16	bcbs	hmo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	592.16	592.16	bcbs	hmo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	592.16	592.16	bcbs	pos
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	592.16	592.16	bcbs	ppo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	592.16	592.16	bcbs	epo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	286.66	286.66	bcbs	hmo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	286.66	286.66	bcbs	hmo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	286.66	286.66	bcbs	pos
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	286.66	286.66	bcbs	ppo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	286.66	286.66	bcbs	epo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	502.02	502.02	bcbs	hmo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	502.02	502.02	bcbs	hmo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	502.02	502.02	bcbs	pos
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	502.02	502.02	bcbs	ppo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	502.02	502.02	bcbs	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	216.32	216.32	bcbs	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	216.32	216.32	bcbs	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	216.32	216.32	bcbs	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	216.32	216.32	bcbs	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	216.32	216.32	bcbs	epo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	861.28	861.28	bcbs	hmo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	861.28	861.28	bcbs	hmo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	861.28	861.28	bcbs	pos
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	861.28	861.28	bcbs	ppo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	861.28	861.28	bcbs	epo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	2071.58	2071.58	bcbs	hmo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	2071.58	2071.58	bcbs	hmo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	2071.58	2071.58	bcbs	pos
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	2071.58	2071.58	bcbs	ppo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	2071.58	2071.58	bcbs	epo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	632.1	632.1	bcbs	hmo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	632.1	632.1	bcbs	hmo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	632.1	632.1	bcbs	pos
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	632.1	632.1	bcbs	ppo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	632.1	632.1	bcbs	epo
Peripheral arterial disease (PAD) rehabilitation per session	cpt	93668	882.84	882.84	389.84	389.84	1271.42	1271.42	1059.52	1059.52	O	882.84	882.84	bcbs	hmo
Peripheral arterial disease (PAD) rehabilitation per session	cpt	93668	882.84	882.84	389.84	389.84	1271.42	1271.42	1059.52	1059.52	O	882.84	882.84	bcbs	hmo
Peripheral arterial disease (PAD) rehabilitation per session	cpt	93668	882.84	882.84	389.84	389.84	1271.42	1271.42	1059.52	1059.52	O	882.84	882.84	bcbs	pos
Peripheral arterial disease (PAD) rehabilitation per session	cpt	93668	882.84	882.84	389.84	389.84	1271.42	1271.42	1059.52	1059.52	O	882.84	882.84	bcbs	ppo
Peripheral arterial disease (PAD) rehabilitation per session	cpt	93668	882.84	882.84	389.84	389.84	1271.42	1271.42	1059.52	1059.52	O	882.84	882.84	bcbs	epo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	286.66	286.66	bcbs	hmo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	286.66	286.66	bcbs	hmo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	286.66	286.66	bcbs	pos
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	286.66	286.66	bcbs	ppo
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	286.66	286.66	bcbs	epo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2405.95	2405.95	bcbs	hmo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2405.95	2405.95	bcbs	hmo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2405.95	2405.95	bcbs	pos
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2405.95	2405.95	bcbs	ppo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2405.95	2405.95	bcbs	epo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	968.88	968.88	bcbs	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	968.88	968.88	bcbs	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	968.88	968.88	bcbs	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	968.88	968.88	bcbs	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	968.88	968.88	bcbs	epo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	8256.27	8256.27	bcbs	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	8256.27	8256.27	bcbs	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	8256.27	8256.27	bcbs	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	8256.27	8256.27	bcbs	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	8256.27	8256.27	bcbs	epo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	514.25	514.25	bcbs	hmo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	514.25	514.25	bcbs	hmo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	514.25	514.25	bcbs	pos
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	514.25	514.25	bcbs	ppo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	514.25	514.25	bcbs	epo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	1612.53	1612.53	bcbs	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	1612.53	1612.53	bcbs	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	1612.53	1612.53	bcbs	pos
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	1612.53	1612.53	bcbs	ppo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	1612.53	1612.53	bcbs	epo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	1825.81	1825.81	bcbs	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	1825.81	1825.81	bcbs	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	1825.81	1825.81	bcbs	pos
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	1825.81	1825.81	bcbs	ppo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	1825.81	1825.81	bcbs	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	514.25	514.25	bcbs	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	514.25	514.25	bcbs	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	514.25	514.25	bcbs	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	514.25	514.25	bcbs	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	514.25	514.25	bcbs	epo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	76.59	76.59	bcbs	hmo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	76.59	76.59	bcbs	hmo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	76.59	76.59	bcbs	pos
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	76.59	76.59	bcbs	ppo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	76.59	76.59	bcbs	epo
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	2589.58	2589.58	bcbs	hmo
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	2589.58	2589.58	bcbs	hmo
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	2589.58	2589.58	bcbs	pos
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	2589.58	2589.58	bcbs	ppo
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	2589.58	2589.58	bcbs	epo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	71.59	71.59	bcbs	hmo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	71.59	71.59	bcbs	hmo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	71.59	71.59	bcbs	pos
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	71.59	71.59	bcbs	ppo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	71.59	71.59	bcbs	epo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	124.38	124.38	bcbs	hmo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	124.38	124.38	bcbs	hmo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	124.38	124.38	bcbs	pos
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	124.38	124.38	bcbs	ppo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	124.38	124.38	bcbs	epo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	117.12	117.12	bcbs	hmo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	117.12	117.12	bcbs	hmo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	117.12	117.12	bcbs	pos
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	117.12	117.12	bcbs	ppo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	117.12	117.12	bcbs	epo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	pos
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	ppo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	epo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	pos
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	ppo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	280.13	280.13	bcbs	epo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	337.93	337.93	bcbs	hmo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	337.93	337.93	bcbs	hmo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	337.93	337.93	bcbs	pos
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	337.93	337.93	bcbs	ppo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	337.93	337.93	bcbs	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1335.61	1335.61	bcbs	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1335.61	1335.61	bcbs	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1335.61	1335.61	bcbs	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1335.61	1335.61	bcbs	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1335.61	1335.61	bcbs	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.78	10.78	bcbs	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.78	10.78	bcbs	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.78	10.78	bcbs	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.78	10.78	bcbs	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.78	10.78	bcbs	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	732.88	732.88	bcbs	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	732.88	732.88	bcbs	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	732.88	732.88	bcbs	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	732.88	732.88	bcbs	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	732.88	732.88	bcbs	epo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	249.81	249.81	bcbs	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	249.81	249.81	bcbs	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	249.81	249.81	bcbs	pos
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	249.81	249.81	bcbs	ppo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	249.81	249.81	bcbs	epo
Follow-through X-ray of upper digestive tract with multiple serial films	cpt	74248	89.7	89.7	39.82	39.82	241.01	241.01	200.84	200.84	O	89.7	89.7	bcbs	hmo
Follow-through X-ray of upper digestive tract with multiple serial films	cpt	74248	89.7	89.7	39.82	39.82	241.01	241.01	200.84	200.84	O	89.7	89.7	bcbs	hmo
Follow-through X-ray of upper digestive tract with multiple serial films	cpt	74248	89.7	89.7	39.82	39.82	241.01	241.01	200.84	200.84	O	89.7	89.7	bcbs	pos
Follow-through X-ray of upper digestive tract with multiple serial films	cpt	74248	89.7	89.7	39.82	39.82	241.01	241.01	200.84	200.84	O	89.7	89.7	bcbs	ppo
Follow-through X-ray of upper digestive tract with multiple serial films	cpt	74248	89.7	89.7	39.82	39.82	241.01	241.01	200.84	200.84	O	89.7	89.7	bcbs	epo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	pos
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	ppo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	294.32	294.32	bcbs	epo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	296.91	296.91	bcbs	hmo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	296.91	296.91	bcbs	hmo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	296.91	296.91	bcbs	pos
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	296.91	296.91	bcbs	ppo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	296.91	296.91	bcbs	epo
X-ray of large bowel with contrast	cpt	74270	360.9	360.9	107.05	107.05	737.76	737.76	614.8	614.8	O	360.9	360.9	bcbs	hmo
X-ray of large bowel with contrast	cpt	74270	360.9	360.9	107.05	107.05	737.76	737.76	614.8	614.8	O	360.9	360.9	bcbs	hmo
X-ray of large bowel with contrast	cpt	74270	360.9	360.9	107.05	107.05	737.76	737.76	614.8	614.8	O	360.9	360.9	bcbs	pos
X-ray of large bowel with contrast	cpt	74270	360.9	360.9	107.05	107.05	737.76	737.76	614.8	614.8	O	360.9	360.9	bcbs	ppo
X-ray of large bowel with contrast	cpt	74270	360.9	360.9	107.05	107.05	737.76	737.76	614.8	614.8	O	360.9	360.9	bcbs	epo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	318.52	318.52	bcbs	hmo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	318.52	318.52	bcbs	hmo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	318.52	318.52	bcbs	pos
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	318.52	318.52	bcbs	ppo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	318.52	318.52	bcbs	epo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	1660.63	1660.63	bcbs	hmo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	1660.63	1660.63	bcbs	hmo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	1660.63	1660.63	bcbs	pos
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	1660.63	1660.63	bcbs	ppo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	1660.63	1660.63	bcbs	epo
Imaging of urinary tract	cpt	74420	176.61	176.61	176.61	176.61	1086.29	1086.29	905.24	905.24	O	176.61	176.61	bcbs	hmo
Imaging of urinary tract	cpt	74420	176.61	176.61	176.61	176.61	1086.29	1086.29	905.24	905.24	O	176.61	176.61	bcbs	hmo
Imaging of urinary tract	cpt	74420	176.61	176.61	176.61	176.61	1086.29	1086.29	905.24	905.24	O	176.61	176.61	bcbs	pos
Imaging of urinary tract	cpt	74420	176.61	176.61	176.61	176.61	1086.29	1086.29	905.24	905.24	O	176.61	176.61	bcbs	ppo
Imaging of urinary tract	cpt	74420	176.61	176.61	176.61	176.61	1086.29	1086.29	905.24	905.24	O	176.61	176.61	bcbs	epo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	bcbs	hmo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	bcbs	hmo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	bcbs	pos
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	bcbs	ppo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	bcbs	epo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	358.77	358.77	bcbs	hmo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	358.77	358.77	bcbs	hmo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	358.77	358.77	bcbs	pos
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	358.77	358.77	bcbs	ppo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	358.77	358.77	bcbs	epo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	304.08	304.08	143.86	143.86	1881.6	1881.6	1568	1568	O	247.67	247.67	bcbs	hmo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	304.08	304.08	143.86	143.86	1881.6	1881.6	1568	1568	O	247.67	247.67	bcbs	hmo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	304.08	304.08	143.86	143.86	1881.6	1881.6	1568	1568	O	247.67	247.67	bcbs	pos
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	304.08	304.08	143.86	143.86	1881.6	1881.6	1568	1568	O	247.67	247.67	bcbs	ppo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	304.08	304.08	143.86	143.86	1881.6	1881.6	1568	1568	O	247.67	247.67	bcbs	epo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	21516.54	21516.54	bcbs	hmo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	21516.54	21516.54	bcbs	hmo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	21516.54	21516.54	bcbs	pos
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	21516.54	21516.54	bcbs	ppo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	21516.54	21516.54	bcbs	epo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2526.65	2526.65	bcbs	hmo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2526.65	2526.65	bcbs	hmo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2526.65	2526.65	bcbs	pos
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2526.65	2526.65	bcbs	ppo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2526.65	2526.65	bcbs	epo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	600.96	600.96	bcbs	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	600.96	600.96	bcbs	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	600.96	600.96	bcbs	pos
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	600.96	600.96	bcbs	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	600.96	600.96	bcbs	epo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	557.59	557.59	bcbs	hmo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	557.59	557.59	bcbs	hmo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	557.59	557.59	bcbs	pos
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	557.59	557.59	bcbs	ppo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	557.59	557.59	bcbs	epo
Radiological supervision and interpretation of imaging of artery of one arm or leg	cpt	75710	2455.02	2455.02	831.17	831.17	3573.05	3573.05	2977.54	2977.54	O	831.17	831.17	bcbs	hmo
Radiological supervision and interpretation of imaging of artery of one arm or leg	cpt	75710	2455.02	2455.02	831.17	831.17	3573.05	3573.05	2977.54	2977.54	O	831.17	831.17	bcbs	hmo
Radiological supervision and interpretation of imaging of artery of one arm or leg	cpt	75710	2455.02	2455.02	831.17	831.17	3573.05	3573.05	2977.54	2977.54	O	831.17	831.17	bcbs	pos
Radiological supervision and interpretation of imaging of artery of one arm or leg	cpt	75710	2455.02	2455.02	831.17	831.17	3573.05	3573.05	2977.54	2977.54	O	831.17	831.17	bcbs	ppo
Radiological supervision and interpretation of imaging of artery of one arm or leg	cpt	75710	2455.02	2455.02	831.17	831.17	3573.05	3573.05	2977.54	2977.54	O	831.17	831.17	bcbs	epo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	1105.41	1105.41	bcbs	hmo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	1105.41	1105.41	bcbs	hmo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	1105.41	1105.41	bcbs	pos
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	1105.41	1105.41	bcbs	ppo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	1105.41	1105.41	bcbs	epo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	216.32	216.32	bcbs	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	216.32	216.32	bcbs	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	216.32	216.32	bcbs	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	216.32	216.32	bcbs	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	216.32	216.32	bcbs	epo
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	600.96	600.96	bcbs	hmo
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	600.96	600.96	bcbs	hmo
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	600.96	600.96	bcbs	pos
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	600.96	600.96	bcbs	ppo
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	600.96	600.96	bcbs	epo
"Semen evaluation volume, sperm count, motility and analysis"	cpt	89320	127.99	127.99	12.36	12.36	146.28	146.28	121.9	121.9	O	127.99	127.99	bcbs	hmo
"Semen evaluation volume, sperm count, motility and analysis"	cpt	89320	127.99	127.99	12.36	12.36	146.28	146.28	121.9	121.9	O	127.99	127.99	bcbs	hmo
"Semen evaluation volume, sperm count, motility and analysis"	cpt	89320	127.99	127.99	12.36	12.36	146.28	146.28	121.9	121.9	O	127.99	127.99	bcbs	pos
"Semen evaluation volume, sperm count, motility and analysis"	cpt	89320	127.99	127.99	12.36	12.36	146.28	146.28	121.9	121.9	O	127.99	127.99	bcbs	ppo
"Semen evaluation volume, sperm count, motility and analysis"	cpt	89320	127.99	127.99	12.36	12.36	146.28	146.28	121.9	121.9	O	127.99	127.99	bcbs	epo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	18.24	18.24	bcbs	hmo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	18.24	18.24	bcbs	hmo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	18.24	18.24	bcbs	pos
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	18.24	18.24	bcbs	ppo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	18.24	18.24	bcbs	epo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	19.36	19.36	bcbs	hmo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	19.36	19.36	bcbs	hmo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	19.36	19.36	bcbs	pos
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	19.36	19.36	bcbs	ppo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	19.36	19.36	bcbs	epo
Ultrasound of chest	cpt	76604	282.79	282.79	282.79	282.79	625.82	625.82	521.52	521.52	O	282.79	282.79	bcbs	hmo
Ultrasound of chest	cpt	76604	282.79	282.79	282.79	282.79	625.82	625.82	521.52	521.52	O	282.79	282.79	bcbs	hmo
Ultrasound of chest	cpt	76604	282.79	282.79	282.79	282.79	625.82	625.82	521.52	521.52	O	282.79	282.79	bcbs	pos
Ultrasound of chest	cpt	76604	282.79	282.79	282.79	282.79	625.82	625.82	521.52	521.52	O	282.79	282.79	bcbs	ppo
Ultrasound of chest	cpt	76604	282.79	282.79	282.79	282.79	625.82	625.82	521.52	521.52	O	282.79	282.79	bcbs	epo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	216.32	216.32	bcbs	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	216.32	216.32	bcbs	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	216.32	216.32	bcbs	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	216.32	216.32	bcbs	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	216.32	216.32	bcbs	epo
"Microscopic genetic analysis of tumor, using computer-assisted technology"	cpt	88361	106.81	106.81	62.77	62.77	321.82	321.82	268.18	268.18	O	106.81	106.81	bcbs	hmo
"Microscopic genetic analysis of tumor, using computer-assisted technology"	cpt	88361	106.81	106.81	62.77	62.77	321.82	321.82	268.18	268.18	O	106.81	106.81	bcbs	hmo
"Microscopic genetic analysis of tumor, using computer-assisted technology"	cpt	88361	106.81	106.81	62.77	62.77	321.82	321.82	268.18	268.18	O	106.81	106.81	bcbs	pos
"Microscopic genetic analysis of tumor, using computer-assisted technology"	cpt	88361	106.81	106.81	62.77	62.77	321.82	321.82	268.18	268.18	O	106.81	106.81	bcbs	ppo
"Microscopic genetic analysis of tumor, using computer-assisted technology"	cpt	88361	106.81	106.81	62.77	62.77	321.82	321.82	268.18	268.18	O	106.81	106.81	bcbs	epo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	142.58	142.58	bcbs	hmo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	142.58	142.58	bcbs	hmo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	142.58	142.58	bcbs	pos
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	142.58	142.58	bcbs	ppo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	142.58	142.58	bcbs	epo
"Special stained specimen slides to examine tissue, each additional procedure"	cpt	88341	53.59	53.59	17.97	17.97	134.83	134.83	112.36	112.36	O	17.97	17.97	bcbs	hmo
"Special stained specimen slides to examine tissue, each additional procedure"	cpt	88341	53.59	53.59	17.97	17.97	134.83	134.83	112.36	112.36	O	17.97	17.97	bcbs	hmo
"Special stained specimen slides to examine tissue, each additional procedure"	cpt	88341	53.59	53.59	17.97	17.97	134.83	134.83	112.36	112.36	O	17.97	17.97	bcbs	pos
"Special stained specimen slides to examine tissue, each additional procedure"	cpt	88341	53.59	53.59	17.97	17.97	134.83	134.83	112.36	112.36	O	17.97	17.97	bcbs	ppo
"Special stained specimen slides to examine tissue, each additional procedure"	cpt	88341	53.59	53.59	17.97	17.97	134.83	134.83	112.36	112.36	O	17.97	17.97	bcbs	epo
"Pathology cytologic examination of specimen during surgery, initial site"	cpt	88333	556.51	556.51	21.76	21.76	179.35	179.35	149.46	149.46	O	23.46	23.46	bcbs	hmo
"Pathology cytologic examination of specimen during surgery, initial site"	cpt	88333	556.51	556.51	21.76	21.76	179.35	179.35	149.46	149.46	O	23.46	23.46	bcbs	hmo
"Pathology cytologic examination of specimen during surgery, initial site"	cpt	88333	556.51	556.51	21.76	21.76	179.35	179.35	149.46	149.46	O	23.46	23.46	bcbs	pos
"Pathology cytologic examination of specimen during surgery, initial site"	cpt	88333	556.51	556.51	21.76	21.76	179.35	179.35	149.46	149.46	O	23.46	23.46	bcbs	ppo
"Pathology cytologic examination of specimen during surgery, initial site"	cpt	88333	556.51	556.51	21.76	21.76	179.35	179.35	149.46	149.46	O	23.46	23.46	bcbs	epo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	32.89	32.89	bcbs	hmo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	32.89	32.89	bcbs	hmo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	32.89	32.89	bcbs	pos
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	32.89	32.89	bcbs	ppo
Special stained specimen slides to examine tissue including interpretation and report	cpt	88313	63.17	63.17	32.89	32.89	128.47	128.47	107.06	107.06	O	32.89	32.89	bcbs	epo
Special stained specimen slides to identify organisms including interpretation and report	cpt	88312	57.24	57.24	16.85	16.85	68.69	68.69	57.24	57.24	O	16.85	16.85	bcbs	hmo
Special stained specimen slides to identify organisms including interpretation and report	cpt	88312	57.24	57.24	16.85	16.85	68.69	68.69	57.24	57.24	O	16.85	16.85	bcbs	hmo
Special stained specimen slides to identify organisms including interpretation and report	cpt	88312	57.24	57.24	16.85	16.85	68.69	68.69	57.24	57.24	O	16.85	16.85	bcbs	pos
Special stained specimen slides to identify organisms including interpretation and report	cpt	88312	57.24	57.24	16.85	16.85	68.69	68.69	57.24	57.24	O	16.85	16.85	bcbs	ppo
Special stained specimen slides to identify organisms including interpretation and report	cpt	88312	57.24	57.24	16.85	16.85	68.69	68.69	57.24	57.24	O	16.85	16.85	bcbs	epo
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	15.58	15.58	bcbs	hmo
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	15.58	15.58	bcbs	hmo
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	15.58	15.58	bcbs	pos
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	15.58	15.58	bcbs	ppo
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	15.58	15.58	bcbs	epo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	60.63	60.63	bcbs	hmo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	60.63	60.63	bcbs	hmo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	60.63	60.63	bcbs	pos
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	60.63	60.63	bcbs	ppo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	60.63	60.63	bcbs	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	216.32	216.32	bcbs	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	216.32	216.32	bcbs	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	216.32	216.32	bcbs	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	216.32	216.32	bcbs	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	216.32	216.32	bcbs	epo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	88.25	88.25	bcbs	hmo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	88.25	88.25	bcbs	hmo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	88.25	88.25	bcbs	pos
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	88.25	88.25	bcbs	ppo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	88.25	88.25	bcbs	epo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	56.53	56.53	bcbs	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	56.53	56.53	bcbs	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	56.53	56.53	bcbs	pos
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	56.53	56.53	bcbs	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	56.53	56.53	bcbs	epo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	216.32	216.32	bcbs	hmo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	216.32	216.32	bcbs	hmo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	216.32	216.32	bcbs	pos
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	216.32	216.32	bcbs	ppo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	216.32	216.32	bcbs	epo
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	30.28	30.28	bcbs	hmo
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	30.28	30.28	bcbs	hmo
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	30.28	30.28	bcbs	pos
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	30.28	30.28	bcbs	ppo
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	30.28	30.28	bcbs	epo
"Pathology examination of tissue using a microscope, limited examination"	cpt	88300	36.94	36.94	9.46	9.46	100.49	100.49	83.74	83.74	O	36.94	36.94	bcbs	hmo
"Pathology examination of tissue using a microscope, limited examination"	cpt	88300	36.94	36.94	9.46	9.46	100.49	100.49	83.74	83.74	O	36.94	36.94	bcbs	hmo
"Pathology examination of tissue using a microscope, limited examination"	cpt	88300	36.94	36.94	9.46	9.46	100.49	100.49	83.74	83.74	O	36.94	36.94	bcbs	pos
"Pathology examination of tissue using a microscope, limited examination"	cpt	88300	36.94	36.94	9.46	9.46	100.49	100.49	83.74	83.74	O	36.94	36.94	bcbs	ppo
"Pathology examination of tissue using a microscope, limited examination"	cpt	88300	36.94	36.94	9.46	9.46	100.49	100.49	83.74	83.74	O	36.94	36.94	bcbs	epo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	26.39	26.39	bcbs	hmo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	26.39	26.39	bcbs	hmo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	26.39	26.39	bcbs	pos
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	26.39	26.39	bcbs	ppo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	26.39	26.39	bcbs	epo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	216.32	216.32	bcbs	hmo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	216.32	216.32	bcbs	hmo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	216.32	216.32	bcbs	pos
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	216.32	216.32	bcbs	ppo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	216.32	216.32	bcbs	epo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.45	58.45	bcbs	hmo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.45	58.45	bcbs	hmo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.45	58.45	bcbs	pos
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.45	58.45	bcbs	ppo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	58.45	58.45	bcbs	epo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	221.85	221.85	bcbs	hmo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	221.85	221.85	bcbs	hmo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	221.85	221.85	bcbs	pos
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	221.85	221.85	bcbs	ppo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	221.85	221.85	bcbs	epo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	229.19	229.19	bcbs	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	229.19	229.19	bcbs	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	229.19	229.19	bcbs	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	229.19	229.19	bcbs	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	229.19	229.19	bcbs	epo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	22.87	22.87	bcbs	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	22.87	22.87	bcbs	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	22.87	22.87	bcbs	pos
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	22.87	22.87	bcbs	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	22.87	22.87	bcbs	epo
"Cell examination of specimen, concentration technique"	cpt	88108	111.15	111.15	29.38	29.38	226.42	226.42	188.68	188.68	O	111.15	111.15	bcbs	hmo
"Cell examination of specimen, concentration technique"	cpt	88108	111.15	111.15	29.38	29.38	226.42	226.42	188.68	188.68	O	111.15	111.15	bcbs	hmo
"Cell examination of specimen, concentration technique"	cpt	88108	111.15	111.15	29.38	29.38	226.42	226.42	188.68	188.68	O	111.15	111.15	bcbs	pos
"Cell examination of specimen, concentration technique"	cpt	88108	111.15	111.15	29.38	29.38	226.42	226.42	188.68	188.68	O	111.15	111.15	bcbs	ppo
"Cell examination of specimen, concentration technique"	cpt	88108	111.15	111.15	29.38	29.38	226.42	226.42	188.68	188.68	O	111.15	111.15	bcbs	epo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	73.57	73.57	bcbs	hmo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	73.57	73.57	bcbs	hmo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	73.57	73.57	bcbs	pos
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	73.57	73.57	bcbs	ppo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	73.57	73.57	bcbs	epo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)	cpt	76802	84.12	84.12	18.34	18.34	132.29	132.29	110.24	110.24	O	84.12	84.12	bcbs	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)	cpt	76802	84.12	84.12	18.34	18.34	132.29	132.29	110.24	110.24	O	84.12	84.12	bcbs	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)	cpt	76802	84.12	84.12	18.34	18.34	132.29	132.29	110.24	110.24	O	84.12	84.12	bcbs	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)	cpt	76802	84.12	84.12	18.34	18.34	132.29	132.29	110.24	110.24	O	84.12	84.12	bcbs	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days)	cpt	76802	84.12	84.12	18.34	18.34	132.29	132.29	110.24	110.24	O	84.12	84.12	bcbs	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	36.77	36.77	bcbs	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	36.77	36.77	bcbs	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	36.77	36.77	bcbs	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	36.77	36.77	bcbs	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	36.77	36.77	bcbs	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	28.91	28.91	bcbs	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	28.91	28.91	bcbs	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	28.91	28.91	bcbs	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	28.91	28.91	bcbs	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	28.91	28.91	bcbs	epo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	160.06	160.06	bcbs	hmo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	160.06	160.06	bcbs	hmo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	160.06	160.06	bcbs	pos
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	160.06	160.06	bcbs	ppo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	160.06	160.06	bcbs	epo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	60.01	60.01	bcbs	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	60.01	60.01	bcbs	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	60.01	60.01	bcbs	pos
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	60.01	60.01	bcbs	ppo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	60.01	60.01	bcbs	epo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	79.43	79.43	bcbs	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	79.43	79.43	bcbs	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	79.43	79.43	bcbs	pos
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	79.43	79.43	bcbs	ppo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	79.43	79.43	bcbs	epo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	194.63	194.63	bcbs	hmo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	194.63	194.63	bcbs	hmo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	194.63	194.63	bcbs	pos
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	194.63	194.63	bcbs	ppo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	194.63	194.63	bcbs	epo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	26.28	26.28	bcbs	hmo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	26.28	26.28	bcbs	hmo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	26.28	26.28	bcbs	pos
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	26.28	26.28	bcbs	ppo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	26.28	26.28	bcbs	epo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	68.65	68.65	bcbs	hmo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	68.65	68.65	bcbs	hmo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	68.65	68.65	bcbs	pos
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	68.65	68.65	bcbs	ppo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	68.65	68.65	bcbs	epo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	28.45	28.45	bcbs	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	28.45	28.45	bcbs	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	28.45	28.45	bcbs	pos
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	28.45	28.45	bcbs	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	28.45	28.45	bcbs	epo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	149.81	149.81	bcbs	hmo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	149.81	149.81	bcbs	hmo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	149.81	149.81	bcbs	pos
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	149.81	149.81	bcbs	ppo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	149.81	149.81	bcbs	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	epo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	170.26	170.26	bcbs	hmo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	170.26	170.26	bcbs	hmo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	170.26	170.26	bcbs	pos
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	170.26	170.26	bcbs	ppo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	170.26	170.26	bcbs	epo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	489.72	489.72	bcbs	hmo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	489.72	489.72	bcbs	hmo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	489.72	489.72	bcbs	pos
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	489.72	489.72	bcbs	ppo
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	489.72	489.72	bcbs	epo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	29.68	29.68	bcbs	hmo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	29.68	29.68	bcbs	hmo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	29.68	29.68	bcbs	pos
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	29.68	29.68	bcbs	ppo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	29.68	29.68	bcbs	epo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	50.36	50.36	bcbs	hmo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	50.36	50.36	bcbs	hmo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	50.36	50.36	bcbs	pos
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	50.36	50.36	bcbs	ppo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	50.36	50.36	bcbs	epo
"Detection test by nucleic acid for Hepatitis B virus, quantification"	cpt	87517	63.64	63.64	38.11	38.11	208.8	208.8	174	174	O	63.64	63.64	bcbs	hmo
"Detection test by nucleic acid for Hepatitis B virus, quantification"	cpt	87517	63.64	63.64	38.11	38.11	208.8	208.8	174	174	O	63.64	63.64	bcbs	hmo
"Detection test by nucleic acid for Hepatitis B virus, quantification"	cpt	87517	63.64	63.64	38.11	38.11	208.8	208.8	174	174	O	63.64	63.64	bcbs	pos
"Detection test by nucleic acid for Hepatitis B virus, quantification"	cpt	87517	63.64	63.64	38.11	38.11	208.8	208.8	174	174	O	63.64	63.64	bcbs	ppo
"Detection test by nucleic acid for Hepatitis B virus, quantification"	cpt	87517	63.64	63.64	38.11	38.11	208.8	208.8	174	174	O	63.64	63.64	bcbs	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	epo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	282.79	282.79	bcbs	hmo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	282.79	282.79	bcbs	hmo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	282.79	282.79	bcbs	pos
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	282.79	282.79	bcbs	ppo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	282.79	282.79	bcbs	epo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	44.91	44.91	bcbs	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	44.91	44.91	bcbs	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	44.91	44.91	bcbs	pos
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	44.91	44.91	bcbs	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	44.91	44.91	bcbs	epo
Partial ultrasound of joint or other non-blood vessel structure of arm or leg	cpt	76882	216.32	216.32	27.68	27.68	255.85	255.85	213.21	213.21	O	216.32	216.32	bcbs	hmo
Partial ultrasound of joint or other non-blood vessel structure of arm or leg	cpt	76882	216.32	216.32	27.68	27.68	255.85	255.85	213.21	213.21	O	216.32	216.32	bcbs	hmo
Partial ultrasound of joint or other non-blood vessel structure of arm or leg	cpt	76882	216.32	216.32	27.68	27.68	255.85	255.85	213.21	213.21	O	216.32	216.32	bcbs	pos
Partial ultrasound of joint or other non-blood vessel structure of arm or leg	cpt	76882	216.32	216.32	27.68	27.68	255.85	255.85	213.21	213.21	O	216.32	216.32	bcbs	ppo
Partial ultrasound of joint or other non-blood vessel structure of arm or leg	cpt	76882	216.32	216.32	27.68	27.68	255.85	255.85	213.21	213.21	O	216.32	216.32	bcbs	epo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	207.4	207.4	bcbs	hmo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	207.4	207.4	bcbs	hmo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	207.4	207.4	bcbs	pos
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	207.4	207.4	bcbs	ppo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	207.4	207.4	bcbs	epo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	bcbs	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	bcbs	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	bcbs	pos
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	bcbs	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	116.32	116.32	bcbs	epo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	216.32	216.32	bcbs	hmo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	216.32	216.32	bcbs	hmo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	216.32	216.32	bcbs	pos
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	216.32	216.32	bcbs	ppo
Ultrasound procedure	cpt	76999	216.32	216.32	70.7	70.7	256.94	256.94	214.12	214.12	O	216.32	216.32	bcbs	epo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	208.53	208.53	bcbs	hmo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	208.53	208.53	bcbs	hmo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	208.53	208.53	bcbs	pos
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	208.53	208.53	bcbs	ppo
"Fluoroscopic guidance for insertion, replacement or removal of central venous access device"	cpt	77001	424.02	424.02	208.53	208.53	862.42	862.42	718.68	718.68	O	208.53	208.53	bcbs	epo
Fluoroscopic guidance for insertion of needle	cpt	77002	470.47	470.47	470.47	470.47	1854.58	1854.58	1545.48	1545.48	O	470.47	470.47	bcbs	hmo
Fluoroscopic guidance for insertion of needle	cpt	77002	470.47	470.47	470.47	470.47	1854.58	1854.58	1545.48	1545.48	O	470.47	470.47	bcbs	hmo
Fluoroscopic guidance for insertion of needle	cpt	77002	470.47	470.47	470.47	470.47	1854.58	1854.58	1545.48	1545.48	O	470.47	470.47	bcbs	pos
Fluoroscopic guidance for insertion of needle	cpt	77002	470.47	470.47	470.47	470.47	1854.58	1854.58	1545.48	1545.48	O	470.47	470.47	bcbs	ppo
Fluoroscopic guidance for insertion of needle	cpt	77002	470.47	470.47	470.47	470.47	1854.58	1854.58	1545.48	1545.48	O	470.47	470.47	bcbs	epo
MRI of both breasts with and without contrast	cpt	77049	871.56	871.56	244.47	244.47	3246.14	3246.14	2705.12	2705.12	O	871.56	871.56	bcbs	hmo
MRI of both breasts with and without contrast	cpt	77049	871.56	871.56	244.47	244.47	3246.14	3246.14	2705.12	2705.12	O	871.56	871.56	bcbs	hmo
MRI of both breasts with and without contrast	cpt	77049	871.56	871.56	244.47	244.47	3246.14	3246.14	2705.12	2705.12	O	871.56	871.56	bcbs	pos
MRI of both breasts with and without contrast	cpt	77049	871.56	871.56	244.47	244.47	3246.14	3246.14	2705.12	2705.12	O	871.56	871.56	bcbs	ppo
MRI of both breasts with and without contrast	cpt	77049	871.56	871.56	244.47	244.47	3246.14	3246.14	2705.12	2705.12	O	871.56	871.56	bcbs	epo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	167.23	167.23	bcbs	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	167.23	167.23	bcbs	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	167.23	167.23	bcbs	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	167.23	167.23	bcbs	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	167.23	167.23	bcbs	epo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	13.82	13.82	bcbs	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	13.82	13.82	bcbs	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	13.82	13.82	bcbs	pos
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	13.82	13.82	bcbs	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	13.82	13.82	bcbs	epo
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	40043.51	40043.51	bcbs	hmo
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	40043.51	40043.51	bcbs	hmo
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	40043.51	40043.51	bcbs	pos
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	40043.51	40043.51	bcbs	ppo
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	40043.51	40043.51	bcbs	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	38.7	38.7	bcbs	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	27.18	27.18	bcbs	epo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	61.44	61.44	bcbs	hmo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	61.44	61.44	bcbs	hmo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	61.44	61.44	bcbs	pos
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	61.44	61.44	bcbs	ppo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	61.44	61.44	bcbs	epo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	pos
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	ppo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	epo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	106.95	106.95	bcbs	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	106.95	106.95	bcbs	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	106.95	106.95	bcbs	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	106.95	106.95	bcbs	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	106.95	106.95	bcbs	epo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	15.73	15.73	bcbs	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	15.73	15.73	bcbs	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	15.73	15.73	bcbs	pos
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	15.73	15.73	bcbs	ppo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	15.73	15.73	bcbs	epo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.51	10.51	bcbs	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.51	10.51	bcbs	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.51	10.51	bcbs	pos
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.51	10.51	bcbs	ppo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.51	10.51	bcbs	epo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	24.45	24.45	bcbs	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	24.45	24.45	bcbs	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	24.45	24.45	bcbs	pos
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	24.45	24.45	bcbs	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	24.45	24.45	bcbs	epo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	588.1	588.1	bcbs	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	588.1	588.1	bcbs	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	588.1	588.1	bcbs	pos
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	588.1	588.1	bcbs	ppo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	588.1	588.1	bcbs	epo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	113.27	113.27	bcbs	hmo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	113.27	113.27	bcbs	hmo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	113.27	113.27	bcbs	pos
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	113.27	113.27	bcbs	ppo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	113.27	113.27	bcbs	epo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1016.1	1016.1	bcbs	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1016.1	1016.1	bcbs	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1016.1	1016.1	bcbs	pos
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1016.1	1016.1	bcbs	ppo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1016.1	1016.1	bcbs	epo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	pos
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	ppo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	10.43	10.43	bcbs	epo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	59.47	59.47	bcbs	hmo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	59.47	59.47	bcbs	hmo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	59.47	59.47	bcbs	pos
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	59.47	59.47	bcbs	ppo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	59.47	59.47	bcbs	epo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1003.61	1003.61	bcbs	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1003.61	1003.61	bcbs	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1003.61	1003.61	bcbs	pos
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1003.61	1003.61	bcbs	ppo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1003.61	1003.61	bcbs	epo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	20.63	20.63	bcbs	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	20.63	20.63	bcbs	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	20.63	20.63	bcbs	pos
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	20.63	20.63	bcbs	ppo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	20.63	20.63	bcbs	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	10.56	10.56	bcbs	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	10.56	10.56	bcbs	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	10.56	10.56	bcbs	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	10.56	10.56	bcbs	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	10.56	10.56	bcbs	epo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	143.46	143.46	bcbs	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	143.46	143.46	bcbs	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	143.46	143.46	bcbs	pos
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	143.46	143.46	bcbs	ppo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	143.46	143.46	bcbs	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	7.8	7.8	bcbs	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	7.8	7.8	bcbs	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	7.8	7.8	bcbs	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	7.8	7.8	bcbs	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	7.8	7.8	bcbs	epo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	16.24	16.24	bcbs	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	16.24	16.24	bcbs	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	16.24	16.24	bcbs	pos
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	16.24	16.24	bcbs	ppo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	16.24	16.24	bcbs	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	7.27	7.27	bcbs	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	7.27	7.27	bcbs	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	7.27	7.27	bcbs	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	7.27	7.27	bcbs	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	7.27	7.27	bcbs	epo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1262.13	1262.13	bcbs	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1262.13	1262.13	bcbs	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1262.13	1262.13	bcbs	pos
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1262.13	1262.13	bcbs	ppo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1262.13	1262.13	bcbs	epo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	15.25	15.25	bcbs	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	15.25	15.25	bcbs	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	15.25	15.25	bcbs	pos
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	15.25	15.25	bcbs	ppo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	15.25	15.25	bcbs	epo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	264.62	264.62	bcbs	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	264.62	264.62	bcbs	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	264.62	264.62	bcbs	pos
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	264.62	264.62	bcbs	ppo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	264.62	264.62	bcbs	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	21.32	21.32	bcbs	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	21.32	21.32	bcbs	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	21.32	21.32	bcbs	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	21.32	21.32	bcbs	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	21.32	21.32	bcbs	epo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	bcbs	hmo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	bcbs	hmo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	bcbs	pos
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	bcbs	ppo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	bcbs	epo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	11.68	11.68	bcbs	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	11.68	11.68	bcbs	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	11.68	11.68	bcbs	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	11.68	11.68	bcbs	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	11.68	11.68	bcbs	epo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	20.43	20.43	bcbs	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	20.43	20.43	bcbs	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	20.43	20.43	bcbs	pos
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	20.43	20.43	bcbs	ppo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	20.43	20.43	bcbs	epo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	318.89	318.89	bcbs	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	318.89	318.89	bcbs	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	318.89	318.89	bcbs	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	318.89	318.89	bcbs	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	318.89	318.89	bcbs	epo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	14.94	14.94	bcbs	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	14.94	14.94	bcbs	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	14.94	14.94	bcbs	pos
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	14.94	14.94	bcbs	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	14.94	14.94	bcbs	epo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	188.32	188.32	bcbs	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	188.32	188.32	bcbs	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	188.32	188.32	bcbs	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	188.32	188.32	bcbs	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	188.32	188.32	bcbs	epo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.14	9.14	bcbs	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.14	9.14	bcbs	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.14	9.14	bcbs	pos
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.14	9.14	bcbs	ppo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.14	9.14	bcbs	epo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	13.91	13.91	bcbs	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	13.91	13.91	bcbs	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	13.91	13.91	bcbs	pos
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	13.91	13.91	bcbs	ppo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	13.91	13.91	bcbs	epo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	47.62	47.62	bcbs	hmo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	47.62	47.62	bcbs	hmo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	47.62	47.62	bcbs	pos
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	47.62	47.62	bcbs	ppo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	47.62	47.62	bcbs	epo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	308.14	308.14	bcbs	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	308.14	308.14	bcbs	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	308.14	308.14	bcbs	pos
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	308.14	308.14	bcbs	ppo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	308.14	308.14	bcbs	epo
"Blood unit compatibility test, antiglobulin technique"	cpt	86922	62.47	62.47	42.14	42.14	320.54	320.54	267.12	267.12	O	62.47	62.47	bcbs	hmo
"Blood unit compatibility test, antiglobulin technique"	cpt	86922	62.47	62.47	42.14	42.14	320.54	320.54	267.12	267.12	O	62.47	62.47	bcbs	hmo
"Blood unit compatibility test, antiglobulin technique"	cpt	86922	62.47	62.47	42.14	42.14	320.54	320.54	267.12	267.12	O	62.47	62.47	bcbs	pos
"Blood unit compatibility test, antiglobulin technique"	cpt	86922	62.47	62.47	42.14	42.14	320.54	320.54	267.12	267.12	O	62.47	62.47	bcbs	ppo
"Blood unit compatibility test, antiglobulin technique"	cpt	86922	62.47	62.47	42.14	42.14	320.54	320.54	267.12	267.12	O	62.47	62.47	bcbs	epo
"Blood unit compatibility test, incubation technique"	cpt	86921	36.44	36.44	18.72	18.72	82.68	82.68	68.9	68.9	O	36.44	36.44	bcbs	hmo
"Blood unit compatibility test, incubation technique"	cpt	86921	36.44	36.44	18.72	18.72	82.68	82.68	68.9	68.9	O	36.44	36.44	bcbs	hmo
"Blood unit compatibility test, incubation technique"	cpt	86921	36.44	36.44	18.72	18.72	82.68	82.68	68.9	68.9	O	36.44	36.44	bcbs	pos
"Blood unit compatibility test, incubation technique"	cpt	86921	36.44	36.44	18.72	18.72	82.68	82.68	68.9	68.9	O	36.44	36.44	bcbs	ppo
"Blood unit compatibility test, incubation technique"	cpt	86921	36.44	36.44	18.72	18.72	82.68	82.68	68.9	68.9	O	36.44	36.44	bcbs	epo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	231.69	231.69	bcbs	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	231.69	231.69	bcbs	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	231.69	231.69	bcbs	pos
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	231.69	231.69	bcbs	ppo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	231.69	231.69	bcbs	epo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	717.88	717.88	bcbs	hmo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	717.88	717.88	bcbs	hmo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	717.88	717.88	bcbs	pos
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	717.88	717.88	bcbs	ppo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	717.88	717.88	bcbs	epo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	493.14	493.14	bcbs	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	493.14	493.14	bcbs	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	493.14	493.14	bcbs	pos
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	493.14	493.14	bcbs	ppo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	493.14	493.14	bcbs	epo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.11	13.11	bcbs	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.11	13.11	bcbs	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.11	13.11	bcbs	pos
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.11	13.11	bcbs	ppo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.11	13.11	bcbs	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.76	19.76	bcbs	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.76	19.76	bcbs	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.76	19.76	bcbs	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.76	19.76	bcbs	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.76	19.76	bcbs	epo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	155.94	155.94	bcbs	hmo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	155.94	155.94	bcbs	hmo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	155.94	155.94	bcbs	pos
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	155.94	155.94	bcbs	ppo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	155.94	155.94	bcbs	epo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	45.6	45.6	bcbs	hmo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	45.6	45.6	bcbs	hmo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	45.6	45.6	bcbs	pos
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	45.6	45.6	bcbs	ppo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	45.6	45.6	bcbs	epo
Identification of red blood cell antibodies	cpt	86870	251.07	251.07	23.42	23.42	310.8	310.8	259	259	O	62.53	62.53	bcbs	hmo
Identification of red blood cell antibodies	cpt	86870	251.07	251.07	23.42	23.42	310.8	310.8	259	259	O	62.53	62.53	bcbs	hmo
Identification of red blood cell antibodies	cpt	86870	251.07	251.07	23.42	23.42	310.8	310.8	259	259	O	62.53	62.53	bcbs	pos
Identification of red blood cell antibodies	cpt	86870	251.07	251.07	23.42	23.42	310.8	310.8	259	259	O	62.53	62.53	bcbs	ppo
Identification of red blood cell antibodies	cpt	86870	251.07	251.07	23.42	23.42	310.8	310.8	259	259	O	62.53	62.53	bcbs	epo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	14.68	14.68	bcbs	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	14.68	14.68	bcbs	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	14.68	14.68	bcbs	pos
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	14.68	14.68	bcbs	ppo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	14.68	14.68	bcbs	epo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	660.29	660.29	bcbs	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	660.29	660.29	bcbs	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	660.29	660.29	bcbs	pos
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	660.29	660.29	bcbs	ppo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	660.29	660.29	bcbs	epo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	17.59	17.59	bcbs	hmo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	17.59	17.59	bcbs	hmo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	17.59	17.59	bcbs	pos
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	17.59	17.59	bcbs	ppo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	17.59	17.59	bcbs	epo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.53	26.53	bcbs	hmo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.53	26.53	bcbs	hmo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.53	26.53	bcbs	pos
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.53	26.53	bcbs	ppo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.53	26.53	bcbs	epo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	21.21	21.21	bcbs	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	21.21	21.21	bcbs	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	21.21	21.21	bcbs	pos
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	21.21	21.21	bcbs	ppo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	21.21	21.21	bcbs	epo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.85	15.85	bcbs	hmo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.85	15.85	bcbs	hmo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.85	15.85	bcbs	pos
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.85	15.85	bcbs	ppo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.85	15.85	bcbs	epo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	7.94	7.94	bcbs	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	7.94	7.94	bcbs	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	7.94	7.94	bcbs	pos
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	7.94	7.94	bcbs	ppo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	7.94	7.94	bcbs	epo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	757.43	757.43	bcbs	hmo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	757.43	757.43	bcbs	hmo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	757.43	757.43	bcbs	pos
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	757.43	757.43	bcbs	ppo
Thyroid imaging with vascular flow	cpt	78014	757.43	757.43	273.97	273.97	1326.7	1326.7	1105.58	1105.58	O	757.43	757.43	bcbs	epo
Imaging of lymphatic tissue and lymph node	cpt	78195	368.89	368.89	368.89	368.89	2732.4	2732.4	2277	2277	O	368.89	368.89	bcbs	hmo
Imaging of lymphatic tissue and lymph node	cpt	78195	368.89	368.89	368.89	368.89	2732.4	2732.4	2277	2277	O	368.89	368.89	bcbs	hmo
Imaging of lymphatic tissue and lymph node	cpt	78195	368.89	368.89	368.89	368.89	2732.4	2732.4	2277	2277	O	368.89	368.89	bcbs	pos
Imaging of lymphatic tissue and lymph node	cpt	78195	368.89	368.89	368.89	368.89	2732.4	2732.4	2277	2277	O	368.89	368.89	bcbs	ppo
Imaging of lymphatic tissue and lymph node	cpt	78195	368.89	368.89	368.89	368.89	2732.4	2732.4	2277	2277	O	368.89	368.89	bcbs	epo
"Analysis for antibody, Treponema pallidum"	cpt	86780	42.59	42.59	11.78	11.78	357.43	357.43	297.86	297.86	O	42.59	42.59	bcbs	hmo
"Analysis for antibody, Treponema pallidum"	cpt	86780	42.59	42.59	11.78	11.78	357.43	357.43	297.86	297.86	O	42.59	42.59	bcbs	hmo
"Analysis for antibody, Treponema pallidum"	cpt	86780	42.59	42.59	11.78	11.78	357.43	357.43	297.86	297.86	O	42.59	42.59	bcbs	pos
"Analysis for antibody, Treponema pallidum"	cpt	86780	42.59	42.59	11.78	11.78	357.43	357.43	297.86	297.86	O	42.59	42.59	bcbs	ppo
"Analysis for antibody, Treponema pallidum"	cpt	86780	42.59	42.59	11.78	11.78	357.43	357.43	297.86	297.86	O	42.59	42.59	bcbs	epo
Analysis for antibody (IgM) to Toxoplasma (parasite)	cpt	86778	14.12	14.12	14.06	14.06	164.09	164.09	136.74	136.74	O	14.06	14.06	bcbs	hmo
Analysis for antibody (IgM) to Toxoplasma (parasite)	cpt	86778	14.12	14.12	14.06	14.06	164.09	164.09	136.74	136.74	O	14.06	14.06	bcbs	hmo
Analysis for antibody (IgM) to Toxoplasma (parasite)	cpt	86778	14.12	14.12	14.06	14.06	164.09	164.09	136.74	136.74	O	14.06	14.06	bcbs	pos
Analysis for antibody (IgM) to Toxoplasma (parasite)	cpt	86778	14.12	14.12	14.06	14.06	164.09	164.09	136.74	136.74	O	14.06	14.06	bcbs	ppo
Analysis for antibody (IgM) to Toxoplasma (parasite)	cpt	86778	14.12	14.12	14.06	14.06	164.09	164.09	136.74	136.74	O	14.06	14.06	bcbs	epo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	890.61	890.61	bcbs	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	890.61	890.61	bcbs	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	890.61	890.61	bcbs	pos
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	890.61	890.61	bcbs	ppo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	890.61	890.61	bcbs	epo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	13.81	13.81	bcbs	hmo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	13.81	13.81	bcbs	hmo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	13.81	13.81	bcbs	pos
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	13.81	13.81	bcbs	ppo
Analysis for antibody to Toxoplasma (parasite)	cpt	86777	83.27	83.27	13.81	13.81	164.09	164.09	136.74	136.74	O	13.81	13.81	bcbs	epo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	522.98	522.98	bcbs	hmo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	522.98	522.98	bcbs	hmo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	522.98	522.98	bcbs	pos
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	522.98	522.98	bcbs	ppo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	522.98	522.98	bcbs	epo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	676.94	676.94	bcbs	hmo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	676.94	676.94	bcbs	hmo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	676.94	676.94	bcbs	pos
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	676.94	676.94	bcbs	ppo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	676.94	676.94	bcbs	epo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	17.41	17.41	bcbs	hmo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	17.41	17.41	bcbs	hmo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	17.41	17.41	bcbs	pos
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	17.41	17.41	bcbs	ppo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	17.41	17.41	bcbs	epo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	6.66	6.66	bcbs	hmo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	6.66	6.66	bcbs	hmo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	6.66	6.66	bcbs	pos
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	6.66	6.66	bcbs	ppo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	6.66	6.66	bcbs	epo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	20.99	20.99	bcbs	hmo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	20.99	20.99	bcbs	hmo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	20.99	20.99	bcbs	pos
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	20.99	20.99	bcbs	ppo
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	20.99	20.99	bcbs	epo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	36305.41	36305.41	bcbs	hmo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	36305.41	36305.41	bcbs	hmo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	36305.41	36305.41	bcbs	pos
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	36305.41	36305.41	bcbs	ppo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	36305.41	36305.41	bcbs	epo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	16.72	16.72	bcbs	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	16.72	16.72	bcbs	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	16.72	16.72	bcbs	pos
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	16.72	16.72	bcbs	ppo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	16.72	16.72	bcbs	epo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	23.03	23.03	bcbs	hmo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	23.03	23.03	bcbs	hmo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	23.03	23.03	bcbs	pos
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	23.03	23.03	bcbs	ppo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	23.03	23.03	bcbs	epo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	23.8	23.8	bcbs	hmo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	23.8	23.8	bcbs	hmo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	23.8	23.8	bcbs	pos
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	23.8	23.8	bcbs	ppo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	23.8	23.8	bcbs	epo
Analysis for antibody to histoplasma (fungus)	cpt	86698	22.57	22.57	13.66	13.66	228	228	190	190	O	22.57	22.57	bcbs	hmo
Analysis for antibody to histoplasma (fungus)	cpt	86698	22.57	22.57	13.66	13.66	228	228	190	190	O	22.57	22.57	bcbs	hmo
Analysis for antibody to histoplasma (fungus)	cpt	86698	22.57	22.57	13.66	13.66	228	228	190	190	O	22.57	22.57	bcbs	pos
Analysis for antibody to histoplasma (fungus)	cpt	86698	22.57	22.57	13.66	13.66	228	228	190	190	O	22.57	22.57	bcbs	ppo
Analysis for antibody to histoplasma (fungus)	cpt	86698	22.57	22.57	13.66	13.66	228	228	190	190	O	22.57	22.57	bcbs	epo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	25.1	25.1	bcbs	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	25.1	25.1	bcbs	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	25.1	25.1	bcbs	pos
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	25.1	25.1	bcbs	ppo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	25.1	25.1	bcbs	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	995.51	995.51	bcbs	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	995.51	995.51	bcbs	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	995.51	995.51	bcbs	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	995.51	995.51	bcbs	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	995.51	995.51	bcbs	epo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	17.83	17.83	bcbs	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	17.83	17.83	bcbs	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	17.83	17.83	bcbs	pos
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	17.83	17.83	bcbs	ppo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	17.83	17.83	bcbs	epo
Analysis for antibody (IgM) to Cytomegalovirus (CMV)	cpt	86645	21.06	21.06	14.99	14.99	77.59	77.59	64.66	64.66	O	21.06	21.06	bcbs	hmo
Analysis for antibody (IgM) to Cytomegalovirus (CMV)	cpt	86645	21.06	21.06	14.99	14.99	77.59	77.59	64.66	64.66	O	21.06	21.06	bcbs	hmo
Analysis for antibody (IgM) to Cytomegalovirus (CMV)	cpt	86645	21.06	21.06	14.99	14.99	77.59	77.59	64.66	64.66	O	21.06	21.06	bcbs	pos
Analysis for antibody (IgM) to Cytomegalovirus (CMV)	cpt	86645	21.06	21.06	14.99	14.99	77.59	77.59	64.66	64.66	O	21.06	21.06	bcbs	ppo
Analysis for antibody (IgM) to Cytomegalovirus (CMV)	cpt	86645	21.06	21.06	14.99	14.99	77.59	77.59	64.66	64.66	O	21.06	21.06	bcbs	epo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	23.13	23.13	bcbs	hmo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	23.13	23.13	bcbs	hmo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	23.13	23.13	bcbs	pos
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	23.13	23.13	bcbs	ppo
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	23.13	23.13	bcbs	epo
Analysis for antibody to Coccidioides (bacteria)	cpt	86635	13.84	13.84	11.36	11.36	100.49	100.49	83.74	83.74	O	13.84	13.84	bcbs	hmo
Analysis for antibody to Coccidioides (bacteria)	cpt	86635	13.84	13.84	11.36	11.36	100.49	100.49	83.74	83.74	O	13.84	13.84	bcbs	hmo
Analysis for antibody to Coccidioides (bacteria)	cpt	86635	13.84	13.84	11.36	11.36	100.49	100.49	83.74	83.74	O	13.84	13.84	bcbs	pos
Analysis for antibody to Coccidioides (bacteria)	cpt	86635	13.84	13.84	11.36	11.36	100.49	100.49	83.74	83.74	O	13.84	13.84	bcbs	ppo
Analysis for antibody to Coccidioides (bacteria)	cpt	86635	13.84	13.84	11.36	11.36	100.49	100.49	83.74	83.74	O	13.84	13.84	bcbs	epo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	44.5	44.5	bcbs	hmo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	44.5	44.5	bcbs	hmo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	44.5	44.5	bcbs	pos
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	44.5	44.5	bcbs	ppo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	44.5	44.5	bcbs	epo
Analysis for antibody to blastomyces (fungus)	cpt	86612	12.77	12.77	5.08	5.08	94.8	94.8	79	79	O	5.08	5.08	bcbs	hmo
Analysis for antibody to blastomyces (fungus)	cpt	86612	12.77	12.77	5.08	5.08	94.8	94.8	79	79	O	5.08	5.08	bcbs	hmo
Analysis for antibody to blastomyces (fungus)	cpt	86612	12.77	12.77	5.08	5.08	94.8	94.8	79	79	O	5.08	5.08	bcbs	pos
Analysis for antibody to blastomyces (fungus)	cpt	86612	12.77	12.77	5.08	5.08	94.8	94.8	79	79	O	5.08	5.08	bcbs	ppo
Analysis for antibody to blastomyces (fungus)	cpt	86612	12.77	12.77	5.08	5.08	94.8	94.8	79	79	O	5.08	5.08	bcbs	epo
Analysis for antibody bacteria	cpt	86609	13.9	13.9	13.9	13.9	38.64	38.64	32.2	32.2	O	13.9	13.9	bcbs	hmo
Analysis for antibody bacteria	cpt	86609	13.9	13.9	13.9	13.9	38.64	38.64	32.2	32.2	O	13.9	13.9	bcbs	hmo
Analysis for antibody bacteria	cpt	86609	13.9	13.9	13.9	13.9	38.64	38.64	32.2	32.2	O	13.9	13.9	bcbs	pos
Analysis for antibody bacteria	cpt	86609	13.9	13.9	13.9	13.9	38.64	38.64	32.2	32.2	O	13.9	13.9	bcbs	ppo
Analysis for antibody bacteria	cpt	86609	13.9	13.9	13.9	13.9	38.64	38.64	32.2	32.2	O	13.9	13.9	bcbs	epo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	2549.99	2549.99	bcbs	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	2549.99	2549.99	bcbs	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	2549.99	2549.99	bcbs	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	2549.99	2549.99	bcbs	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	2549.99	2549.99	bcbs	epo
Nuclear medicine study with CT imaging whole body	cpt	78816	2822.36	2822.36	1257.95	1257.95	8147.16	8147.16	6789.3	6789.3	O	2822.36	2822.36	bcbs	hmo
Nuclear medicine study with CT imaging whole body	cpt	78816	2822.36	2822.36	1257.95	1257.95	8147.16	8147.16	6789.3	6789.3	O	2822.36	2822.36	bcbs	hmo
Nuclear medicine study with CT imaging whole body	cpt	78816	2822.36	2822.36	1257.95	1257.95	8147.16	8147.16	6789.3	6789.3	O	2822.36	2822.36	bcbs	pos
Nuclear medicine study with CT imaging whole body	cpt	78816	2822.36	2822.36	1257.95	1257.95	8147.16	8147.16	6789.3	6789.3	O	2822.36	2822.36	bcbs	ppo
Nuclear medicine study with CT imaging whole body	cpt	78816	2822.36	2822.36	1257.95	1257.95	8147.16	8147.16	6789.3	6789.3	O	2822.36	2822.36	bcbs	epo
Analysis for antibody to aspergillus (fungus)	cpt	86606	16.25	16.25	16.25	16.25	102	102	85	85	O	16.25	16.25	bcbs	hmo
Analysis for antibody to aspergillus (fungus)	cpt	86606	16.25	16.25	16.25	16.25	102	102	85	85	O	16.25	16.25	bcbs	hmo
Analysis for antibody to aspergillus (fungus)	cpt	86606	16.25	16.25	16.25	16.25	102	102	85	85	O	16.25	16.25	bcbs	pos
Analysis for antibody to aspergillus (fungus)	cpt	86606	16.25	16.25	16.25	16.25	102	102	85	85	O	16.25	16.25	bcbs	ppo
Analysis for antibody to aspergillus (fungus)	cpt	86606	16.25	16.25	16.25	16.25	102	102	85	85	O	16.25	16.25	bcbs	epo
Oral administration of radioactive material therapy agent	cpt	79005	494.33	494.33	42.5	42.5	2750.06	2750.06	2291.72	2291.72	O	494.33	494.33	bcbs	hmo
Oral administration of radioactive material therapy agent	cpt	79005	494.33	494.33	42.5	42.5	2750.06	2750.06	2291.72	2291.72	O	494.33	494.33	bcbs	hmo
Oral administration of radioactive material therapy agent	cpt	79005	494.33	494.33	42.5	42.5	2750.06	2750.06	2291.72	2291.72	O	494.33	494.33	bcbs	pos
Oral administration of radioactive material therapy agent	cpt	79005	494.33	494.33	42.5	42.5	2750.06	2750.06	2291.72	2291.72	O	494.33	494.33	bcbs	ppo
Oral administration of radioactive material therapy agent	cpt	79005	494.33	494.33	42.5	42.5	2750.06	2750.06	2291.72	2291.72	O	494.33	494.33	bcbs	epo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	6	6	bcbs	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	6	6	bcbs	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	6	6	bcbs	pos
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	6	6	bcbs	ppo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	6	6	bcbs	epo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	33.45	33.45	bcbs	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	33.45	33.45	bcbs	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	33.45	33.45	bcbs	pos
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	33.45	33.45	bcbs	ppo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	33.45	33.45	bcbs	epo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	47.79	47.79	bcbs	hmo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	47.79	47.79	bcbs	hmo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	47.79	47.79	bcbs	pos
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	47.79	47.79	bcbs	ppo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	47.79	47.79	bcbs	epo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	30.33	30.33	bcbs	hmo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	30.33	30.33	bcbs	hmo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	30.33	30.33	bcbs	pos
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	30.33	30.33	bcbs	ppo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	30.33	30.33	bcbs	epo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.91	6.91	bcbs	hmo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.91	6.91	bcbs	hmo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.91	6.91	bcbs	pos
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.91	6.91	bcbs	ppo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.91	6.91	bcbs	epo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	5.66	5.66	bcbs	hmo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	5.66	5.66	bcbs	hmo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	5.66	5.66	bcbs	pos
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	5.66	5.66	bcbs	ppo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	5.66	5.66	bcbs	epo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.56	14.56	bcbs	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.56	14.56	bcbs	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.56	14.56	bcbs	pos
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.56	14.56	bcbs	ppo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.56	14.56	bcbs	epo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	31.4	31.4	bcbs	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	31.4	31.4	bcbs	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	31.4	31.4	bcbs	pos
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	31.4	31.4	bcbs	ppo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	31.4	31.4	bcbs	epo
Islet cell (pancreas) antibody measurement	cpt	86341	24.9	24.9	20.97	20.97	150.1	150.1	125.08	125.08	O	24.9	24.9	bcbs	hmo
Islet cell (pancreas) antibody measurement	cpt	86341	24.9	24.9	20.97	20.97	150.1	150.1	125.08	125.08	O	24.9	24.9	bcbs	hmo
Islet cell (pancreas) antibody measurement	cpt	86341	24.9	24.9	20.97	20.97	150.1	150.1	125.08	125.08	O	24.9	24.9	bcbs	pos
Islet cell (pancreas) antibody measurement	cpt	86341	24.9	24.9	20.97	20.97	150.1	150.1	125.08	125.08	O	24.9	24.9	bcbs	ppo
Islet cell (pancreas) antibody measurement	cpt	86341	24.9	24.9	20.97	20.97	150.1	150.1	125.08	125.08	O	24.9	24.9	bcbs	epo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	21.05	21.05	bcbs	hmo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	21.05	21.05	bcbs	hmo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	21.05	21.05	bcbs	pos
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	21.05	21.05	bcbs	ppo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	21.05	21.05	bcbs	epo
Immunologic analysis for detection of antigen or antibody	cpt	86331	12.93	12.93	12.93	12.93	35.94	35.94	29.95	29.95	O	12.93	12.93	bcbs	hmo
Immunologic analysis for detection of antigen or antibody	cpt	86331	12.93	12.93	12.93	12.93	35.94	35.94	29.95	29.95	O	12.93	12.93	bcbs	hmo
Immunologic analysis for detection of antigen or antibody	cpt	86331	12.93	12.93	12.93	12.93	35.94	35.94	29.95	29.95	O	12.93	12.93	bcbs	pos
Immunologic analysis for detection of antigen or antibody	cpt	86331	12.93	12.93	12.93	12.93	35.94	35.94	29.95	29.95	O	12.93	12.93	bcbs	ppo
Immunologic analysis for detection of antigen or antibody	cpt	86331	12.93	12.93	12.93	12.93	35.94	35.94	29.95	29.95	O	12.93	12.93	bcbs	epo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	15.53	15.53	bcbs	hmo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	15.53	15.53	bcbs	hmo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	15.53	15.53	bcbs	pos
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	15.53	15.53	bcbs	ppo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	15.53	15.53	bcbs	epo
"Detection of infectious agent antibody, quantitative"	cpt	86317	14.99	14.99	9.85	9.85	160.27	160.27	133.56	133.56	O	9.85	9.85	bcbs	hmo
"Detection of infectious agent antibody, quantitative"	cpt	86317	14.99	14.99	9.85	9.85	160.27	160.27	133.56	133.56	O	9.85	9.85	bcbs	hmo
"Detection of infectious agent antibody, quantitative"	cpt	86317	14.99	14.99	9.85	9.85	160.27	160.27	133.56	133.56	O	9.85	9.85	bcbs	pos
"Detection of infectious agent antibody, quantitative"	cpt	86317	14.99	14.99	9.85	9.85	160.27	160.27	133.56	133.56	O	9.85	9.85	bcbs	ppo
"Detection of infectious agent antibody, quantitative"	cpt	86317	14.99	14.99	9.85	9.85	160.27	160.27	133.56	133.56	O	9.85	9.85	bcbs	epo
Screening test for mononucleosis (mono)	cpt	86308	21.25	21.25	4.61	4.61	44.52	44.52	37.1	37.1	O	21.25	21.25	bcbs	hmo
Screening test for mononucleosis (mono)	cpt	86308	21.25	21.25	4.61	4.61	44.52	44.52	37.1	37.1	O	21.25	21.25	bcbs	hmo
Screening test for mononucleosis (mono)	cpt	86308	21.25	21.25	4.61	4.61	44.52	44.52	37.1	37.1	O	21.25	21.25	bcbs	pos
Screening test for mononucleosis (mono)	cpt	86308	21.25	21.25	4.61	4.61	44.52	44.52	37.1	37.1	O	21.25	21.25	bcbs	ppo
Screening test for mononucleosis (mono)	cpt	86308	21.25	21.25	4.61	4.61	44.52	44.52	37.1	37.1	O	21.25	21.25	bcbs	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	43.28	43.28	bcbs	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	43.28	43.28	bcbs	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	43.28	43.28	bcbs	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	43.28	43.28	bcbs	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	43.28	43.28	bcbs	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	79.34	79.34	bcbs	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	79.34	79.34	bcbs	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	79.34	79.34	bcbs	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	79.34	79.34	bcbs	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	79.34	79.34	bcbs	epo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	47.79	47.79	bcbs	hmo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	47.79	47.79	bcbs	hmo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	47.79	47.79	bcbs	pos
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	47.79	47.79	bcbs	ppo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	47.79	47.79	bcbs	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	77.89	77.89	bcbs	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	77.89	77.89	bcbs	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	77.89	77.89	bcbs	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	77.89	77.89	bcbs	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	77.89	77.89	bcbs	epo
Screening test for antibody to noninfectious agent	cpt	86255	12.1	12.1	8.25	8.25	94.8	94.8	79	79	O	8.25	8.25	bcbs	hmo
Screening test for antibody to noninfectious agent	cpt	86255	12.1	12.1	8.25	8.25	94.8	94.8	79	79	O	8.25	8.25	bcbs	hmo
Screening test for antibody to noninfectious agent	cpt	86255	12.1	12.1	8.25	8.25	94.8	94.8	79	79	O	8.25	8.25	bcbs	pos
Screening test for antibody to noninfectious agent	cpt	86255	12.1	12.1	8.25	8.25	94.8	94.8	79	79	O	8.25	8.25	bcbs	ppo
Screening test for antibody to noninfectious agent	cpt	86255	12.1	12.1	8.25	8.25	94.8	94.8	79	79	O	8.25	8.25	bcbs	epo
Phenobarbital level	cpt	80184	17.41	17.41	13.61	13.61	109.26	109.26	91.05	91.05	O	17.41	17.41	bcbs	hmo
Phenobarbital level	cpt	80184	17.41	17.41	13.61	13.61	109.26	109.26	91.05	91.05	O	17.41	17.41	bcbs	hmo
Phenobarbital level	cpt	80184	17.41	17.41	13.61	13.61	109.26	109.26	91.05	91.05	O	17.41	17.41	bcbs	pos
Phenobarbital level	cpt	80184	17.41	17.41	13.61	13.61	109.26	109.26	91.05	91.05	O	17.41	17.41	bcbs	ppo
Phenobarbital level	cpt	80184	17.41	17.41	13.61	13.61	109.26	109.26	91.05	91.05	O	17.41	17.41	bcbs	epo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	8.28	8.28	bcbs	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	8.28	8.28	bcbs	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	8.28	8.28	bcbs	pos
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	8.28	8.28	bcbs	ppo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	8.28	8.28	bcbs	epo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	150.25	150.25	bcbs	hmo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	150.25	150.25	bcbs	hmo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	150.25	150.25	bcbs	pos
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	150.25	150.25	bcbs	ppo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	150.25	150.25	bcbs	epo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	38.68	38.68	bcbs	hmo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	38.68	38.68	bcbs	hmo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	38.68	38.68	bcbs	pos
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	38.68	38.68	bcbs	ppo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	38.68	38.68	bcbs	epo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	39.93	39.93	bcbs	hmo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	39.93	39.93	bcbs	hmo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	39.93	39.93	bcbs	pos
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	39.93	39.93	bcbs	ppo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	39.93	39.93	bcbs	epo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	10.31	10.31	bcbs	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	10.31	10.31	bcbs	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	10.31	10.31	bcbs	pos
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	10.31	10.31	bcbs	ppo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	10.31	10.31	bcbs	epo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	12.63	12.63	bcbs	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	12.63	12.63	bcbs	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	12.63	12.63	bcbs	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	12.63	12.63	bcbs	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	12.63	12.63	bcbs	epo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	36.28	36.28	bcbs	hmo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	36.28	36.28	bcbs	hmo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	36.28	36.28	bcbs	pos
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	36.28	36.28	bcbs	ppo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	36.28	36.28	bcbs	epo
Quantitation of therapeutic drug	cpt	80299	18.72	18.72	5.39	5.39	36.89	36.89	30.74	30.74	O	5.39	5.39	bcbs	hmo
Quantitation of therapeutic drug	cpt	80299	18.72	18.72	5.39	5.39	36.89	36.89	30.74	30.74	O	5.39	5.39	bcbs	hmo
Quantitation of therapeutic drug	cpt	80299	18.72	18.72	5.39	5.39	36.89	36.89	30.74	30.74	O	5.39	5.39	bcbs	pos
Quantitation of therapeutic drug	cpt	80299	18.72	18.72	5.39	5.39	36.89	36.89	30.74	30.74	O	5.39	5.39	bcbs	ppo
Quantitation of therapeutic drug	cpt	80299	18.72	18.72	5.39	5.39	36.89	36.89	30.74	30.74	O	5.39	5.39	bcbs	epo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	16.59	16.59	bcbs	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	16.59	16.59	bcbs	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	16.59	16.59	bcbs	pos
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	16.59	16.59	bcbs	ppo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	16.59	16.59	bcbs	epo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	17.09	17.09	bcbs	hmo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	17.09	17.09	bcbs	hmo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	17.09	17.09	bcbs	pos
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	17.09	17.09	bcbs	ppo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	17.09	17.09	bcbs	epo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	5.57	5.57	bcbs	hmo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	5.57	5.57	bcbs	hmo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	5.57	5.57	bcbs	pos
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	5.57	5.57	bcbs	ppo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	5.57	5.57	bcbs	epo
"Measurement of antibody (IgG) to allergic substance, each allergen"	cpt	86001	4.38	4.38	4.38	4.38	27.64	27.64	23.03	23.03	O	4.38	4.38	bcbs	hmo
"Measurement of antibody (IgG) to allergic substance, each allergen"	cpt	86001	4.38	4.38	4.38	4.38	27.64	27.64	23.03	23.03	O	4.38	4.38	bcbs	hmo
"Measurement of antibody (IgG) to allergic substance, each allergen"	cpt	86001	4.38	4.38	4.38	4.38	27.64	27.64	23.03	23.03	O	4.38	4.38	bcbs	pos
"Measurement of antibody (IgG) to allergic substance, each allergen"	cpt	86001	4.38	4.38	4.38	4.38	27.64	27.64	23.03	23.03	O	4.38	4.38	bcbs	ppo
"Measurement of antibody (IgG) to allergic substance, each allergen"	cpt	86001	4.38	4.38	4.38	4.38	27.64	27.64	23.03	23.03	O	4.38	4.38	bcbs	epo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	4.28	4.28	bcbs	hmo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	4.28	4.28	bcbs	hmo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	4.28	4.28	bcbs	pos
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	4.28	4.28	bcbs	ppo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	4.28	4.28	bcbs	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	42.96	42.96	bcbs	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	42.96	42.96	bcbs	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	42.96	42.96	bcbs	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	42.96	42.96	bcbs	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	42.96	42.96	bcbs	epo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	7.02	7.02	bcbs	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	7.02	7.02	bcbs	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	7.02	7.02	bcbs	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	7.02	7.02	bcbs	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	7.02	7.02	bcbs	epo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	5.42	5.42	bcbs	hmo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	5.42	5.42	bcbs	hmo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	5.42	5.42	bcbs	pos
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	5.42	5.42	bcbs	ppo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	5.42	5.42	bcbs	epo
Alcohols levels	cpt	80320	33.87	33.87	33.87	33.87	287.47	287.47	239.56	239.56	O	33.87	33.87	bcbs	hmo
Alcohols levels	cpt	80320	33.87	33.87	33.87	33.87	287.47	287.47	239.56	239.56	O	33.87	33.87	bcbs	hmo
Alcohols levels	cpt	80320	33.87	33.87	33.87	33.87	287.47	287.47	239.56	239.56	O	33.87	33.87	bcbs	pos
Alcohols levels	cpt	80320	33.87	33.87	33.87	33.87	287.47	287.47	239.56	239.56	O	33.87	33.87	bcbs	ppo
Alcohols levels	cpt	80320	33.87	33.87	33.87	33.87	287.47	287.47	239.56	239.56	O	33.87	33.87	bcbs	epo
"Alcohols levels, 1 or 2"	cpt	80321	7.63	7.63	7.63	7.63	300.92	300.92	250.77	250.77	O	7.63	7.63	bcbs	hmo
"Alcohols levels, 1 or 2"	cpt	80321	7.63	7.63	7.63	7.63	300.92	300.92	250.77	250.77	O	7.63	7.63	bcbs	hmo
"Alcohols levels, 1 or 2"	cpt	80321	7.63	7.63	7.63	7.63	300.92	300.92	250.77	250.77	O	7.63	7.63	bcbs	pos
"Alcohols levels, 1 or 2"	cpt	80321	7.63	7.63	7.63	7.63	300.92	300.92	250.77	250.77	O	7.63	7.63	bcbs	ppo
"Alcohols levels, 1 or 2"	cpt	80321	7.63	7.63	7.63	7.63	300.92	300.92	250.77	250.77	O	7.63	7.63	bcbs	epo
"Amphetamines levels, 1 or 2"	cpt	80324	6.03	6.03	6.03	6.03	300.92	300.92	250.77	250.77	O	6.03	6.03	bcbs	hmo
"Amphetamines levels, 1 or 2"	cpt	80324	6.03	6.03	6.03	6.03	300.92	300.92	250.77	250.77	O	6.03	6.03	bcbs	hmo
"Amphetamines levels, 1 or 2"	cpt	80324	6.03	6.03	6.03	6.03	300.92	300.92	250.77	250.77	O	6.03	6.03	bcbs	pos
"Amphetamines levels, 1 or 2"	cpt	80324	6.03	6.03	6.03	6.03	300.92	300.92	250.77	250.77	O	6.03	6.03	bcbs	ppo
"Amphetamines levels, 1 or 2"	cpt	80324	6.03	6.03	6.03	6.03	300.92	300.92	250.77	250.77	O	6.03	6.03	bcbs	epo
"Analgesics levels, 1 or 2"	cpt	80329	24.83	24.83	24.83	24.83	202.88	202.88	169.07	169.07	O	24.83	24.83	bcbs	hmo
"Analgesics levels, 1 or 2"	cpt	80329	24.83	24.83	24.83	24.83	202.88	202.88	169.07	169.07	O	24.83	24.83	bcbs	hmo
"Analgesics levels, 1 or 2"	cpt	80329	24.83	24.83	24.83	24.83	202.88	202.88	169.07	169.07	O	24.83	24.83	bcbs	pos
"Analgesics levels, 1 or 2"	cpt	80329	24.83	24.83	24.83	24.83	202.88	202.88	169.07	169.07	O	24.83	24.83	bcbs	ppo
"Analgesics levels, 1 or 2"	cpt	80329	24.83	24.83	24.83	24.83	202.88	202.88	169.07	169.07	O	24.83	24.83	bcbs	epo
"Antidepressants levels, 1 or 2 (tricyclic and other cyclicals)"	cpt	80335	6.47	6.47	6.47	6.47	300.92	300.92	250.77	250.77	O	6.47	6.47	bcbs	hmo
"Antidepressants levels, 1 or 2 (tricyclic and other cyclicals)"	cpt	80335	6.47	6.47	6.47	6.47	300.92	300.92	250.77	250.77	O	6.47	6.47	bcbs	hmo
"Antidepressants levels, 1 or 2 (tricyclic and other cyclicals)"	cpt	80335	6.47	6.47	6.47	6.47	300.92	300.92	250.77	250.77	O	6.47	6.47	bcbs	pos
"Antidepressants levels, 1 or 2 (tricyclic and other cyclicals)"	cpt	80335	6.47	6.47	6.47	6.47	300.92	300.92	250.77	250.77	O	6.47	6.47	bcbs	ppo
"Antidepressants levels, 1 or 2 (tricyclic and other cyclicals)"	cpt	80335	6.47	6.47	6.47	6.47	300.92	300.92	250.77	250.77	O	6.47	6.47	bcbs	epo
Barbiturates levels	cpt	80345	5.32	5.32	5.32	5.32	300.92	300.92	250.77	250.77	O	5.32	5.32	bcbs	hmo
Barbiturates levels	cpt	80345	5.32	5.32	5.32	5.32	300.92	300.92	250.77	250.77	O	5.32	5.32	bcbs	hmo
Barbiturates levels	cpt	80345	5.32	5.32	5.32	5.32	300.92	300.92	250.77	250.77	O	5.32	5.32	bcbs	pos
Barbiturates levels	cpt	80345	5.32	5.32	5.32	5.32	300.92	300.92	250.77	250.77	O	5.32	5.32	bcbs	ppo
Barbiturates levels	cpt	80345	5.32	5.32	5.32	5.32	300.92	300.92	250.77	250.77	O	5.32	5.32	bcbs	epo
Buprenorphine level	cpt	80348	7.68	7.68	7.68	7.68	300.35	300.35	250.29	250.29	O	7.68	7.68	bcbs	hmo
Buprenorphine level	cpt	80348	7.68	7.68	7.68	7.68	300.35	300.35	250.29	250.29	O	7.68	7.68	bcbs	hmo
Buprenorphine level	cpt	80348	7.68	7.68	7.68	7.68	300.35	300.35	250.29	250.29	O	7.68	7.68	bcbs	pos
Buprenorphine level	cpt	80348	7.68	7.68	7.68	7.68	300.35	300.35	250.29	250.29	O	7.68	7.68	bcbs	ppo
Buprenorphine level	cpt	80348	7.68	7.68	7.68	7.68	300.35	300.35	250.29	250.29	O	7.68	7.68	bcbs	epo
"Cannabinoids levels, natural"	cpt	80349	3.01	3.01	3.01	3.01	128.09	128.09	106.74	106.74	O	3.01	3.01	bcbs	hmo
"Cannabinoids levels, natural"	cpt	80349	3.01	3.01	3.01	3.01	128.09	128.09	106.74	106.74	O	3.01	3.01	bcbs	hmo
"Cannabinoids levels, natural"	cpt	80349	3.01	3.01	3.01	3.01	128.09	128.09	106.74	106.74	O	3.01	3.01	bcbs	pos
"Cannabinoids levels, natural"	cpt	80349	3.01	3.01	3.01	3.01	128.09	128.09	106.74	106.74	O	3.01	3.01	bcbs	ppo
"Cannabinoids levels, natural"	cpt	80349	3.01	3.01	3.01	3.01	128.09	128.09	106.74	106.74	O	3.01	3.01	bcbs	epo
Fentanyl level	cpt	80354	7.76	7.76	7.76	7.76	357.94	357.94	298.28	298.28	O	7.76	7.76	bcbs	hmo
Fentanyl level	cpt	80354	7.76	7.76	7.76	7.76	357.94	357.94	298.28	298.28	O	7.76	7.76	bcbs	hmo
Fentanyl level	cpt	80354	7.76	7.76	7.76	7.76	357.94	357.94	298.28	298.28	O	7.76	7.76	bcbs	pos
Fentanyl level	cpt	80354	7.76	7.76	7.76	7.76	357.94	357.94	298.28	298.28	O	7.76	7.76	bcbs	ppo
Fentanyl level	cpt	80354	7.76	7.76	7.76	7.76	357.94	357.94	298.28	298.28	O	7.76	7.76	bcbs	epo
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	2.18	2.18	bcbs	hmo
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	2.18	2.18	bcbs	hmo
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	2.18	2.18	bcbs	pos
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	2.18	2.18	bcbs	ppo
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	2.18	2.18	bcbs	epo
Oxycodone levels	cpt	80365	1.82	1.82	1.82	1.82	86.35	86.35	71.96	71.96	O	1.82	1.82	bcbs	hmo
Oxycodone levels	cpt	80365	1.82	1.82	1.82	1.82	86.35	86.35	71.96	71.96	O	1.82	1.82	bcbs	hmo
Oxycodone levels	cpt	80365	1.82	1.82	1.82	1.82	86.35	86.35	71.96	71.96	O	1.82	1.82	bcbs	pos
Oxycodone levels	cpt	80365	1.82	1.82	1.82	1.82	86.35	86.35	71.96	71.96	O	1.82	1.82	bcbs	ppo
Oxycodone levels	cpt	80365	1.82	1.82	1.82	1.82	86.35	86.35	71.96	71.96	O	1.82	1.82	bcbs	epo
Tramadol level	cpt	80373	8.7	8.7	8.7	8.7	357.94	357.94	298.28	298.28	O	8.7	8.7	bcbs	hmo
Tramadol level	cpt	80373	8.7	8.7	8.7	8.7	357.94	357.94	298.28	298.28	O	8.7	8.7	bcbs	hmo
Tramadol level	cpt	80373	8.7	8.7	8.7	8.7	357.94	357.94	298.28	298.28	O	8.7	8.7	bcbs	pos
Tramadol level	cpt	80373	8.7	8.7	8.7	8.7	357.94	357.94	298.28	298.28	O	8.7	8.7	bcbs	ppo
Tramadol level	cpt	80373	8.7	8.7	8.7	8.7	357.94	357.94	298.28	298.28	O	8.7	8.7	bcbs	epo
Stereoisomer (enantiomer) drug analysis	cpt	80374	4.72	4.72	4.72	4.72	300.92	300.92	250.77	250.77	O	4.72	4.72	bcbs	hmo
Stereoisomer (enantiomer) drug analysis	cpt	80374	4.72	4.72	4.72	4.72	300.92	300.92	250.77	250.77	O	4.72	4.72	bcbs	hmo
Stereoisomer (enantiomer) drug analysis	cpt	80374	4.72	4.72	4.72	4.72	300.92	300.92	250.77	250.77	O	4.72	4.72	bcbs	pos
Stereoisomer (enantiomer) drug analysis	cpt	80374	4.72	4.72	4.72	4.72	300.92	300.92	250.77	250.77	O	4.72	4.72	bcbs	ppo
Stereoisomer (enantiomer) drug analysis	cpt	80374	4.72	4.72	4.72	4.72	300.92	300.92	250.77	250.77	O	4.72	4.72	bcbs	epo
PCP drug level	cpt	83992	11.17	11.17	11.17	11.17	300.92	300.92	250.77	250.77	O	11.17	11.17	bcbs	hmo
PCP drug level	cpt	83992	11.17	11.17	11.17	11.17	300.92	300.92	250.77	250.77	O	11.17	11.17	bcbs	hmo
PCP drug level	cpt	83992	11.17	11.17	11.17	11.17	300.92	300.92	250.77	250.77	O	11.17	11.17	bcbs	pos
PCP drug level	cpt	83992	11.17	11.17	11.17	11.17	300.92	300.92	250.77	250.77	O	11.17	11.17	bcbs	ppo
PCP drug level	cpt	83992	11.17	11.17	11.17	11.17	300.92	300.92	250.77	250.77	O	11.17	11.17	bcbs	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	35.28	35.28	bcbs	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	35.28	35.28	bcbs	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	35.28	35.28	bcbs	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	35.28	35.28	bcbs	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	35.28	35.28	bcbs	epo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	8.78	8.78	bcbs	hmo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	8.78	8.78	bcbs	hmo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	8.78	8.78	bcbs	pos
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	8.78	8.78	bcbs	ppo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	8.78	8.78	bcbs	epo
Clotting factor VIII (VW factor) measurement	cpt	85245	40.84	40.84	20.4	20.4	143.74	143.74	119.78	119.78	O	40.84	40.84	bcbs	hmo
Clotting factor VIII (VW factor) measurement	cpt	85245	40.84	40.84	20.4	20.4	143.74	143.74	119.78	119.78	O	40.84	40.84	bcbs	hmo
Clotting factor VIII (VW factor) measurement	cpt	85245	40.84	40.84	20.4	20.4	143.74	143.74	119.78	119.78	O	40.84	40.84	bcbs	pos
Clotting factor VIII (VW factor) measurement	cpt	85245	40.84	40.84	20.4	20.4	143.74	143.74	119.78	119.78	O	40.84	40.84	bcbs	ppo
Clotting factor VIII (VW factor) measurement	cpt	85245	40.84	40.84	20.4	20.4	143.74	143.74	119.78	119.78	O	40.84	40.84	bcbs	epo
"Gene analysis (cytochrome P450, family 2, subfamily C, polypeptide 19) common variants"	cpt	81225	254.94	254.94	254.94	254.94	874.08	874.08	728.4	728.4	O	254.94	254.94	bcbs	hmo
"Gene analysis (cytochrome P450, family 2, subfamily C, polypeptide 19) common variants"	cpt	81225	254.94	254.94	254.94	254.94	874.08	874.08	728.4	728.4	O	254.94	254.94	bcbs	hmo
"Gene analysis (cytochrome P450, family 2, subfamily C, polypeptide 19) common variants"	cpt	81225	254.94	254.94	254.94	254.94	874.08	874.08	728.4	728.4	O	254.94	254.94	bcbs	pos
"Gene analysis (cytochrome P450, family 2, subfamily C, polypeptide 19) common variants"	cpt	81225	254.94	254.94	254.94	254.94	874.08	874.08	728.4	728.4	O	254.94	254.94	bcbs	ppo
"Gene analysis (cytochrome P450, family 2, subfamily C, polypeptide 19) common variants"	cpt	81225	254.94	254.94	254.94	254.94	874.08	874.08	728.4	728.4	O	254.94	254.94	bcbs	epo
Blood smear interpretation by physician with written report	cpt	85060	31.36	31.36	31.36	31.36	75.05	75.05	62.54	62.54	O	31.36	31.36	bcbs	hmo
Blood smear interpretation by physician with written report	cpt	85060	31.36	31.36	31.36	31.36	75.05	75.05	62.54	62.54	O	31.36	31.36	bcbs	hmo
Blood smear interpretation by physician with written report	cpt	85060	31.36	31.36	31.36	31.36	75.05	75.05	62.54	62.54	O	31.36	31.36	bcbs	pos
Blood smear interpretation by physician with written report	cpt	85060	31.36	31.36	31.36	31.36	75.05	75.05	62.54	62.54	O	31.36	31.36	bcbs	ppo
Blood smear interpretation by physician with written report	cpt	85060	31.36	31.36	31.36	31.36	75.05	75.05	62.54	62.54	O	31.36	31.36	bcbs	epo
Gene analysis (hemochromatosis) common variants	cpt	81256	65.36	65.36	46.98	46.98	382.87	382.87	319.06	319.06	O	46.98	46.98	bcbs	hmo
Gene analysis (hemochromatosis) common variants	cpt	81256	65.36	65.36	46.98	46.98	382.87	382.87	319.06	319.06	O	46.98	46.98	bcbs	hmo
Gene analysis (hemochromatosis) common variants	cpt	81256	65.36	65.36	46.98	46.98	382.87	382.87	319.06	319.06	O	46.98	46.98	bcbs	pos
Gene analysis (hemochromatosis) common variants	cpt	81256	65.36	65.36	46.98	46.98	382.87	382.87	319.06	319.06	O	46.98	46.98	bcbs	ppo
Gene analysis (hemochromatosis) common variants	cpt	81256	65.36	65.36	46.98	46.98	382.87	382.87	319.06	319.06	O	46.98	46.98	bcbs	epo
Molecular pathology procedure level 1	cpt	81400	159	159	159	159	190.8	190.8	159	159	O	159	159	bcbs	hmo
Molecular pathology procedure level 1	cpt	81400	159	159	159	159	190.8	190.8	159	159	O	159	159	bcbs	hmo
Molecular pathology procedure level 1	cpt	81400	159	159	159	159	190.8	190.8	159	159	O	159	159	bcbs	pos
Molecular pathology procedure level 1	cpt	81400	159	159	159	159	190.8	190.8	159	159	O	159	159	bcbs	ppo
Molecular pathology procedure level 1	cpt	81400	159	159	159	159	190.8	190.8	159	159	O	159	159	bcbs	epo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	9.87	9.87	bcbs	hmo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	9.87	9.87	bcbs	hmo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	9.87	9.87	bcbs	pos
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	9.87	9.87	bcbs	ppo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	9.87	9.87	bcbs	epo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	16.5	16.5	bcbs	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	16.5	16.5	bcbs	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	16.5	16.5	bcbs	pos
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	16.5	16.5	bcbs	ppo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	16.5	16.5	bcbs	epo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	7.82	7.82	bcbs	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	7.82	7.82	bcbs	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	7.82	7.82	bcbs	pos
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	7.82	7.82	bcbs	ppo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	7.82	7.82	bcbs	epo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	2.27	2.27	bcbs	hmo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	2.27	2.27	bcbs	hmo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	2.27	2.27	bcbs	pos
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	2.27	2.27	bcbs	ppo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	2.27	2.27	bcbs	epo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	5.52	5.52	bcbs	hmo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	5.52	5.52	bcbs	hmo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	5.52	5.52	bcbs	pos
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	5.52	5.52	bcbs	ppo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	5.52	5.52	bcbs	epo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	5.38	5.38	bcbs	hmo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	5.38	5.38	bcbs	hmo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	5.38	5.38	bcbs	pos
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	5.38	5.38	bcbs	ppo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	5.38	5.38	bcbs	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	27.35	27.35	bcbs	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	27.35	27.35	bcbs	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	27.35	27.35	bcbs	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	27.35	27.35	bcbs	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	27.35	27.35	bcbs	epo
Arsenic level	cpt	82175	18.97	18.97	13.5	13.5	100.49	100.49	83.74	83.74	O	13.5	13.5	bcbs	hmo
Arsenic level	cpt	82175	18.97	18.97	13.5	13.5	100.49	100.49	83.74	83.74	O	13.5	13.5	bcbs	hmo
Arsenic level	cpt	82175	18.97	18.97	13.5	13.5	100.49	100.49	83.74	83.74	O	13.5	13.5	bcbs	pos
Arsenic level	cpt	82175	18.97	18.97	13.5	13.5	100.49	100.49	83.74	83.74	O	13.5	13.5	bcbs	ppo
Arsenic level	cpt	82175	18.97	18.97	13.5	13.5	100.49	100.49	83.74	83.74	O	13.5	13.5	bcbs	epo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	34.65	34.65	bcbs	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	34.65	34.65	bcbs	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	34.65	34.65	bcbs	pos
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	34.65	34.65	bcbs	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	34.65	34.65	bcbs	epo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	9.99	9.99	bcbs	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	9.99	9.99	bcbs	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	9.99	9.99	bcbs	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	9.99	9.99	bcbs	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	9.99	9.99	bcbs	epo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	19.19	19.19	bcbs	hmo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	19.19	19.19	bcbs	hmo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	19.19	19.19	bcbs	pos
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	19.19	19.19	bcbs	ppo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	19.19	19.19	bcbs	epo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	12.67	12.67	bcbs	hmo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	12.67	12.67	bcbs	hmo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	12.67	12.67	bcbs	pos
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	12.67	12.67	bcbs	ppo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	12.67	12.67	bcbs	epo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	26.27	26.27	bcbs	hmo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	26.27	26.27	bcbs	hmo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	26.27	26.27	bcbs	pos
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	26.27	26.27	bcbs	ppo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	26.27	26.27	bcbs	epo
Zinc level	cpt	84630	11.44	11.44	10.07	10.07	82.68	82.68	68.9	68.9	O	10.07	10.07	bcbs	hmo
Zinc level	cpt	84630	11.44	11.44	10.07	10.07	82.68	82.68	68.9	68.9	O	10.07	10.07	bcbs	hmo
Zinc level	cpt	84630	11.44	11.44	10.07	10.07	82.68	82.68	68.9	68.9	O	10.07	10.07	bcbs	pos
Zinc level	cpt	84630	11.44	11.44	10.07	10.07	82.68	82.68	68.9	68.9	O	10.07	10.07	bcbs	ppo
Zinc level	cpt	84630	11.44	11.44	10.07	10.07	82.68	82.68	68.9	68.9	O	10.07	10.07	bcbs	epo
Vitamin measurement	cpt	84591	6.57	6.57	6.57	6.57	51.18	51.18	42.65	42.65	O	6.57	6.57	bcbs	hmo
Vitamin measurement	cpt	84591	6.57	6.57	6.57	6.57	51.18	51.18	42.65	42.65	O	6.57	6.57	bcbs	hmo
Vitamin measurement	cpt	84591	6.57	6.57	6.57	6.57	51.18	51.18	42.65	42.65	O	6.57	6.57	bcbs	pos
Vitamin measurement	cpt	84591	6.57	6.57	6.57	6.57	51.18	51.18	42.65	42.65	O	6.57	6.57	bcbs	ppo
Vitamin measurement	cpt	84591	6.57	6.57	6.57	6.57	51.18	51.18	42.65	42.65	O	6.57	6.57	bcbs	epo
Urine vanillylmandelic acid	cpt	84585	59.38	59.38	13.79	13.79	160.27	160.27	133.56	133.56	O	59.38	59.38	bcbs	hmo
Urine vanillylmandelic acid	cpt	84585	59.38	59.38	13.79	13.79	160.27	160.27	133.56	133.56	O	59.38	59.38	bcbs	hmo
Urine vanillylmandelic acid	cpt	84585	59.38	59.38	13.79	13.79	160.27	160.27	133.56	133.56	O	59.38	59.38	bcbs	pos
Urine vanillylmandelic acid	cpt	84585	59.38	59.38	13.79	13.79	160.27	160.27	133.56	133.56	O	59.38	59.38	bcbs	ppo
Urine vanillylmandelic acid	cpt	84585	59.38	59.38	13.79	13.79	160.27	160.27	133.56	133.56	O	59.38	59.38	bcbs	epo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	68.52	68.52	bcbs	hmo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	68.52	68.52	bcbs	hmo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	68.52	68.52	bcbs	pos
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	68.52	68.52	bcbs	ppo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	68.52	68.52	bcbs	epo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	6618.99	6618.99	bcbs	hmo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	6618.99	6618.99	bcbs	hmo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	6618.99	6618.99	bcbs	pos
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	6618.99	6618.99	bcbs	ppo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	6618.99	6618.99	bcbs	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	9.42	9.42	bcbs	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	9.42	9.42	bcbs	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	9.42	9.42	bcbs	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	9.42	9.42	bcbs	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	9.42	9.42	bcbs	epo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	8.36	8.36	bcbs	hmo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	8.36	8.36	bcbs	hmo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	8.36	8.36	bcbs	pos
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	8.36	8.36	bcbs	ppo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	8.36	8.36	bcbs	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	50.17	50.17	bcbs	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	50.17	50.17	bcbs	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	50.17	50.17	bcbs	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	50.17	50.17	bcbs	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	50.17	50.17	bcbs	epo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	10.15	10.15	bcbs	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	10.15	10.15	bcbs	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	10.15	10.15	bcbs	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	10.15	10.15	bcbs	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	10.15	10.15	bcbs	epo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	10.84	10.84	bcbs	hmo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	10.84	10.84	bcbs	hmo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	10.84	10.84	bcbs	pos
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	10.84	10.84	bcbs	ppo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	10.84	10.84	bcbs	epo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	23.89	23.89	bcbs	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	23.89	23.89	bcbs	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	23.89	23.89	bcbs	pos
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	23.89	23.89	bcbs	ppo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	23.89	23.89	bcbs	epo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	21.69	21.69	bcbs	hmo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	21.69	21.69	bcbs	hmo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	21.69	21.69	bcbs	pos
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	21.69	21.69	bcbs	ppo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	21.69	21.69	bcbs	epo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	19.91	19.91	bcbs	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	19.91	19.91	bcbs	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	19.91	19.91	bcbs	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	19.91	19.91	bcbs	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	19.91	19.91	bcbs	epo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	18.44	18.44	bcbs	hmo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	18.44	18.44	bcbs	hmo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	18.44	18.44	bcbs	pos
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	18.44	18.44	bcbs	ppo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	18.44	18.44	bcbs	epo
"Ascorbic acid (Vitamin C) level, blood"	cpt	82180	18.18	18.18	18.18	18.18	116.18	116.18	96.82	96.82	O	18.18	18.18	bcbs	hmo
"Ascorbic acid (Vitamin C) level, blood"	cpt	82180	18.18	18.18	18.18	18.18	116.18	116.18	96.82	96.82	O	18.18	18.18	bcbs	hmo
"Ascorbic acid (Vitamin C) level, blood"	cpt	82180	18.18	18.18	18.18	18.18	116.18	116.18	96.82	96.82	O	18.18	18.18	bcbs	pos
"Ascorbic acid (Vitamin C) level, blood"	cpt	82180	18.18	18.18	18.18	18.18	116.18	116.18	96.82	96.82	O	18.18	18.18	bcbs	ppo
"Ascorbic acid (Vitamin C) level, blood"	cpt	82180	18.18	18.18	18.18	18.18	116.18	116.18	96.82	96.82	O	18.18	18.18	bcbs	epo
Triglycerides level	cpt	84478	8.51	8.51	8.51	8.51	67.42	67.42	56.18	56.18	O	8.51	8.51	bcbs	hmo
Triglycerides level	cpt	84478	8.51	8.51	8.51	8.51	67.42	67.42	56.18	56.18	O	8.51	8.51	bcbs	hmo
Triglycerides level	cpt	84478	8.51	8.51	8.51	8.51	67.42	67.42	56.18	56.18	O	8.51	8.51	bcbs	pos
Triglycerides level	cpt	84478	8.51	8.51	8.51	8.51	67.42	67.42	56.18	56.18	O	8.51	8.51	bcbs	ppo
Triglycerides level	cpt	84478	8.51	8.51	8.51	8.51	67.42	67.42	56.18	56.18	O	8.51	8.51	bcbs	epo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	28.98	28.98	bcbs	hmo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	28.98	28.98	bcbs	hmo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	28.98	28.98	bcbs	pos
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	28.98	28.98	bcbs	ppo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	28.98	28.98	bcbs	epo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	10.99	10.99	bcbs	hmo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	10.99	10.99	bcbs	hmo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	10.99	10.99	bcbs	pos
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	10.99	10.99	bcbs	ppo
Transferrin (iron binding protein) level	cpt	84466	36.8	36.8	10.99	10.99	76.13	76.13	63.44	63.44	O	10.99	10.99	bcbs	epo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	7.18	7.18	bcbs	hmo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	7.18	7.18	bcbs	hmo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	7.18	7.18	bcbs	pos
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	7.18	7.18	bcbs	ppo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	7.18	7.18	bcbs	epo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	6.41	6.41	bcbs	hmo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	6.41	6.41	bcbs	hmo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	6.41	6.41	bcbs	pos
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	6.41	6.41	bcbs	ppo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	6.41	6.41	bcbs	epo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	12.66	12.66	bcbs	hmo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	12.66	12.66	bcbs	hmo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	12.66	12.66	bcbs	pos
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	12.66	12.66	bcbs	ppo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	12.66	12.66	bcbs	epo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	6.05	6.05	bcbs	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	6.05	6.05	bcbs	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	6.05	6.05	bcbs	pos
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	6.05	6.05	bcbs	ppo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	6.05	6.05	bcbs	epo
Thyroid stimulating immune globulins (thyroid related protein) level	cpt	84445	60.12	60.12	45.24	45.24	146.28	146.28	121.9	121.9	O	60.12	60.12	bcbs	hmo
Thyroid stimulating immune globulins (thyroid related protein) level	cpt	84445	60.12	60.12	45.24	45.24	146.28	146.28	121.9	121.9	O	60.12	60.12	bcbs	hmo
Thyroid stimulating immune globulins (thyroid related protein) level	cpt	84445	60.12	60.12	45.24	45.24	146.28	146.28	121.9	121.9	O	60.12	60.12	bcbs	pos
Thyroid stimulating immune globulins (thyroid related protein) level	cpt	84445	60.12	60.12	45.24	45.24	146.28	146.28	121.9	121.9	O	60.12	60.12	bcbs	ppo
Thyroid stimulating immune globulins (thyroid related protein) level	cpt	84445	60.12	60.12	45.24	45.24	146.28	146.28	121.9	121.9	O	60.12	60.12	bcbs	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	10.66	10.66	bcbs	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	10.66	10.66	bcbs	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	10.66	10.66	bcbs	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	10.66	10.66	bcbs	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	10.66	10.66	bcbs	epo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	20.52	20.52	bcbs	hmo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	20.52	20.52	bcbs	hmo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	20.52	20.52	bcbs	pos
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	20.52	20.52	bcbs	ppo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	20.52	20.52	bcbs	epo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	8.2	8.2	bcbs	hmo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	8.2	8.2	bcbs	hmo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	8.2	8.2	bcbs	pos
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	8.2	8.2	bcbs	ppo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	8.2	8.2	bcbs	epo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	23.54	23.54	bcbs	hmo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	23.54	23.54	bcbs	hmo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	23.54	23.54	bcbs	pos
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	23.54	23.54	bcbs	ppo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	23.54	23.54	bcbs	epo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	33.25	33.25	bcbs	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	33.25	33.25	bcbs	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	33.25	33.25	bcbs	pos
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	33.25	33.25	bcbs	ppo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	33.25	33.25	bcbs	epo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	16.99	16.99	bcbs	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	16.99	16.99	bcbs	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	16.99	16.99	bcbs	pos
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	16.99	16.99	bcbs	ppo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	16.99	16.99	bcbs	epo
Somatomedin (growth factor) level	cpt	84305	38.53	38.53	18.91	18.91	276.02	276.02	230.02	230.02	O	38.53	38.53	bcbs	hmo
Somatomedin (growth factor) level	cpt	84305	38.53	38.53	18.91	18.91	276.02	276.02	230.02	230.02	O	38.53	38.53	bcbs	hmo
Somatomedin (growth factor) level	cpt	84305	38.53	38.53	18.91	18.91	276.02	276.02	230.02	230.02	O	38.53	38.53	bcbs	pos
Somatomedin (growth factor) level	cpt	84305	38.53	38.53	18.91	18.91	276.02	276.02	230.02	230.02	O	38.53	38.53	bcbs	ppo
Somatomedin (growth factor) level	cpt	84305	38.53	38.53	18.91	18.91	276.02	276.02	230.02	230.02	O	38.53	38.53	bcbs	epo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	21.78	21.78	bcbs	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	21.78	21.78	bcbs	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	21.78	21.78	bcbs	pos
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	21.78	21.78	bcbs	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	21.78	21.78	bcbs	epo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	21.64	21.64	bcbs	hmo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	21.64	21.64	bcbs	hmo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	21.64	21.64	bcbs	pos
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	21.64	21.64	bcbs	ppo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	21.64	21.64	bcbs	epo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	18.61	18.61	bcbs	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	18.61	18.61	bcbs	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	18.61	18.61	bcbs	pos
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	18.61	18.61	bcbs	ppo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	18.61	18.61	bcbs	epo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	54.56	54.56	bcbs	hmo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	54.56	54.56	bcbs	hmo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	54.56	54.56	bcbs	pos
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	54.56	54.56	bcbs	ppo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	54.56	54.56	bcbs	epo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	11.85	11.85	bcbs	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	11.85	11.85	bcbs	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	11.85	11.85	bcbs	pos
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	11.85	11.85	bcbs	ppo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	11.85	11.85	bcbs	epo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	11.66	11.66	bcbs	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	11.66	11.66	bcbs	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	11.66	11.66	bcbs	pos
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	11.66	11.66	bcbs	ppo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	11.66	11.66	bcbs	epo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	10.97	10.97	bcbs	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	10.97	10.97	bcbs	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	10.97	10.97	bcbs	pos
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	10.97	10.97	bcbs	ppo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	10.97	10.97	bcbs	epo
"Calcium level, ionized"	cpt	82330	48.87	48.87	13.68	13.68	99.08	99.08	82.57	82.57	O	48.87	48.87	bcbs	hmo
"Calcium level, ionized"	cpt	82330	48.87	48.87	13.68	13.68	99.08	99.08	82.57	82.57	O	48.87	48.87	bcbs	hmo
"Calcium level, ionized"	cpt	82330	48.87	48.87	13.68	13.68	99.08	99.08	82.57	82.57	O	48.87	48.87	bcbs	pos
"Calcium level, ionized"	cpt	82330	48.87	48.87	13.68	13.68	99.08	99.08	82.57	82.57	O	48.87	48.87	bcbs	ppo
"Calcium level, ionized"	cpt	82330	48.87	48.87	13.68	13.68	99.08	99.08	82.57	82.57	O	48.87	48.87	bcbs	epo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	22.99	22.99	bcbs	hmo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	22.99	22.99	bcbs	hmo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	22.99	22.99	bcbs	pos
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	22.99	22.99	bcbs	ppo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	22.99	22.99	bcbs	epo
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	29	29	bcbs	hmo
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	29	29	bcbs	hmo
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	29	29	bcbs	pos
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	29	29	bcbs	ppo
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	29	29	bcbs	epo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	20.21	20.21	bcbs	hmo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	20.21	20.21	bcbs	hmo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	20.21	20.21	bcbs	pos
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	20.21	20.21	bcbs	ppo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	20.21	20.21	bcbs	epo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	20.74	20.74	bcbs	hmo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	20.74	20.74	bcbs	hmo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	20.74	20.74	bcbs	pos
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	20.74	20.74	bcbs	ppo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	20.74	20.74	bcbs	epo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	28.49	28.49	bcbs	hmo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	28.49	28.49	bcbs	hmo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	28.49	28.49	bcbs	pos
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	28.49	28.49	bcbs	ppo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	28.49	28.49	bcbs	epo
Carcinoembryonic antigen (CEA) protein level	cpt	82378	34.13	34.13	16.86	16.86	137.4	137.4	114.5	114.5	O	34.13	34.13	bcbs	hmo
Carcinoembryonic antigen (CEA) protein level	cpt	82378	34.13	34.13	16.86	16.86	137.4	137.4	114.5	114.5	O	34.13	34.13	bcbs	hmo
Carcinoembryonic antigen (CEA) protein level	cpt	82378	34.13	34.13	16.86	16.86	137.4	137.4	114.5	114.5	O	34.13	34.13	bcbs	pos
Carcinoembryonic antigen (CEA) protein level	cpt	82378	34.13	34.13	16.86	16.86	137.4	137.4	114.5	114.5	O	34.13	34.13	bcbs	ppo
Carcinoembryonic antigen (CEA) protein level	cpt	82378	34.13	34.13	16.86	16.86	137.4	137.4	114.5	114.5	O	34.13	34.13	bcbs	epo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.64	14.64	bcbs	hmo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.64	14.64	bcbs	hmo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.64	14.64	bcbs	pos
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.64	14.64	bcbs	ppo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.64	14.64	bcbs	epo
Catecholamines (organic nitrogen) level	cpt	82384	38.12	38.12	22.46	22.46	211.15	211.15	175.96	175.96	O	38.12	38.12	bcbs	hmo
Catecholamines (organic nitrogen) level	cpt	82384	38.12	38.12	22.46	22.46	211.15	211.15	175.96	175.96	O	38.12	38.12	bcbs	hmo
Catecholamines (organic nitrogen) level	cpt	82384	38.12	38.12	22.46	22.46	211.15	211.15	175.96	175.96	O	38.12	38.12	bcbs	pos
Catecholamines (organic nitrogen) level	cpt	82384	38.12	38.12	22.46	22.46	211.15	211.15	175.96	175.96	O	38.12	38.12	bcbs	ppo
Catecholamines (organic nitrogen) level	cpt	82384	38.12	38.12	22.46	22.46	211.15	211.15	175.96	175.96	O	38.12	38.12	bcbs	epo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	16.07	16.07	bcbs	hmo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	16.07	16.07	bcbs	hmo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	16.07	16.07	bcbs	pos
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	16.07	16.07	bcbs	ppo
Ceruloplasmin (protein) level	cpt	82390	39.38	39.38	9.55	9.55	77.59	77.59	64.66	64.66	O	16.07	16.07	bcbs	epo
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	11.42	11.42	bcbs	hmo
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	11.42	11.42	bcbs	hmo
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	11.42	11.42	bcbs	pos
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	11.42	11.42	bcbs	ppo
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	11.42	11.42	bcbs	epo
Analysis using chemiluminescent technique (light and chemical )reaction	cpt	82397	14.18	14.18	6.55	6.55	58.19	58.19	48.49	48.49	O	6.55	6.55	bcbs	hmo
Analysis using chemiluminescent technique (light and chemical )reaction	cpt	82397	14.18	14.18	6.55	6.55	58.19	58.19	48.49	48.49	O	6.55	6.55	bcbs	hmo
Analysis using chemiluminescent technique (light and chemical )reaction	cpt	82397	14.18	14.18	6.55	6.55	58.19	58.19	48.49	48.49	O	6.55	6.55	bcbs	pos
Analysis using chemiluminescent technique (light and chemical )reaction	cpt	82397	14.18	14.18	6.55	6.55	58.19	58.19	48.49	48.49	O	6.55	6.55	bcbs	ppo
Analysis using chemiluminescent technique (light and chemical )reaction	cpt	82397	14.18	14.18	6.55	6.55	58.19	58.19	48.49	48.49	O	6.55	6.55	bcbs	epo
Urine porphyrins (metabolism substance) measurement	cpt	84120	36.78	36.78	36.78	36.78	44.14	44.14	36.78	36.78	O	36.78	36.78	bcbs	hmo
Urine porphyrins (metabolism substance) measurement	cpt	84120	36.78	36.78	36.78	36.78	44.14	44.14	36.78	36.78	O	36.78	36.78	bcbs	hmo
Urine porphyrins (metabolism substance) measurement	cpt	84120	36.78	36.78	36.78	36.78	44.14	44.14	36.78	36.78	O	36.78	36.78	bcbs	pos
Urine porphyrins (metabolism substance) measurement	cpt	84120	36.78	36.78	36.78	36.78	44.14	44.14	36.78	36.78	O	36.78	36.78	bcbs	ppo
Urine porphyrins (metabolism substance) measurement	cpt	84120	36.78	36.78	36.78	36.78	44.14	44.14	36.78	36.78	O	36.78	36.78	bcbs	epo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	149.99	149.99	bcbs	hmo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	149.99	149.99	bcbs	hmo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	149.99	149.99	bcbs	pos
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	149.99	149.99	bcbs	ppo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	149.99	149.99	bcbs	epo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	38.69	38.69	bcbs	hmo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	38.69	38.69	bcbs	hmo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	38.69	38.69	bcbs	pos
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	38.69	38.69	bcbs	ppo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	38.69	38.69	bcbs	epo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	35.81	35.81	bcbs	hmo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	35.81	35.81	bcbs	hmo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	35.81	35.81	bcbs	pos
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	35.81	35.81	bcbs	ppo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	35.81	35.81	bcbs	epo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	5.92	5.92	bcbs	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	5.92	5.92	bcbs	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	5.92	5.92	bcbs	pos
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	5.92	5.92	bcbs	ppo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	5.92	5.92	bcbs	epo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	18.64	18.64	bcbs	hmo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	18.64	18.64	bcbs	hmo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	18.64	18.64	bcbs	pos
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	18.64	18.64	bcbs	ppo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	18.64	18.64	bcbs	epo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	14.08	14.08	bcbs	hmo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	14.08	14.08	bcbs	hmo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	14.08	14.08	bcbs	pos
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	14.08	14.08	bcbs	ppo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	14.08	14.08	bcbs	epo
Chemical analysis using chromatography technique	cpt	82542	21.43	21.43	17.69	17.69	105.58	105.58	87.98	87.98	O	17.69	17.69	bcbs	hmo
Chemical analysis using chromatography technique	cpt	82542	21.43	21.43	17.69	17.69	105.58	105.58	87.98	87.98	O	17.69	17.69	bcbs	hmo
Chemical analysis using chromatography technique	cpt	82542	21.43	21.43	17.69	17.69	105.58	105.58	87.98	87.98	O	17.69	17.69	bcbs	pos
Chemical analysis using chromatography technique	cpt	82542	21.43	21.43	17.69	17.69	105.58	105.58	87.98	87.98	O	17.69	17.69	bcbs	ppo
Chemical analysis using chromatography technique	cpt	82542	21.43	21.43	17.69	17.69	105.58	105.58	87.98	87.98	O	17.69	17.69	bcbs	epo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	29.88	29.88	bcbs	hmo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	29.88	29.88	bcbs	hmo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	29.88	29.88	bcbs	pos
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	29.88	29.88	bcbs	ppo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	29.88	29.88	bcbs	epo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	16.85	16.85	bcbs	hmo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	16.85	16.85	bcbs	hmo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	16.85	16.85	bcbs	pos
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	16.85	16.85	bcbs	ppo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	16.85	16.85	bcbs	epo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	41.9	41.9	bcbs	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	41.9	41.9	bcbs	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	41.9	41.9	bcbs	pos
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	41.9	41.9	bcbs	ppo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	41.9	41.9	bcbs	epo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	17.18	17.18	bcbs	hmo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	17.18	17.18	bcbs	hmo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	17.18	17.18	bcbs	pos
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	17.18	17.18	bcbs	ppo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	17.18	17.18	bcbs	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	33.93	33.93	bcbs	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	33.93	33.93	bcbs	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	33.93	33.93	bcbs	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	33.93	33.93	bcbs	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	33.93	33.93	bcbs	epo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	23.49	23.49	bcbs	hmo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	23.49	23.49	bcbs	hmo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	23.49	23.49	bcbs	pos
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	23.49	23.49	bcbs	ppo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	23.49	23.49	bcbs	epo
Mercury level	cpt	83825	19.14	19.14	14.46	14.46	142.46	142.46	118.72	118.72	O	19.14	19.14	bcbs	hmo
Mercury level	cpt	83825	19.14	19.14	14.46	14.46	142.46	142.46	118.72	118.72	O	19.14	19.14	bcbs	hmo
Mercury level	cpt	83825	19.14	19.14	14.46	14.46	142.46	142.46	118.72	118.72	O	19.14	19.14	bcbs	pos
Mercury level	cpt	83825	19.14	19.14	14.46	14.46	142.46	142.46	118.72	118.72	O	19.14	19.14	bcbs	ppo
Mercury level	cpt	83825	19.14	19.14	14.46	14.46	142.46	142.46	118.72	118.72	O	19.14	19.14	bcbs	epo
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc	ms-drg	989	10770.23	10770.23	10770.23	10770.23	23596.02	23596.02	19663.35	19663.35	I	10770.23	10770.23	bcbs	hmo
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc	ms-drg	989	10770.23	10770.23	10770.23	10770.23	23596.02	23596.02	19663.35	19663.35	I	10770.23	10770.23	bcbs	hmo
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc	ms-drg	989	10770.23	10770.23	10770.23	10770.23	23596.02	23596.02	19663.35	19663.35	I	10770.23	10770.23	bcbs	pos
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc	ms-drg	989	10770.23	10770.23	10770.23	10770.23	23596.02	23596.02	19663.35	19663.35	I	10770.23	10770.23	bcbs	ppo
non-extensive o.r. procedures unrelated to principal diagnosis without cc/mcc	ms-drg	989	10770.23	10770.23	10770.23	10770.23	23596.02	23596.02	19663.35	19663.35	I	10770.23	10770.23	bcbs	epo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	43.72	43.72	bcbs	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	43.72	43.72	bcbs	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	43.72	43.72	bcbs	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	43.72	43.72	bcbs	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	43.72	43.72	bcbs	epo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	14.63	14.63	bcbs	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	14.63	14.63	bcbs	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	14.63	14.63	bcbs	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	14.63	14.63	bcbs	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	14.63	14.63	bcbs	epo
Lipoprotein (A) level	cpt	83695	18.46	18.46	12.74	12.74	90.31	90.31	75.26	75.26	O	18.46	18.46	bcbs	hmo
Lipoprotein (A) level	cpt	83695	18.46	18.46	12.74	12.74	90.31	90.31	75.26	75.26	O	18.46	18.46	bcbs	hmo
Lipoprotein (A) level	cpt	83695	18.46	18.46	12.74	12.74	90.31	90.31	75.26	75.26	O	18.46	18.46	bcbs	pos
Lipoprotein (A) level	cpt	83695	18.46	18.46	12.74	12.74	90.31	90.31	75.26	75.26	O	18.46	18.46	bcbs	ppo
Lipoprotein (A) level	cpt	83695	18.46	18.46	12.74	12.74	90.31	90.31	75.26	75.26	O	18.46	18.46	bcbs	epo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	8.93	8.93	bcbs	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	8.93	8.93	bcbs	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	8.93	8.93	bcbs	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	8.93	8.93	bcbs	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	8.93	8.93	bcbs	epo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	32	32	bcbs	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	32	32	bcbs	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	32	32	bcbs	pos
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	32	32	bcbs	ppo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	32	32	bcbs	epo
Lead level	cpt	83655	12.11	12.11	10.77	10.77	64.87	64.87	54.06	54.06	O	11.45	11.45	bcbs	hmo
Lead level	cpt	83655	12.11	12.11	10.77	10.77	64.87	64.87	54.06	54.06	O	11.45	11.45	bcbs	hmo
Lead level	cpt	83655	12.11	12.11	10.77	10.77	64.87	64.87	54.06	54.06	O	11.45	11.45	bcbs	pos
Lead level	cpt	83655	12.11	12.11	10.77	10.77	64.87	64.87	54.06	54.06	O	11.45	11.45	bcbs	ppo
Lead level	cpt	83655	12.11	12.11	10.77	10.77	64.87	64.87	54.06	54.06	O	11.45	11.45	bcbs	epo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	10.83	10.83	bcbs	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	10.83	10.83	bcbs	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	10.83	10.83	bcbs	pos
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	10.83	10.83	bcbs	ppo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	10.83	10.83	bcbs	epo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	8.42	8.42	bcbs	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	8.42	8.42	bcbs	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	8.42	8.42	bcbs	pos
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	8.42	8.42	bcbs	ppo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	8.42	8.42	bcbs	epo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	9.06	9.06	bcbs	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	9.06	9.06	bcbs	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	9.06	9.06	bcbs	pos
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	9.06	9.06	bcbs	ppo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	9.06	9.06	bcbs	epo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	15.32	15.32	bcbs	hmo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	15.32	15.32	bcbs	hmo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	15.32	15.32	bcbs	pos
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	15.32	15.32	bcbs	ppo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	15.32	15.32	bcbs	epo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	24.93	24.93	bcbs	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	24.93	24.93	bcbs	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	24.93	24.93	bcbs	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	24.93	24.93	bcbs	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	24.93	24.93	bcbs	epo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	9.58	9.58	bcbs	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	9.58	9.58	bcbs	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	9.58	9.58	bcbs	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	9.58	9.58	bcbs	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	9.58	9.58	bcbs	epo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.12	11.12	bcbs	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.12	11.12	bcbs	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.12	11.12	bcbs	pos
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.12	11.12	bcbs	ppo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.12	11.12	bcbs	epo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	16.24	16.24	bcbs	hmo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	16.24	16.24	bcbs	hmo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	16.24	16.24	bcbs	pos
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	16.24	16.24	bcbs	ppo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	16.24	16.24	bcbs	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	16.3	16.3	bcbs	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	16.3	16.3	bcbs	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	16.3	16.3	bcbs	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	16.3	16.3	bcbs	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	16.3	16.3	bcbs	epo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	14.89	14.89	bcbs	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	14.89	14.89	bcbs	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	14.89	14.89	bcbs	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	14.89	14.89	bcbs	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	14.89	14.89	bcbs	epo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	15.73	15.73	bcbs	hmo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	15.73	15.73	bcbs	hmo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	15.73	15.73	bcbs	pos
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	15.73	15.73	bcbs	ppo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	15.73	15.73	bcbs	epo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	20.9	20.9	bcbs	hmo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	20.9	20.9	bcbs	hmo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	20.9	20.9	bcbs	pos
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	20.9	20.9	bcbs	ppo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	20.9	20.9	bcbs	epo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	11.15	11.15	bcbs	hmo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	11.15	11.15	bcbs	hmo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	11.15	11.15	bcbs	pos
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	11.15	11.15	bcbs	ppo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	11.15	11.15	bcbs	epo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	41.86	41.86	bcbs	hmo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	41.86	41.86	bcbs	hmo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	41.86	41.86	bcbs	pos
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	41.86	41.86	bcbs	ppo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	41.86	41.86	bcbs	epo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	17.78	17.78	bcbs	hmo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	17.78	17.78	bcbs	hmo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	17.78	17.78	bcbs	pos
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	17.78	17.78	bcbs	ppo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	17.78	17.78	bcbs	epo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	19.44	19.44	bcbs	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	19.44	19.44	bcbs	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	19.44	19.44	bcbs	pos
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	19.44	19.44	bcbs	ppo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	19.44	19.44	bcbs	epo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.1	7.1	bcbs	hmo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.1	7.1	bcbs	hmo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.1	7.1	bcbs	pos
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.1	7.1	bcbs	ppo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.1	7.1	bcbs	epo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	51.19	51.19	bcbs	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	51.19	51.19	bcbs	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	51.19	51.19	bcbs	pos
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	51.19	51.19	bcbs	ppo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	51.19	51.19	bcbs	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	14.24	14.24	bcbs	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	14.24	14.24	bcbs	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	14.24	14.24	bcbs	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	14.24	14.24	bcbs	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	14.24	14.24	bcbs	epo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	22.91	22.91	bcbs	hmo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	22.91	22.91	bcbs	hmo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	22.91	22.91	bcbs	pos
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	22.91	22.91	bcbs	ppo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	22.91	22.91	bcbs	epo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	9.29	9.29	bcbs	hmo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	9.29	9.29	bcbs	hmo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	9.29	9.29	bcbs	pos
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	9.29	9.29	bcbs	ppo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	9.29	9.29	bcbs	epo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	31.11	31.11	bcbs	hmo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	31.11	31.11	bcbs	hmo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	31.11	31.11	bcbs	pos
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	31.11	31.11	bcbs	ppo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	31.11	31.11	bcbs	epo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	22.26	22.26	bcbs	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	22.26	22.26	bcbs	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	22.26	22.26	bcbs	pos
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	22.26	22.26	bcbs	ppo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	22.26	22.26	bcbs	epo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	6.86	6.86	bcbs	hmo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	6.86	6.86	bcbs	hmo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	6.86	6.86	bcbs	pos
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	6.86	6.86	bcbs	ppo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	6.86	6.86	bcbs	epo
Ethylene glycol (antifreeze) measurement	cpt	82693	27.57	27.57	27.57	27.57	349.8	349.8	291.5	291.5	O	27.57	27.57	bcbs	hmo
Ethylene glycol (antifreeze) measurement	cpt	82693	27.57	27.57	27.57	27.57	349.8	349.8	291.5	291.5	O	27.57	27.57	bcbs	hmo
Ethylene glycol (antifreeze) measurement	cpt	82693	27.57	27.57	27.57	27.57	349.8	349.8	291.5	291.5	O	27.57	27.57	bcbs	pos
Ethylene glycol (antifreeze) measurement	cpt	82693	27.57	27.57	27.57	27.57	349.8	349.8	291.5	291.5	O	27.57	27.57	bcbs	ppo
Ethylene glycol (antifreeze) measurement	cpt	82693	27.57	27.57	27.57	27.57	349.8	349.8	291.5	291.5	O	27.57	27.57	bcbs	epo
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	7.28	7.28	bcbs	hmo
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	7.28	7.28	bcbs	hmo
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	7.28	7.28	bcbs	pos
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	7.28	7.28	bcbs	ppo
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	7.28	7.28	bcbs	epo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	78.89	78.89	bcbs	hmo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	78.89	78.89	bcbs	hmo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	78.89	78.89	bcbs	pos
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	78.89	78.89	bcbs	ppo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	78.89	78.89	bcbs	epo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	29.89	29.89	bcbs	hmo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	29.89	29.89	bcbs	hmo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	29.89	29.89	bcbs	pos
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	29.89	29.89	bcbs	ppo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	29.89	29.89	bcbs	epo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	14.13	14.13	bcbs	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	14.13	14.13	bcbs	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	14.13	14.13	bcbs	pos
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	14.13	14.13	bcbs	ppo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	14.13	14.13	bcbs	epo
"Gammaglobulin (immune system protein) measurement, immunoglobulin subclasses"	cpt	82787	8.38	8.38	8.02	8.02	24.06	24.06	20.05	20.05	O	8.38	8.38	bcbs	hmo
"Gammaglobulin (immune system protein) measurement, immunoglobulin subclasses"	cpt	82787	8.38	8.38	8.02	8.02	24.06	24.06	20.05	20.05	O	8.38	8.38	bcbs	hmo
"Gammaglobulin (immune system protein) measurement, immunoglobulin subclasses"	cpt	82787	8.38	8.38	8.02	8.02	24.06	24.06	20.05	20.05	O	8.38	8.38	bcbs	pos
"Gammaglobulin (immune system protein) measurement, immunoglobulin subclasses"	cpt	82787	8.38	8.38	8.02	8.02	24.06	24.06	20.05	20.05	O	8.38	8.38	bcbs	ppo
"Gammaglobulin (immune system protein) measurement, immunoglobulin subclasses"	cpt	82787	8.38	8.38	8.02	8.02	24.06	24.06	20.05	20.05	O	8.38	8.38	bcbs	epo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	106.19	106.19	bcbs	hmo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	106.19	106.19	bcbs	hmo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	106.19	106.19	bcbs	pos
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	106.19	106.19	bcbs	ppo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	106.19	106.19	bcbs	epo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	11.05	11.05	bcbs	hmo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	11.05	11.05	bcbs	hmo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	11.05	11.05	bcbs	pos
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	11.05	11.05	bcbs	ppo
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	11.05	11.05	bcbs	epo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	15.54	15.54	bcbs	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	15.54	15.54	bcbs	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	15.54	15.54	bcbs	pos
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	15.54	15.54	bcbs	ppo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	15.54	15.54	bcbs	epo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	13.09	13.09	bcbs	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	13.09	13.09	bcbs	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	13.09	13.09	bcbs	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	13.09	13.09	bcbs	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	13.09	13.09	bcbs	epo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9633.01	9633.01	bcbs	hmo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9633.01	9633.01	bcbs	hmo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9633.01	9633.01	bcbs	pos
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9633.01	9633.01	bcbs	ppo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9633.01	9633.01	bcbs	epo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	6886.91	6886.91	bcbs	hmo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	6886.91	6886.91	bcbs	hmo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	6886.91	6886.91	bcbs	pos
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	6886.91	6886.91	bcbs	ppo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	6886.91	6886.91	bcbs	epo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	10317.22	10317.22	bcbs	hmo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	10317.22	10317.22	bcbs	hmo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	10317.22	10317.22	bcbs	pos
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	10317.22	10317.22	bcbs	ppo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	10317.22	10317.22	bcbs	epo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	6161.39	6161.39	bcbs	hmo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	6161.39	6161.39	bcbs	hmo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	6161.39	6161.39	bcbs	pos
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	6161.39	6161.39	bcbs	ppo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	6161.39	6161.39	bcbs	epo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	15043.43	15043.43	bcbs	hmo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	15043.43	15043.43	bcbs	hmo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	15043.43	15043.43	bcbs	pos
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	15043.43	15043.43	bcbs	ppo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	15043.43	15043.43	bcbs	epo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	16148.43	16148.43	bcbs	hmo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	16148.43	16148.43	bcbs	hmo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	16148.43	16148.43	bcbs	pos
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	16148.43	16148.43	bcbs	ppo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	16148.43	16148.43	bcbs	epo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	5268.13	5268.13	bcbs	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	5268.13	5268.13	bcbs	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	5268.13	5268.13	bcbs	pos
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	5268.13	5268.13	bcbs	ppo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	5268.13	5268.13	bcbs	epo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	14293.05	14293.05	bcbs	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	14293.05	14293.05	bcbs	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	14293.05	14293.05	bcbs	pos
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	14293.05	14293.05	bcbs	ppo
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	14293.05	14293.05	bcbs	epo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	252.56	252.56	bcbs	hmo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	252.56	252.56	bcbs	hmo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	252.56	252.56	bcbs	pos
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	252.56	252.56	bcbs	ppo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	252.56	252.56	bcbs	epo
organic disturbances and intellectual disability	ms-drg	884	9991.17	9991.17	8103.65	8103.65	24393.3	24393.3	20327.75	20327.75	I	9991.17	9991.17	bcbs	hmo
organic disturbances and intellectual disability	ms-drg	884	9991.17	9991.17	8103.65	8103.65	24393.3	24393.3	20327.75	20327.75	I	9991.17	9991.17	bcbs	hmo
organic disturbances and intellectual disability	ms-drg	884	9991.17	9991.17	8103.65	8103.65	24393.3	24393.3	20327.75	20327.75	I	9991.17	9991.17	bcbs	pos
organic disturbances and intellectual disability	ms-drg	884	9991.17	9991.17	8103.65	8103.65	24393.3	24393.3	20327.75	20327.75	I	9991.17	9991.17	bcbs	ppo
organic disturbances and intellectual disability	ms-drg	884	9991.17	9991.17	8103.65	8103.65	24393.3	24393.3	20327.75	20327.75	I	9991.17	9991.17	bcbs	epo
disorders of personality and impulse control	ms-drg	883	9665.06	9665.06	7955.07	7955.07	22695.91	22695.91	18913.26	18913.26	I	9665.06	9665.06	bcbs	hmo
disorders of personality and impulse control	ms-drg	883	9665.06	9665.06	7955.07	7955.07	22695.91	22695.91	18913.26	18913.26	I	9665.06	9665.06	bcbs	hmo
disorders of personality and impulse control	ms-drg	883	9665.06	9665.06	7955.07	7955.07	22695.91	22695.91	18913.26	18913.26	I	9665.06	9665.06	bcbs	pos
disorders of personality and impulse control	ms-drg	883	9665.06	9665.06	7955.07	7955.07	22695.91	22695.91	18913.26	18913.26	I	9665.06	9665.06	bcbs	ppo
disorders of personality and impulse control	ms-drg	883	9665.06	9665.06	7955.07	7955.07	22695.91	22695.91	18913.26	18913.26	I	9665.06	9665.06	bcbs	epo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5854.77	5854.77	bcbs	hmo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5854.77	5854.77	bcbs	hmo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5854.77	5854.77	bcbs	pos
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5854.77	5854.77	bcbs	ppo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5854.77	5854.77	bcbs	epo
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	105.54	105.54	bcbs	hmo
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	105.54	105.54	bcbs	hmo
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	105.54	105.54	bcbs	pos
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	105.54	105.54	bcbs	ppo
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	105.54	105.54	bcbs	epo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	6995.95	6995.95	bcbs	hmo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	6995.95	6995.95	bcbs	hmo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	6995.95	6995.95	bcbs	pos
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	6995.95	6995.95	bcbs	ppo
acute adjustment reaction and psychosocial dysfunction	ms-drg	880	6995.95	6995.95	2854.92	2854.92	20856.24	20856.24	17380.2	17380.2	I	6995.95	6995.95	bcbs	epo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	216.32	216.32	bcbs	hmo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	216.32	216.32	bcbs	hmo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	216.32	216.32	bcbs	pos
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	216.32	216.32	bcbs	ppo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	216.32	216.32	bcbs	epo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	8660.91	8660.91	bcbs	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	8660.91	8660.91	bcbs	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	8660.91	8660.91	bcbs	pos
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	8660.91	8660.91	bcbs	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	8660.91	8660.91	bcbs	epo
signs and symptoms without mcc	ms-drg	948	7102.12	7102.12	3008.27	3008.27	18472.45	18472.45	15393.71	15393.71	I	7102.12	7102.12	bcbs	hmo
signs and symptoms without mcc	ms-drg	948	7102.12	7102.12	3008.27	3008.27	18472.45	18472.45	15393.71	15393.71	I	7102.12	7102.12	bcbs	hmo
signs and symptoms without mcc	ms-drg	948	7102.12	7102.12	3008.27	3008.27	18472.45	18472.45	15393.71	15393.71	I	7102.12	7102.12	bcbs	pos
signs and symptoms without mcc	ms-drg	948	7102.12	7102.12	3008.27	3008.27	18472.45	18472.45	15393.71	15393.71	I	7102.12	7102.12	bcbs	ppo
signs and symptoms without mcc	ms-drg	948	7102.12	7102.12	3008.27	3008.27	18472.45	18472.45	15393.71	15393.71	I	7102.12	7102.12	bcbs	epo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	756.88	756.88	bcbs	hmo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	756.88	756.88	bcbs	hmo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	756.88	756.88	bcbs	pos
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	756.88	756.88	bcbs	ppo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	756.88	756.88	bcbs	epo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	18280.29	18280.29	bcbs	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	18280.29	18280.29	bcbs	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	18280.29	18280.29	bcbs	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	18280.29	18280.29	bcbs	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	18280.29	18280.29	bcbs	epo
Albumin (protein) level	cpt	82040	9.85	9.85	4.95	4.95	40.44	40.44	33.7	33.7	O	9.85	9.85	bcbs	hmo
Albumin (protein) level	cpt	82040	9.85	9.85	4.95	4.95	40.44	40.44	33.7	33.7	O	9.85	9.85	bcbs	hmo
Albumin (protein) level	cpt	82040	9.85	9.85	4.95	4.95	40.44	40.44	33.7	33.7	O	9.85	9.85	bcbs	pos
Albumin (protein) level	cpt	82040	9.85	9.85	4.95	4.95	40.44	40.44	33.7	33.7	O	9.85	9.85	bcbs	ppo
Albumin (protein) level	cpt	82040	9.85	9.85	4.95	4.95	40.44	40.44	33.7	33.7	O	9.85	9.85	bcbs	epo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1143.84	1143.84	bcbs	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1143.84	1143.84	bcbs	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1143.84	1143.84	bcbs	pos
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1143.84	1143.84	bcbs	ppo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1143.84	1143.84	bcbs	epo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	82754.48	82754.48	bcbs	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	82754.48	82754.48	bcbs	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	82754.48	82754.48	bcbs	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	82754.48	82754.48	bcbs	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	82754.48	82754.48	bcbs	epo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	18368.01	18368.01	bcbs	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	18368.01	18368.01	bcbs	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	18368.01	18368.01	bcbs	pos
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	18368.01	18368.01	bcbs	ppo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	18368.01	18368.01	bcbs	epo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	19157.94	19157.94	bcbs	hmo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	19157.94	19157.94	bcbs	hmo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	19157.94	19157.94	bcbs	pos
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	19157.94	19157.94	bcbs	ppo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	19157.94	19157.94	bcbs	epo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	85704.11	85704.11	bcbs	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	85704.11	85704.11	bcbs	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	85704.11	85704.11	bcbs	pos
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	85704.11	85704.11	bcbs	ppo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	85704.11	85704.11	bcbs	epo
lymphoma and non-acute leukemia with cc	ms-drg	841	24430.5	24430.5	10276.4	10276.4	22126.63	22126.63	18438.86	18438.86	I	24430.5	24430.5	bcbs	hmo
lymphoma and non-acute leukemia with cc	ms-drg	841	24430.5	24430.5	10276.4	10276.4	22126.63	22126.63	18438.86	18438.86	I	24430.5	24430.5	bcbs	hmo
lymphoma and non-acute leukemia with cc	ms-drg	841	24430.5	24430.5	10276.4	10276.4	22126.63	22126.63	18438.86	18438.86	I	24430.5	24430.5	bcbs	pos
lymphoma and non-acute leukemia with cc	ms-drg	841	24430.5	24430.5	10276.4	10276.4	22126.63	22126.63	18438.86	18438.86	I	24430.5	24430.5	bcbs	ppo
lymphoma and non-acute leukemia with cc	ms-drg	841	24430.5	24430.5	10276.4	10276.4	22126.63	22126.63	18438.86	18438.86	I	24430.5	24430.5	bcbs	epo
lymphoma and non-acute leukemia with mcc	ms-drg	840	24876.86	24876.86	16212.54	16212.54	103181.56	103181.56	85984.63	85984.63	I	16212.54	16212.54	bcbs	hmo
lymphoma and non-acute leukemia with mcc	ms-drg	840	24876.86	24876.86	16212.54	16212.54	103181.56	103181.56	85984.63	85984.63	I	16212.54	16212.54	bcbs	hmo
lymphoma and non-acute leukemia with mcc	ms-drg	840	24876.86	24876.86	16212.54	16212.54	103181.56	103181.56	85984.63	85984.63	I	16212.54	16212.54	bcbs	pos
lymphoma and non-acute leukemia with mcc	ms-drg	840	24876.86	24876.86	16212.54	16212.54	103181.56	103181.56	85984.63	85984.63	I	16212.54	16212.54	bcbs	ppo
lymphoma and non-acute leukemia with mcc	ms-drg	840	24876.86	24876.86	16212.54	16212.54	103181.56	103181.56	85984.63	85984.63	I	16212.54	16212.54	bcbs	epo
Drainage of abscess	cpt	10060	686.2	686.2	141.39	141.39	1122.38	1122.38	935.32	935.32	O	686.2	686.2	bcbs	hmo
Drainage of abscess	cpt	10060	686.2	686.2	141.39	141.39	1122.38	1122.38	935.32	935.32	O	686.2	686.2	bcbs	hmo
Drainage of abscess	cpt	10060	686.2	686.2	141.39	141.39	1122.38	1122.38	935.32	935.32	O	686.2	686.2	bcbs	pos
Drainage of abscess	cpt	10060	686.2	686.2	141.39	141.39	1122.38	1122.38	935.32	935.32	O	686.2	686.2	bcbs	ppo
Drainage of abscess	cpt	10060	686.2	686.2	141.39	141.39	1122.38	1122.38	935.32	935.32	O	686.2	686.2	bcbs	epo
acute leukemia without major o.r. procedures with cc	ms-drg	835	26232.54	26232.54	26232.54	26232.54	52465.08	52465.08	43720.9	43720.9	I	26232.54	26232.54	bcbs	hmo
acute leukemia without major o.r. procedures with cc	ms-drg	835	26232.54	26232.54	26232.54	26232.54	52465.08	52465.08	43720.9	43720.9	I	26232.54	26232.54	bcbs	hmo
acute leukemia without major o.r. procedures with cc	ms-drg	835	26232.54	26232.54	26232.54	26232.54	52465.08	52465.08	43720.9	43720.9	I	26232.54	26232.54	bcbs	pos
acute leukemia without major o.r. procedures with cc	ms-drg	835	26232.54	26232.54	26232.54	26232.54	52465.08	52465.08	43720.9	43720.9	I	26232.54	26232.54	bcbs	ppo
acute leukemia without major o.r. procedures with cc	ms-drg	835	26232.54	26232.54	26232.54	26232.54	52465.08	52465.08	43720.9	43720.9	I	26232.54	26232.54	bcbs	epo
Drainage of multiple abscess	cpt	10061	561.42	561.42	278.52	278.52	13987.92	13987.92	11656.6	11656.6	O	561.42	561.42	bcbs	hmo
Drainage of multiple abscess	cpt	10061	561.42	561.42	278.52	278.52	13987.92	13987.92	11656.6	11656.6	O	561.42	561.42	bcbs	hmo
Drainage of multiple abscess	cpt	10061	561.42	561.42	278.52	278.52	13987.92	13987.92	11656.6	11656.6	O	561.42	561.42	bcbs	pos
Drainage of multiple abscess	cpt	10061	561.42	561.42	278.52	278.52	13987.92	13987.92	11656.6	11656.6	O	561.42	561.42	bcbs	ppo
Drainage of multiple abscess	cpt	10061	561.42	561.42	278.52	278.52	13987.92	13987.92	11656.6	11656.6	O	561.42	561.42	bcbs	epo
other antepartum diagnoses without o.r. procedures without cc/mcc	ms-drg	833	4609.85	4609.85	1574.02	1574.02	9601.67	9601.67	8001.39	8001.39	I	4609.85	4609.85	bcbs	hmo
other antepartum diagnoses without o.r. procedures without cc/mcc	ms-drg	833	4609.85	4609.85	1574.02	1574.02	9601.67	9601.67	8001.39	8001.39	I	4609.85	4609.85	bcbs	hmo
other antepartum diagnoses without o.r. procedures without cc/mcc	ms-drg	833	4609.85	4609.85	1574.02	1574.02	9601.67	9601.67	8001.39	8001.39	I	4609.85	4609.85	bcbs	pos
other antepartum diagnoses without o.r. procedures without cc/mcc	ms-drg	833	4609.85	4609.85	1574.02	1574.02	9601.67	9601.67	8001.39	8001.39	I	4609.85	4609.85	bcbs	ppo
other antepartum diagnoses without o.r. procedures without cc/mcc	ms-drg	833	4609.85	4609.85	1574.02	1574.02	9601.67	9601.67	8001.39	8001.39	I	4609.85	4609.85	bcbs	epo
lymphoma and leukemia with major o.r. procedures without cc/mcc	ms-drg	822	18012.77	18012.77	8024.86	8024.86	29988.86	29988.86	24990.72	24990.72	I	18012.77	18012.77	bcbs	hmo
lymphoma and leukemia with major o.r. procedures without cc/mcc	ms-drg	822	18012.77	18012.77	8024.86	8024.86	29988.86	29988.86	24990.72	24990.72	I	18012.77	18012.77	bcbs	hmo
lymphoma and leukemia with major o.r. procedures without cc/mcc	ms-drg	822	18012.77	18012.77	8024.86	8024.86	29988.86	29988.86	24990.72	24990.72	I	18012.77	18012.77	bcbs	pos
lymphoma and leukemia with major o.r. procedures without cc/mcc	ms-drg	822	18012.77	18012.77	8024.86	8024.86	29988.86	29988.86	24990.72	24990.72	I	18012.77	18012.77	bcbs	ppo
lymphoma and leukemia with major o.r. procedures without cc/mcc	ms-drg	822	18012.77	18012.77	8024.86	8024.86	29988.86	29988.86	24990.72	24990.72	I	18012.77	18012.77	bcbs	epo
other antepartum diagnoses with o.r. procedures without cc/mcc	ms-drg	819	9322.89	9322.89	5314.57	5314.57	36119.1	36119.1	30099.25	30099.25	I	9322.89	9322.89	bcbs	hmo
other antepartum diagnoses with o.r. procedures without cc/mcc	ms-drg	819	9322.89	9322.89	5314.57	5314.57	36119.1	36119.1	30099.25	30099.25	I	9322.89	9322.89	bcbs	hmo
other antepartum diagnoses with o.r. procedures without cc/mcc	ms-drg	819	9322.89	9322.89	5314.57	5314.57	36119.1	36119.1	30099.25	30099.25	I	9322.89	9322.89	bcbs	pos
other antepartum diagnoses with o.r. procedures without cc/mcc	ms-drg	819	9322.89	9322.89	5314.57	5314.57	36119.1	36119.1	30099.25	30099.25	I	9322.89	9322.89	bcbs	ppo
other antepartum diagnoses with o.r. procedures without cc/mcc	ms-drg	819	9322.89	9322.89	5314.57	5314.57	36119.1	36119.1	30099.25	30099.25	I	9322.89	9322.89	bcbs	epo
Drainage of blood or fluid accumulation	cpt	10140	5905.66	5905.66	1215.96	1215.96	17090.41	17090.41	14242.01	14242.01	O	5905.66	5905.66	bcbs	hmo
Drainage of blood or fluid accumulation	cpt	10140	5905.66	5905.66	1215.96	1215.96	17090.41	17090.41	14242.01	14242.01	O	5905.66	5905.66	bcbs	hmo
Drainage of blood or fluid accumulation	cpt	10140	5905.66	5905.66	1215.96	1215.96	17090.41	17090.41	14242.01	14242.01	O	5905.66	5905.66	bcbs	pos
Drainage of blood or fluid accumulation	cpt	10140	5905.66	5905.66	1215.96	1215.96	17090.41	17090.41	14242.01	14242.01	O	5905.66	5905.66	bcbs	ppo
Drainage of blood or fluid accumulation	cpt	10140	5905.66	5905.66	1215.96	1215.96	17090.41	17090.41	14242.01	14242.01	O	5905.66	5905.66	bcbs	epo
other antepartum diagnoses with o.r. procedures with cc	ms-drg	818	14729.92	14729.92	3547.55	3547.55	32602.97	32602.97	27169.14	27169.14	I	14729.92	14729.92	bcbs	hmo
other antepartum diagnoses with o.r. procedures with cc	ms-drg	818	14729.92	14729.92	3547.55	3547.55	32602.97	32602.97	27169.14	27169.14	I	14729.92	14729.92	bcbs	hmo
other antepartum diagnoses with o.r. procedures with cc	ms-drg	818	14729.92	14729.92	3547.55	3547.55	32602.97	32602.97	27169.14	27169.14	I	14729.92	14729.92	bcbs	pos
other antepartum diagnoses with o.r. procedures with cc	ms-drg	818	14729.92	14729.92	3547.55	3547.55	32602.97	32602.97	27169.14	27169.14	I	14729.92	14729.92	bcbs	ppo
other antepartum diagnoses with o.r. procedures with cc	ms-drg	818	14729.92	14729.92	3547.55	3547.55	32602.97	32602.97	27169.14	27169.14	I	14729.92	14729.92	bcbs	epo
reticuloendothelial and immunity disorders with cc	ms-drg	815	14091.76	14091.76	6896.24	6896.24	20346.83	20346.83	16955.69	16955.69	I	14091.76	14091.76	bcbs	hmo
reticuloendothelial and immunity disorders with cc	ms-drg	815	14091.76	14091.76	6896.24	6896.24	20346.83	20346.83	16955.69	16955.69	I	14091.76	14091.76	bcbs	hmo
reticuloendothelial and immunity disorders with cc	ms-drg	815	14091.76	14091.76	6896.24	6896.24	20346.83	20346.83	16955.69	16955.69	I	14091.76	14091.76	bcbs	pos
reticuloendothelial and immunity disorders with cc	ms-drg	815	14091.76	14091.76	6896.24	6896.24	20346.83	20346.83	16955.69	16955.69	I	14091.76	14091.76	bcbs	ppo
reticuloendothelial and immunity disorders with cc	ms-drg	815	14091.76	14091.76	6896.24	6896.24	20346.83	20346.83	16955.69	16955.69	I	14091.76	14091.76	bcbs	epo
red blood cell disorders without mcc	ms-drg	812	8135.51	8135.51	3725.55	3725.55	22117.79	22117.79	18431.49	18431.49	I	8135.51	8135.51	bcbs	hmo
red blood cell disorders without mcc	ms-drg	812	8135.51	8135.51	3725.55	3725.55	22117.79	22117.79	18431.49	18431.49	I	8135.51	8135.51	bcbs	hmo
red blood cell disorders without mcc	ms-drg	812	8135.51	8135.51	3725.55	3725.55	22117.79	22117.79	18431.49	18431.49	I	8135.51	8135.51	bcbs	pos
red blood cell disorders without mcc	ms-drg	812	8135.51	8135.51	3725.55	3725.55	22117.79	22117.79	18431.49	18431.49	I	8135.51	8135.51	bcbs	ppo
red blood cell disorders without mcc	ms-drg	812	8135.51	8135.51	3725.55	3725.55	22117.79	22117.79	18431.49	18431.49	I	8135.51	8135.51	bcbs	epo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	15107.34	15107.34	bcbs	hmo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	15107.34	15107.34	bcbs	hmo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	15107.34	15107.34	bcbs	pos
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	15107.34	15107.34	bcbs	ppo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	15107.34	15107.34	bcbs	epo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc	ms-drg	810	8994.96	8994.96	5857.77	5857.77	29353.13	29353.13	24460.94	24460.94	I	8994.96	8994.96	bcbs	hmo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc	ms-drg	810	8994.96	8994.96	5857.77	5857.77	29353.13	29353.13	24460.94	24460.94	I	8994.96	8994.96	bcbs	hmo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc	ms-drg	810	8994.96	8994.96	5857.77	5857.77	29353.13	29353.13	24460.94	24460.94	I	8994.96	8994.96	bcbs	pos
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc	ms-drg	810	8994.96	8994.96	5857.77	5857.77	29353.13	29353.13	24460.94	24460.94	I	8994.96	8994.96	bcbs	ppo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc	ms-drg	810	8994.96	8994.96	5857.77	5857.77	29353.13	29353.13	24460.94	24460.94	I	8994.96	8994.96	bcbs	epo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc	ms-drg	809	12390.44	12390.44	7998.98	7998.98	53770.55	53770.55	44808.79	44808.79	I	12390.44	12390.44	bcbs	hmo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc	ms-drg	809	12390.44	12390.44	7998.98	7998.98	53770.55	53770.55	44808.79	44808.79	I	12390.44	12390.44	bcbs	hmo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc	ms-drg	809	12390.44	12390.44	7998.98	7998.98	53770.55	53770.55	44808.79	44808.79	I	12390.44	12390.44	bcbs	pos
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc	ms-drg	809	12390.44	12390.44	7998.98	7998.98	53770.55	53770.55	44808.79	44808.79	I	12390.44	12390.44	bcbs	ppo
major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders with cc	ms-drg	809	12390.44	12390.44	7998.98	7998.98	53770.55	53770.55	44808.79	44808.79	I	12390.44	12390.44	bcbs	epo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	6229.59	6229.59	bcbs	hmo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	6229.59	6229.59	bcbs	hmo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	6229.59	6229.59	bcbs	pos
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	6229.59	6229.59	bcbs	ppo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	6229.59	6229.59	bcbs	epo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	5438.74	5438.74	bcbs	hmo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	5438.74	5438.74	bcbs	hmo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	5438.74	5438.74	bcbs	pos
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	5438.74	5438.74	bcbs	ppo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	5438.74	5438.74	bcbs	epo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	725.19	725.19	bcbs	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	725.19	725.19	bcbs	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	725.19	725.19	bcbs	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	725.19	725.19	bcbs	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	725.19	725.19	bcbs	epo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	725.19	725.19	bcbs	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	725.19	725.19	bcbs	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	725.19	725.19	bcbs	pos
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	725.19	725.19	bcbs	ppo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	725.19	725.19	bcbs	epo
splenectomy with mcc	ms-drg	799	58397.17	58397.17	58397.17	58397.17	70076.6	70076.6	58397.17	58397.17	I	58397.17	58397.17	bcbs	hmo
splenectomy with mcc	ms-drg	799	58397.17	58397.17	58397.17	58397.17	70076.6	70076.6	58397.17	58397.17	I	58397.17	58397.17	bcbs	hmo
splenectomy with mcc	ms-drg	799	58397.17	58397.17	58397.17	58397.17	70076.6	70076.6	58397.17	58397.17	I	58397.17	58397.17	bcbs	pos
splenectomy with mcc	ms-drg	799	58397.17	58397.17	58397.17	58397.17	70076.6	70076.6	58397.17	58397.17	I	58397.17	58397.17	bcbs	ppo
splenectomy with mcc	ms-drg	799	58397.17	58397.17	58397.17	58397.17	70076.6	70076.6	58397.17	58397.17	I	58397.17	58397.17	bcbs	epo
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	6095.32	6095.32	bcbs	hmo
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	6095.32	6095.32	bcbs	hmo
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	6095.32	6095.32	bcbs	pos
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	6095.32	6095.32	bcbs	ppo
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	6095.32	6095.32	bcbs	epo
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	7536.77	7536.77	bcbs	hmo
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	7536.77	7536.77	bcbs	hmo
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	7536.77	7536.77	bcbs	pos
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	7536.77	7536.77	bcbs	ppo
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	7536.77	7536.77	bcbs	epo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	bcbs	hmo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	bcbs	hmo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	bcbs	pos
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	bcbs	ppo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	bcbs	epo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	5616.54	5616.54	bcbs	hmo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	5616.54	5616.54	bcbs	hmo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	5616.54	5616.54	bcbs	pos
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	5616.54	5616.54	bcbs	ppo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	5616.54	5616.54	bcbs	epo
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	9464.17	9464.17	bcbs	hmo
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	9464.17	9464.17	bcbs	hmo
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	9464.17	9464.17	bcbs	pos
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	9464.17	9464.17	bcbs	ppo
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	9464.17	9464.17	bcbs	epo
inflammation of the male reproductive system without mcc	ms-drg	728	6665.67	6665.67	2407.15	2407.15	11957.9	11957.9	9964.92	9964.92	I	6665.67	6665.67	bcbs	hmo
inflammation of the male reproductive system without mcc	ms-drg	728	6665.67	6665.67	2407.15	2407.15	11957.9	11957.9	9964.92	9964.92	I	6665.67	6665.67	bcbs	hmo
inflammation of the male reproductive system without mcc	ms-drg	728	6665.67	6665.67	2407.15	2407.15	11957.9	11957.9	9964.92	9964.92	I	6665.67	6665.67	bcbs	pos
inflammation of the male reproductive system without mcc	ms-drg	728	6665.67	6665.67	2407.15	2407.15	11957.9	11957.9	9964.92	9964.92	I	6665.67	6665.67	bcbs	ppo
inflammation of the male reproductive system without mcc	ms-drg	728	6665.67	6665.67	2407.15	2407.15	11957.9	11957.9	9964.92	9964.92	I	6665.67	6665.67	bcbs	epo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	39.6	39.6	bcbs	hmo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	39.6	39.6	bcbs	hmo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	39.6	39.6	bcbs	pos
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	39.6	39.6	bcbs	ppo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	39.6	39.6	bcbs	epo
major male pelvic procedures without cc/mcc	ms-drg	708	12301.43	12301.43	8430.85	8430.85	57462.36	57462.36	47885.3	47885.3	I	12301.43	12301.43	bcbs	hmo
major male pelvic procedures without cc/mcc	ms-drg	708	12301.43	12301.43	8430.85	8430.85	57462.36	57462.36	47885.3	47885.3	I	12301.43	12301.43	bcbs	hmo
major male pelvic procedures without cc/mcc	ms-drg	708	12301.43	12301.43	8430.85	8430.85	57462.36	57462.36	47885.3	47885.3	I	12301.43	12301.43	bcbs	pos
major male pelvic procedures without cc/mcc	ms-drg	708	12301.43	12301.43	8430.85	8430.85	57462.36	57462.36	47885.3	47885.3	I	12301.43	12301.43	bcbs	ppo
major male pelvic procedures without cc/mcc	ms-drg	708	12301.43	12301.43	8430.85	8430.85	57462.36	57462.36	47885.3	47885.3	I	12301.43	12301.43	bcbs	epo
major male pelvic procedures with cc/mcc	ms-drg	707	13215.8	13215.8	10639.1	10639.1	62125.99	62125.99	51771.66	51771.66	I	13215.8	13215.8	bcbs	hmo
major male pelvic procedures with cc/mcc	ms-drg	707	13215.8	13215.8	10639.1	10639.1	62125.99	62125.99	51771.66	51771.66	I	13215.8	13215.8	bcbs	hmo
major male pelvic procedures with cc/mcc	ms-drg	707	13215.8	13215.8	10639.1	10639.1	62125.99	62125.99	51771.66	51771.66	I	13215.8	13215.8	bcbs	pos
major male pelvic procedures with cc/mcc	ms-drg	707	13215.8	13215.8	10639.1	10639.1	62125.99	62125.99	51771.66	51771.66	I	13215.8	13215.8	bcbs	ppo
major male pelvic procedures with cc/mcc	ms-drg	707	13215.8	13215.8	10639.1	10639.1	62125.99	62125.99	51771.66	51771.66	I	13215.8	13215.8	bcbs	epo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2173.47	2173.47	bcbs	hmo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2173.47	2173.47	bcbs	hmo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2173.47	2173.47	bcbs	pos
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2173.47	2173.47	bcbs	ppo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2173.47	2173.47	bcbs	epo
other kidney and urinary tract diagnoses without cc/mcc	ms-drg	700	5405.71	5405.71	5149.02	5149.02	16275.34	16275.34	13562.78	13562.78	I	5405.71	5405.71	bcbs	hmo
other kidney and urinary tract diagnoses without cc/mcc	ms-drg	700	5405.71	5405.71	5149.02	5149.02	16275.34	16275.34	13562.78	13562.78	I	5405.71	5405.71	bcbs	hmo
other kidney and urinary tract diagnoses without cc/mcc	ms-drg	700	5405.71	5405.71	5149.02	5149.02	16275.34	16275.34	13562.78	13562.78	I	5405.71	5405.71	bcbs	pos
other kidney and urinary tract diagnoses without cc/mcc	ms-drg	700	5405.71	5405.71	5149.02	5149.02	16275.34	16275.34	13562.78	13562.78	I	5405.71	5405.71	bcbs	ppo
other kidney and urinary tract diagnoses without cc/mcc	ms-drg	700	5405.71	5405.71	5149.02	5149.02	16275.34	16275.34	13562.78	13562.78	I	5405.71	5405.71	bcbs	epo
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	7639.53	7639.53	bcbs	hmo
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	7639.53	7639.53	bcbs	hmo
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	7639.53	7639.53	bcbs	pos
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	7639.53	7639.53	bcbs	ppo
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	7639.53	7639.53	bcbs	epo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	18781.88	18781.88	bcbs	hmo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	18781.88	18781.88	bcbs	hmo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	18781.88	18781.88	bcbs	pos
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	18781.88	18781.88	bcbs	ppo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	18781.88	18781.88	bcbs	epo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	4476.04	4476.04	bcbs	hmo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	4476.04	4476.04	bcbs	hmo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	4476.04	4476.04	bcbs	pos
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	4476.04	4476.04	bcbs	ppo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	4476.04	4476.04	bcbs	epo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	6820.88	6820.88	bcbs	hmo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	6820.88	6820.88	bcbs	hmo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	6820.88	6820.88	bcbs	pos
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	6820.88	6820.88	bcbs	ppo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	6820.88	6820.88	bcbs	epo
"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11423	2631.83	2631.83	1215.96	1215.96	17605.97	17605.97	14671.64	14671.64	O	2631.83	2631.83	bcbs	hmo
"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11423	2631.83	2631.83	1215.96	1215.96	17605.97	17605.97	14671.64	14671.64	O	2631.83	2631.83	bcbs	hmo
"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11423	2631.83	2631.83	1215.96	1215.96	17605.97	17605.97	14671.64	14671.64	O	2631.83	2631.83	bcbs	pos
"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11423	2631.83	2631.83	1215.96	1215.96	17605.97	17605.97	14671.64	14671.64	O	2631.83	2631.83	bcbs	ppo
"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11423	2631.83	2631.83	1215.96	1215.96	17605.97	17605.97	14671.64	14671.64	O	2631.83	2631.83	bcbs	epo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	10878.75	10878.75	bcbs	hmo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	10878.75	10878.75	bcbs	hmo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	10878.75	10878.75	bcbs	pos
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	10878.75	10878.75	bcbs	ppo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	10878.75	10878.75	bcbs	epo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	8376.57	8376.57	bcbs	hmo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	8376.57	8376.57	bcbs	hmo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	8376.57	8376.57	bcbs	pos
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	8376.57	8376.57	bcbs	ppo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	8376.57	8376.57	bcbs	epo
"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs"	cpt	11604	2159.44	2159.44	681.92	681.92	15981.56	15981.56	13317.97	13317.97	O	2159.44	2159.44	bcbs	hmo
"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs"	cpt	11604	2159.44	2159.44	681.92	681.92	15981.56	15981.56	13317.97	13317.97	O	2159.44	2159.44	bcbs	hmo
"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs"	cpt	11604	2159.44	2159.44	681.92	681.92	15981.56	15981.56	13317.97	13317.97	O	2159.44	2159.44	bcbs	pos
"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs"	cpt	11604	2159.44	2159.44	681.92	681.92	15981.56	15981.56	13317.97	13317.97	O	2159.44	2159.44	bcbs	ppo
"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs"	cpt	11604	2159.44	2159.44	681.92	681.92	15981.56	15981.56	13317.97	13317.97	O	2159.44	2159.44	bcbs	epo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	5337.57	5337.57	bcbs	hmo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	5337.57	5337.57	bcbs	hmo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	5337.57	5337.57	bcbs	pos
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	5337.57	5337.57	bcbs	ppo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	5337.57	5337.57	bcbs	epo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	14766.63	14766.63	bcbs	hmo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	14766.63	14766.63	bcbs	hmo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	14766.63	14766.63	bcbs	pos
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	14766.63	14766.63	bcbs	ppo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	14766.63	14766.63	bcbs	epo
other kidney and urinary tract procedures with cc	ms-drg	674	19025.41	19025.41	12967.56	12967.56	50807.44	50807.44	42339.53	42339.53	I	19025.41	19025.41	bcbs	hmo
other kidney and urinary tract procedures with cc	ms-drg	674	19025.41	19025.41	12967.56	12967.56	50807.44	50807.44	42339.53	42339.53	I	19025.41	19025.41	bcbs	hmo
other kidney and urinary tract procedures with cc	ms-drg	674	19025.41	19025.41	12967.56	12967.56	50807.44	50807.44	42339.53	42339.53	I	19025.41	19025.41	bcbs	pos
other kidney and urinary tract procedures with cc	ms-drg	674	19025.41	19025.41	12967.56	12967.56	50807.44	50807.44	42339.53	42339.53	I	19025.41	19025.41	bcbs	ppo
other kidney and urinary tract procedures with cc	ms-drg	674	19025.41	19025.41	12967.56	12967.56	50807.44	50807.44	42339.53	42339.53	I	19025.41	19025.41	bcbs	epo
kidney and ureter procedures for neoplasm with cc	ms-drg	657	19461.2	19461.2	11797.09	11797.09	55709.35	55709.35	46424.46	46424.46	I	19461.2	19461.2	bcbs	hmo
kidney and ureter procedures for neoplasm with cc	ms-drg	657	19461.2	19461.2	11797.09	11797.09	55709.35	55709.35	46424.46	46424.46	I	19461.2	19461.2	bcbs	hmo
kidney and ureter procedures for neoplasm with cc	ms-drg	657	19461.2	19461.2	11797.09	11797.09	55709.35	55709.35	46424.46	46424.46	I	19461.2	19461.2	bcbs	pos
kidney and ureter procedures for neoplasm with cc	ms-drg	657	19461.2	19461.2	11797.09	11797.09	55709.35	55709.35	46424.46	46424.46	I	19461.2	19461.2	bcbs	ppo
kidney and ureter procedures for neoplasm with cc	ms-drg	657	19461.2	19461.2	11797.09	11797.09	55709.35	55709.35	46424.46	46424.46	I	19461.2	19461.2	bcbs	epo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5622.44	5622.44	bcbs	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5622.44	5622.44	bcbs	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5622.44	5622.44	bcbs	pos
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5622.44	5622.44	bcbs	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5622.44	5622.44	bcbs	epo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	4573.79	4573.79	bcbs	hmo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	4573.79	4573.79	bcbs	hmo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	4573.79	4573.79	bcbs	pos
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	4573.79	4573.79	bcbs	ppo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	4573.79	4573.79	bcbs	epo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	10946.86	10946.86	bcbs	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	10946.86	10946.86	bcbs	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	10946.86	10946.86	bcbs	pos
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	10946.86	10946.86	bcbs	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	10946.86	10946.86	bcbs	epo
diabetes without cc/mcc	ms-drg	639	6905	6905	2716.05	2716.05	25004.18	25004.18	20836.82	20836.82	I	6905	6905	bcbs	hmo
diabetes without cc/mcc	ms-drg	639	6905	6905	2716.05	2716.05	25004.18	25004.18	20836.82	20836.82	I	6905	6905	bcbs	hmo
diabetes without cc/mcc	ms-drg	639	6905	6905	2716.05	2716.05	25004.18	25004.18	20836.82	20836.82	I	6905	6905	bcbs	pos
diabetes without cc/mcc	ms-drg	639	6905	6905	2716.05	2716.05	25004.18	25004.18	20836.82	20836.82	I	6905	6905	bcbs	ppo
diabetes without cc/mcc	ms-drg	639	6905	6905	2716.05	2716.05	25004.18	25004.18	20836.82	20836.82	I	6905	6905	bcbs	epo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6594.75	6594.75	bcbs	hmo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6594.75	6594.75	bcbs	hmo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6594.75	6594.75	bcbs	pos
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6594.75	6594.75	bcbs	ppo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6594.75	6594.75	bcbs	epo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1401.49	1401.49	640.72	640.72	1251.49	1251.49	1042.91	1042.91	O	640.72	640.72	bcbs	hmo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1401.49	1401.49	640.72	640.72	1251.49	1251.49	1042.91	1042.91	O	640.72	640.72	bcbs	hmo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1401.49	1401.49	640.72	640.72	1251.49	1251.49	1042.91	1042.91	O	640.72	640.72	bcbs	pos
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1401.49	1401.49	640.72	640.72	1251.49	1251.49	1042.91	1042.91	O	640.72	640.72	bcbs	ppo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1401.49	1401.49	640.72	640.72	1251.49	1251.49	1042.91	1042.91	O	640.72	640.72	bcbs	epo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	17801.06	17801.06	bcbs	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	17801.06	17801.06	bcbs	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	17801.06	17801.06	bcbs	pos
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	17801.06	17801.06	bcbs	ppo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	17801.06	17801.06	bcbs	epo
o.r. procedures for obesity without cc/mcc	ms-drg	621	17948.64	17948.64	9347.86	9347.86	51584.39	51584.39	42986.99	42986.99	I	17948.64	17948.64	bcbs	hmo
o.r. procedures for obesity without cc/mcc	ms-drg	621	17948.64	17948.64	9347.86	9347.86	51584.39	51584.39	42986.99	42986.99	I	17948.64	17948.64	bcbs	hmo
o.r. procedures for obesity without cc/mcc	ms-drg	621	17948.64	17948.64	9347.86	9347.86	51584.39	51584.39	42986.99	42986.99	I	17948.64	17948.64	bcbs	pos
o.r. procedures for obesity without cc/mcc	ms-drg	621	17948.64	17948.64	9347.86	9347.86	51584.39	51584.39	42986.99	42986.99	I	17948.64	17948.64	bcbs	ppo
o.r. procedures for obesity without cc/mcc	ms-drg	621	17948.64	17948.64	9347.86	9347.86	51584.39	51584.39	42986.99	42986.99	I	17948.64	17948.64	bcbs	epo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	19091.29	19091.29	bcbs	hmo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	19091.29	19091.29	bcbs	hmo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	19091.29	19091.29	bcbs	pos
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	19091.29	19091.29	bcbs	ppo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	19091.29	19091.29	bcbs	epo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	616	30355.11	30355.11	21822.12	21822.12	71467.42	71467.42	59556.18	59556.18	I	30355.11	30355.11	bcbs	hmo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	616	30355.11	30355.11	21822.12	21822.12	71467.42	71467.42	59556.18	59556.18	I	30355.11	30355.11	bcbs	hmo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	616	30355.11	30355.11	21822.12	21822.12	71467.42	71467.42	59556.18	59556.18	I	30355.11	30355.11	bcbs	pos
"amputation of lower limb for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	616	30355.11	30355.11	21822.12	21822.12	71467.42	71467.42	59556.18	59556.18	I	30355.11	30355.11	bcbs	ppo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	616	30355.11	30355.11	21822.12	21822.12	71467.42	71467.42	59556.18	59556.18	I	30355.11	30355.11	bcbs	epo
"trauma to the skin, subcutaneous tissue and breast with mcc"	ms-drg	604	18821.82	18821.82	9430.43	9430.43	21023.42	21023.42	17519.52	17519.52	I	18821.82	18821.82	bcbs	hmo
"trauma to the skin, subcutaneous tissue and breast with mcc"	ms-drg	604	18821.82	18821.82	9430.43	9430.43	21023.42	21023.42	17519.52	17519.52	I	18821.82	18821.82	bcbs	hmo
"trauma to the skin, subcutaneous tissue and breast with mcc"	ms-drg	604	18821.82	18821.82	9430.43	9430.43	21023.42	21023.42	17519.52	17519.52	I	18821.82	18821.82	bcbs	pos
"trauma to the skin, subcutaneous tissue and breast with mcc"	ms-drg	604	18821.82	18821.82	9430.43	9430.43	21023.42	21023.42	17519.52	17519.52	I	18821.82	18821.82	bcbs	ppo
"trauma to the skin, subcutaneous tissue and breast with mcc"	ms-drg	604	18821.82	18821.82	9430.43	9430.43	21023.42	21023.42	17519.52	17519.52	I	18821.82	18821.82	bcbs	epo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	1515.89	1515.89	472.89	472.89	1524.65	1524.65	1270.54	1270.54	O	472.89	472.89	bcbs	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	1515.89	1515.89	472.89	472.89	1524.65	1524.65	1270.54	1270.54	O	472.89	472.89	bcbs	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	1515.89	1515.89	472.89	472.89	1524.65	1524.65	1270.54	1270.54	O	472.89	472.89	bcbs	pos
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	1515.89	1515.89	472.89	472.89	1524.65	1524.65	1270.54	1270.54	O	472.89	472.89	bcbs	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	1515.89	1515.89	472.89	472.89	1524.65	1524.65	1270.54	1270.54	O	472.89	472.89	bcbs	epo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7559.03	7559.03	bcbs	hmo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7559.03	7559.03	bcbs	hmo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7559.03	7559.03	bcbs	pos
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7559.03	7559.03	bcbs	ppo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	7559.03	7559.03	bcbs	epo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	16664.06	16664.06	bcbs	hmo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	16664.06	16664.06	bcbs	hmo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	16664.06	16664.06	bcbs	pos
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	16664.06	16664.06	bcbs	ppo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	16664.06	16664.06	bcbs	epo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	640.72	640.72	640.72	640.72	4369.51	4369.51	3641.26	3641.26	O	640.72	640.72	bcbs	hmo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	640.72	640.72	640.72	640.72	4369.51	4369.51	3641.26	3641.26	O	640.72	640.72	bcbs	hmo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	640.72	640.72	640.72	640.72	4369.51	4369.51	3641.26	3641.26	O	640.72	640.72	bcbs	pos
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	640.72	640.72	640.72	640.72	4369.51	4369.51	3641.26	3641.26	O	640.72	640.72	bcbs	ppo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	640.72	640.72	640.72	640.72	4369.51	4369.51	3641.26	3641.26	O	640.72	640.72	bcbs	epo
"other skin, subcutaneous tissue and breast procedures without cc/mcc"	ms-drg	581	9974.04	9974.04	7530.89	7530.89	30712.21	30712.21	25593.51	25593.51	I	9974.04	9974.04	bcbs	hmo
"other skin, subcutaneous tissue and breast procedures without cc/mcc"	ms-drg	581	9974.04	9974.04	7530.89	7530.89	30712.21	30712.21	25593.51	25593.51	I	9974.04	9974.04	bcbs	hmo
"other skin, subcutaneous tissue and breast procedures without cc/mcc"	ms-drg	581	9974.04	9974.04	7530.89	7530.89	30712.21	30712.21	25593.51	25593.51	I	9974.04	9974.04	bcbs	pos
"other skin, subcutaneous tissue and breast procedures without cc/mcc"	ms-drg	581	9974.04	9974.04	7530.89	7530.89	30712.21	30712.21	25593.51	25593.51	I	9974.04	9974.04	bcbs	ppo
"other skin, subcutaneous tissue and breast procedures without cc/mcc"	ms-drg	581	9974.04	9974.04	7530.89	7530.89	30712.21	30712.21	25593.51	25593.51	I	9974.04	9974.04	bcbs	epo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	13853.94	13853.94	bcbs	hmo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	13853.94	13853.94	bcbs	hmo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	13853.94	13853.94	bcbs	pos
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	13853.94	13853.94	bcbs	ppo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	13853.94	13853.94	bcbs	epo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	1652.17	1652.17	bcbs	hmo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	1652.17	1652.17	bcbs	hmo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	1652.17	1652.17	bcbs	pos
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	1652.17	1652.17	bcbs	ppo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	1652.17	1652.17	bcbs	epo
bone diseases and arthropathies without mcc	ms-drg	554	8455.5	8455.5	4967.63	4967.63	18622.21	18622.21	15518.51	15518.51	I	8455.5	8455.5	bcbs	hmo
bone diseases and arthropathies without mcc	ms-drg	554	8455.5	8455.5	4967.63	4967.63	18622.21	18622.21	15518.51	15518.51	I	8455.5	8455.5	bcbs	hmo
bone diseases and arthropathies without mcc	ms-drg	554	8455.5	8455.5	4967.63	4967.63	18622.21	18622.21	15518.51	15518.51	I	8455.5	8455.5	bcbs	pos
bone diseases and arthropathies without mcc	ms-drg	554	8455.5	8455.5	4967.63	4967.63	18622.21	18622.21	15518.51	15518.51	I	8455.5	8455.5	bcbs	ppo
bone diseases and arthropathies without mcc	ms-drg	554	8455.5	8455.5	4967.63	4967.63	18622.21	18622.21	15518.51	15518.51	I	8455.5	8455.5	bcbs	epo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	2122.04	2122.04	2122.04	2122.04	4656.02	4656.02	3880.02	3880.02	O	2122.04	2122.04	bcbs	hmo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	2122.04	2122.04	2122.04	2122.04	4656.02	4656.02	3880.02	3880.02	O	2122.04	2122.04	bcbs	hmo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	2122.04	2122.04	2122.04	2122.04	4656.02	4656.02	3880.02	3880.02	O	2122.04	2122.04	bcbs	pos
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	2122.04	2122.04	2122.04	2122.04	4656.02	4656.02	3880.02	3880.02	O	2122.04	2122.04	bcbs	ppo
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	2122.04	2122.04	2122.04	2122.04	4656.02	4656.02	3880.02	3880.02	O	2122.04	2122.04	bcbs	epo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12032	4468.85	4468.85	1196.5	1196.5	15697.86	15697.86	13081.55	13081.55	O	4468.85	4468.85	bcbs	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12032	4468.85	4468.85	1196.5	1196.5	15697.86	15697.86	13081.55	13081.55	O	4468.85	4468.85	bcbs	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12032	4468.85	4468.85	1196.5	1196.5	15697.86	15697.86	13081.55	13081.55	O	4468.85	4468.85	bcbs	pos
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12032	4468.85	4468.85	1196.5	1196.5	15697.86	15697.86	13081.55	13081.55	O	4468.85	4468.85	bcbs	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12032	4468.85	4468.85	1196.5	1196.5	15697.86	15697.86	13081.55	13081.55	O	4468.85	4468.85	bcbs	epo
"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12036	4483.23	4483.23	4483.23	4483.23	35311.22	35311.22	29426.02	29426.02	O	4483.23	4483.23	bcbs	hmo
"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12036	4483.23	4483.23	4483.23	4483.23	35311.22	35311.22	29426.02	29426.02	O	4483.23	4483.23	bcbs	hmo
"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12036	4483.23	4483.23	4483.23	4483.23	35311.22	35311.22	29426.02	29426.02	O	4483.23	4483.23	bcbs	pos
"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12036	4483.23	4483.23	4483.23	4483.23	35311.22	35311.22	29426.02	29426.02	O	4483.23	4483.23	bcbs	ppo
"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs"	cpt	12036	4483.23	4483.23	4483.23	4483.23	35311.22	35311.22	29426.02	29426.02	O	4483.23	4483.23	bcbs	epo
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	12327.66	12327.66	bcbs	hmo
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	12327.66	12327.66	bcbs	hmo
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	12327.66	12327.66	bcbs	pos
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	12327.66	12327.66	bcbs	ppo
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	12327.66	12327.66	bcbs	epo
medical back problems without mcc	ms-drg	552	6174.92	6174.92	4114.58	4114.58	24041.95	24041.95	20034.96	20034.96	I	5986.67	5986.67	bcbs	hmo
medical back problems without mcc	ms-drg	552	6174.92	6174.92	4114.58	4114.58	24041.95	24041.95	20034.96	20034.96	I	5986.67	5986.67	bcbs	hmo
medical back problems without mcc	ms-drg	552	6174.92	6174.92	4114.58	4114.58	24041.95	24041.95	20034.96	20034.96	I	5986.67	5986.67	bcbs	pos
medical back problems without mcc	ms-drg	552	6174.92	6174.92	4114.58	4114.58	24041.95	24041.95	20034.96	20034.96	I	5986.67	5986.67	bcbs	ppo
medical back problems without mcc	ms-drg	552	6174.92	6174.92	4114.58	4114.58	24041.95	24041.95	20034.96	20034.96	I	5986.67	5986.67	bcbs	epo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	12494.82	12494.82	bcbs	hmo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	12494.82	12494.82	bcbs	hmo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	12494.82	12494.82	bcbs	pos
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	12494.82	12494.82	bcbs	ppo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	12494.82	12494.82	bcbs	epo
soft tissue procedures without cc/mcc	ms-drg	502	10743.81	10743.81	7599.45	7599.45	46045.74	46045.74	38371.45	38371.45	I	10743.81	10743.81	bcbs	hmo
soft tissue procedures without cc/mcc	ms-drg	502	10743.81	10743.81	7599.45	7599.45	46045.74	46045.74	38371.45	38371.45	I	10743.81	10743.81	bcbs	hmo
soft tissue procedures without cc/mcc	ms-drg	502	10743.81	10743.81	7599.45	7599.45	46045.74	46045.74	38371.45	38371.45	I	10743.81	10743.81	bcbs	pos
soft tissue procedures without cc/mcc	ms-drg	502	10743.81	10743.81	7599.45	7599.45	46045.74	46045.74	38371.45	38371.45	I	10743.81	10743.81	bcbs	ppo
soft tissue procedures without cc/mcc	ms-drg	502	10743.81	10743.81	7599.45	7599.45	46045.74	46045.74	38371.45	38371.45	I	10743.81	10743.81	bcbs	epo
"Partial thickness skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)"	cpt	15100	6603.11	6603.11	6603.11	6603.11	20368.04	20368.04	16973.37	16973.37	O	6603.11	6603.11	bcbs	hmo
"Partial thickness skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)"	cpt	15100	6603.11	6603.11	6603.11	6603.11	20368.04	20368.04	16973.37	16973.37	O	6603.11	6603.11	bcbs	hmo
"Partial thickness skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)"	cpt	15100	6603.11	6603.11	6603.11	6603.11	20368.04	20368.04	16973.37	16973.37	O	6603.11	6603.11	bcbs	pos
"Partial thickness skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)"	cpt	15100	6603.11	6603.11	6603.11	6603.11	20368.04	20368.04	16973.37	16973.37	O	6603.11	6603.11	bcbs	ppo
"Partial thickness skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)"	cpt	15100	6603.11	6603.11	6603.11	6603.11	20368.04	20368.04	16973.37	16973.37	O	6603.11	6603.11	bcbs	epo
"lower extremity and humerus procedures except hip, foot and femur with cc"	ms-drg	493	17098.05	17098.05	11409.73	11409.73	65822.2	65822.2	54851.83	54851.83	I	17098.05	17098.05	bcbs	hmo
"lower extremity and humerus procedures except hip, foot and femur with cc"	ms-drg	493	17098.05	17098.05	11409.73	11409.73	65822.2	65822.2	54851.83	54851.83	I	17098.05	17098.05	bcbs	hmo
"lower extremity and humerus procedures except hip, foot and femur with cc"	ms-drg	493	17098.05	17098.05	11409.73	11409.73	65822.2	65822.2	54851.83	54851.83	I	17098.05	17098.05	bcbs	pos
"lower extremity and humerus procedures except hip, foot and femur with cc"	ms-drg	493	17098.05	17098.05	11409.73	11409.73	65822.2	65822.2	54851.83	54851.83	I	17098.05	17098.05	bcbs	ppo
"lower extremity and humerus procedures except hip, foot and femur with cc"	ms-drg	493	17098.05	17098.05	11409.73	11409.73	65822.2	65822.2	54851.83	54851.83	I	17098.05	17098.05	bcbs	epo
knee procedures without principal diagnosis of infection with cc/mcc	ms-drg	488	19799.11	19799.11	19799.11	19799.11	82344.42	82344.42	68620.35	68620.35	I	19799.11	19799.11	bcbs	hmo
knee procedures without principal diagnosis of infection with cc/mcc	ms-drg	488	19799.11	19799.11	19799.11	19799.11	82344.42	82344.42	68620.35	68620.35	I	19799.11	19799.11	bcbs	hmo
knee procedures without principal diagnosis of infection with cc/mcc	ms-drg	488	19799.11	19799.11	19799.11	19799.11	82344.42	82344.42	68620.35	68620.35	I	19799.11	19799.11	bcbs	pos
knee procedures without principal diagnosis of infection with cc/mcc	ms-drg	488	19799.11	19799.11	19799.11	19799.11	82344.42	82344.42	68620.35	68620.35	I	19799.11	19799.11	bcbs	ppo
knee procedures without principal diagnosis of infection with cc/mcc	ms-drg	488	19799.11	19799.11	19799.11	19799.11	82344.42	82344.42	68620.35	68620.35	I	19799.11	19799.11	bcbs	epo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)"	cpt	15273	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	hmo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)"	cpt	15273	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	hmo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)"	cpt	15273	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	pos
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)"	cpt	15273	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	ppo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)"	cpt	15273	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	epo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs"	cpt	15274	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	hmo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs"	cpt	15274	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	hmo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs"	cpt	15274	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	pos
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs"	cpt	15274	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	ppo
"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs"	cpt	15274	2485.7	2485.7	2485.7	2485.7	29471.2	29471.2	24559.33	24559.33	O	2485.7	2485.7	bcbs	epo
knee procedures with principal diagnosis of infection without cc/mcc	ms-drg	487	19088.23	19088.23	9332	9332	41727.58	41727.58	34772.98	34772.98	I	19088.23	19088.23	bcbs	hmo
knee procedures with principal diagnosis of infection without cc/mcc	ms-drg	487	19088.23	19088.23	9332	9332	41727.58	41727.58	34772.98	34772.98	I	19088.23	19088.23	bcbs	hmo
knee procedures with principal diagnosis of infection without cc/mcc	ms-drg	487	19088.23	19088.23	9332	9332	41727.58	41727.58	34772.98	34772.98	I	19088.23	19088.23	bcbs	pos
knee procedures with principal diagnosis of infection without cc/mcc	ms-drg	487	19088.23	19088.23	9332	9332	41727.58	41727.58	34772.98	34772.98	I	19088.23	19088.23	bcbs	ppo
knee procedures with principal diagnosis of infection without cc/mcc	ms-drg	487	19088.23	19088.23	9332	9332	41727.58	41727.58	34772.98	34772.98	I	19088.23	19088.23	bcbs	epo
knee procedures with principal diagnosis of infection with mcc	ms-drg	485	44864.13	44864.13	44864.13	44864.13	141650.32	141650.32	118041.93	118041.93	I	44864.13	44864.13	bcbs	hmo
knee procedures with principal diagnosis of infection with mcc	ms-drg	485	44864.13	44864.13	44864.13	44864.13	141650.32	141650.32	118041.93	118041.93	I	44864.13	44864.13	bcbs	hmo
knee procedures with principal diagnosis of infection with mcc	ms-drg	485	44864.13	44864.13	44864.13	44864.13	141650.32	141650.32	118041.93	118041.93	I	44864.13	44864.13	bcbs	pos
knee procedures with principal diagnosis of infection with mcc	ms-drg	485	44864.13	44864.13	44864.13	44864.13	141650.32	141650.32	118041.93	118041.93	I	44864.13	44864.13	bcbs	ppo
knee procedures with principal diagnosis of infection with mcc	ms-drg	485	44864.13	44864.13	44864.13	44864.13	141650.32	141650.32	118041.93	118041.93	I	44864.13	44864.13	bcbs	epo
hip and femur procedures except major joint without cc/mcc	ms-drg	482	18778.5	18778.5	9099.73	9099.73	55806.76	55806.76	46505.63	46505.63	I	18778.5	18778.5	bcbs	hmo
hip and femur procedures except major joint without cc/mcc	ms-drg	482	18778.5	18778.5	9099.73	9099.73	55806.76	55806.76	46505.63	46505.63	I	18778.5	18778.5	bcbs	hmo
hip and femur procedures except major joint without cc/mcc	ms-drg	482	18778.5	18778.5	9099.73	9099.73	55806.76	55806.76	46505.63	46505.63	I	18778.5	18778.5	bcbs	pos
hip and femur procedures except major joint without cc/mcc	ms-drg	482	18778.5	18778.5	9099.73	9099.73	55806.76	55806.76	46505.63	46505.63	I	18778.5	18778.5	bcbs	ppo
hip and femur procedures except major joint without cc/mcc	ms-drg	482	18778.5	18778.5	9099.73	9099.73	55806.76	55806.76	46505.63	46505.63	I	18778.5	18778.5	bcbs	epo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	22569.55	22569.55	bcbs	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	22569.55	22569.55	bcbs	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	22569.55	22569.55	bcbs	pos
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	22569.55	22569.55	bcbs	ppo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	22569.55	22569.55	bcbs	epo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	4127.82	4127.82	bcbs	hmo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	4127.82	4127.82	bcbs	hmo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	4127.82	4127.82	bcbs	pos
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	4127.82	4127.82	bcbs	ppo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	4127.82	4127.82	bcbs	epo
disorders of the biliary tract without cc/mcc	ms-drg	446	4281.93	4281.93	626.37	626.37	12293.78	12293.78	10244.82	10244.82	I	2148.22	2148.22	bcbs	hmo
disorders of the biliary tract without cc/mcc	ms-drg	446	4281.93	4281.93	626.37	626.37	12293.78	12293.78	10244.82	10244.82	I	2148.22	2148.22	bcbs	hmo
disorders of the biliary tract without cc/mcc	ms-drg	446	4281.93	4281.93	626.37	626.37	12293.78	12293.78	10244.82	10244.82	I	2148.22	2148.22	bcbs	pos
disorders of the biliary tract without cc/mcc	ms-drg	446	4281.93	4281.93	626.37	626.37	12293.78	12293.78	10244.82	10244.82	I	2148.22	2148.22	bcbs	ppo
disorders of the biliary tract without cc/mcc	ms-drg	446	4281.93	4281.93	626.37	626.37	12293.78	12293.78	10244.82	10244.82	I	2148.22	2148.22	bcbs	epo
disorders of the biliary tract with cc	ms-drg	445	8690.18	8690.18	5165.72	5165.72	22817.4	22817.4	19014.5	19014.5	I	8690.18	8690.18	bcbs	hmo
disorders of the biliary tract with cc	ms-drg	445	8690.18	8690.18	5165.72	5165.72	22817.4	22817.4	19014.5	19014.5	I	8690.18	8690.18	bcbs	hmo
disorders of the biliary tract with cc	ms-drg	445	8690.18	8690.18	5165.72	5165.72	22817.4	22817.4	19014.5	19014.5	I	8690.18	8690.18	bcbs	pos
disorders of the biliary tract with cc	ms-drg	445	8690.18	8690.18	5165.72	5165.72	22817.4	22817.4	19014.5	19014.5	I	8690.18	8690.18	bcbs	ppo
disorders of the biliary tract with cc	ms-drg	445	8690.18	8690.18	5165.72	5165.72	22817.4	22817.4	19014.5	19014.5	I	8690.18	8690.18	bcbs	epo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without cc/mcc"	ms-drg	443	8609.76	8609.76	3148.67	3148.67	12770.82	12770.82	10642.35	10642.35	I	8609.76	8609.76	bcbs	hmo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without cc/mcc"	ms-drg	443	8609.76	8609.76	3148.67	3148.67	12770.82	12770.82	10642.35	10642.35	I	8609.76	8609.76	bcbs	hmo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without cc/mcc"	ms-drg	443	8609.76	8609.76	3148.67	3148.67	12770.82	12770.82	10642.35	10642.35	I	8609.76	8609.76	bcbs	pos
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without cc/mcc"	ms-drg	443	8609.76	8609.76	3148.67	3148.67	12770.82	12770.82	10642.35	10642.35	I	8609.76	8609.76	bcbs	ppo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without cc/mcc"	ms-drg	443	8609.76	8609.76	3148.67	3148.67	12770.82	12770.82	10642.35	10642.35	I	8609.76	8609.76	bcbs	epo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	11912.5	11912.5	bcbs	hmo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	11912.5	11912.5	bcbs	hmo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	11912.5	11912.5	bcbs	pos
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	11912.5	11912.5	bcbs	ppo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	11912.5	11912.5	bcbs	epo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	4127.82	4127.82	bcbs	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	4127.82	4127.82	bcbs	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	4127.82	4127.82	bcbs	pos
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	4127.82	4127.82	bcbs	ppo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	4127.82	4127.82	bcbs	epo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	25700.17	25700.17	bcbs	hmo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	25700.17	25700.17	bcbs	hmo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	25700.17	25700.17	bcbs	pos
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	25700.17	25700.17	bcbs	ppo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	25700.17	25700.17	bcbs	epo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	4003.45	4003.45	bcbs	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	4003.45	4003.45	bcbs	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	4003.45	4003.45	bcbs	pos
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	4003.45	4003.45	bcbs	ppo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	4003.45	4003.45	bcbs	epo
malignancy of hepatobiliary system or pancreas with cc	ms-drg	436	13157.45	13157.45	6996.06	6996.06	33590.44	33590.44	27992.03	27992.03	I	13157.45	13157.45	bcbs	hmo
malignancy of hepatobiliary system or pancreas with cc	ms-drg	436	13157.45	13157.45	6996.06	6996.06	33590.44	33590.44	27992.03	27992.03	I	13157.45	13157.45	bcbs	hmo
malignancy of hepatobiliary system or pancreas with cc	ms-drg	436	13157.45	13157.45	6996.06	6996.06	33590.44	33590.44	27992.03	27992.03	I	13157.45	13157.45	bcbs	pos
malignancy of hepatobiliary system or pancreas with cc	ms-drg	436	13157.45	13157.45	6996.06	6996.06	33590.44	33590.44	27992.03	27992.03	I	13157.45	13157.45	bcbs	ppo
malignancy of hepatobiliary system or pancreas with cc	ms-drg	436	13157.45	13157.45	6996.06	6996.06	33590.44	33590.44	27992.03	27992.03	I	13157.45	13157.45	bcbs	epo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	10629.2	10629.2	bcbs	hmo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	10629.2	10629.2	bcbs	hmo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	10629.2	10629.2	bcbs	pos
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	10629.2	10629.2	bcbs	ppo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	10629.2	10629.2	bcbs	epo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	9763.9	9763.9	bcbs	hmo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	9763.9	9763.9	bcbs	hmo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	9763.9	9763.9	bcbs	pos
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	9763.9	9763.9	bcbs	ppo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	9763.9	9763.9	bcbs	epo
laparoscopic cholecystectomy without c.d.e. with cc	ms-drg	418	12197.9	12197.9	5638.44	5638.44	46278.29	46278.29	38565.24	38565.24	I	12197.9	12197.9	bcbs	hmo
laparoscopic cholecystectomy without c.d.e. with cc	ms-drg	418	12197.9	12197.9	5638.44	5638.44	46278.29	46278.29	38565.24	38565.24	I	12197.9	12197.9	bcbs	hmo
laparoscopic cholecystectomy without c.d.e. with cc	ms-drg	418	12197.9	12197.9	5638.44	5638.44	46278.29	46278.29	38565.24	38565.24	I	12197.9	12197.9	bcbs	pos
laparoscopic cholecystectomy without c.d.e. with cc	ms-drg	418	12197.9	12197.9	5638.44	5638.44	46278.29	46278.29	38565.24	38565.24	I	12197.9	12197.9	bcbs	ppo
laparoscopic cholecystectomy without c.d.e. with cc	ms-drg	418	12197.9	12197.9	5638.44	5638.44	46278.29	46278.29	38565.24	38565.24	I	12197.9	12197.9	bcbs	epo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	8915.14	8915.14	bcbs	hmo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	8915.14	8915.14	bcbs	hmo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	8915.14	8915.14	bcbs	pos
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	8915.14	8915.14	bcbs	ppo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	8915.14	8915.14	bcbs	epo
cholecystectomy except by laparoscope without c.d.e. with cc	ms-drg	415	19326.82	19326.82	12873.6	12873.6	68989.45	68989.45	57491.21	57491.21	I	19326.82	19326.82	bcbs	hmo
cholecystectomy except by laparoscope without c.d.e. with cc	ms-drg	415	19326.82	19326.82	12873.6	12873.6	68989.45	68989.45	57491.21	57491.21	I	19326.82	19326.82	bcbs	hmo
cholecystectomy except by laparoscope without c.d.e. with cc	ms-drg	415	19326.82	19326.82	12873.6	12873.6	68989.45	68989.45	57491.21	57491.21	I	19326.82	19326.82	bcbs	pos
cholecystectomy except by laparoscope without c.d.e. with cc	ms-drg	415	19326.82	19326.82	12873.6	12873.6	68989.45	68989.45	57491.21	57491.21	I	19326.82	19326.82	bcbs	ppo
cholecystectomy except by laparoscope without c.d.e. with cc	ms-drg	415	19326.82	19326.82	12873.6	12873.6	68989.45	68989.45	57491.21	57491.21	I	19326.82	19326.82	bcbs	epo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	6014.04	6014.04	bcbs	hmo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	6014.04	6014.04	bcbs	hmo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	6014.04	6014.04	bcbs	pos
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	6014.04	6014.04	bcbs	ppo
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	6014.04	6014.04	bcbs	epo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	8388.74	8388.74	bcbs	hmo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	8388.74	8388.74	bcbs	hmo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	8388.74	8388.74	bcbs	pos
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	8388.74	8388.74	bcbs	ppo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	8388.74	8388.74	bcbs	epo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	6171.29	6171.29	bcbs	hmo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	6171.29	6171.29	bcbs	hmo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	6171.29	6171.29	bcbs	pos
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	6171.29	6171.29	bcbs	ppo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	6171.29	6171.29	bcbs	epo
"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction"	cpt	19340	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	hmo
"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction"	cpt	19340	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	hmo
"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction"	cpt	19340	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	pos
"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction"	cpt	19340	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	ppo
"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction"	cpt	19340	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	epo
Removal of capsule surrounding breast	cpt	19371	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	hmo
Removal of capsule surrounding breast	cpt	19371	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	hmo
Removal of capsule surrounding breast	cpt	19371	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	pos
Removal of capsule surrounding breast	cpt	19371	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	ppo
Removal of capsule surrounding breast	cpt	19371	5905.66	5905.66	5905.66	5905.66	25535.18	25535.18	21279.32	21279.32	O	5905.66	5905.66	bcbs	epo
Injections of tendon attachment to bone	cpt	20551	16365.34	16365.34	329.32	329.32	641.84	641.84	534.87	534.87	O	16365.34	16365.34	bcbs	hmo
Injections of tendon attachment to bone	cpt	20551	16365.34	16365.34	329.32	329.32	641.84	641.84	534.87	534.87	O	16365.34	16365.34	bcbs	hmo
Injections of tendon attachment to bone	cpt	20551	16365.34	16365.34	329.32	329.32	641.84	641.84	534.87	534.87	O	16365.34	16365.34	bcbs	pos
Injections of tendon attachment to bone	cpt	20551	16365.34	16365.34	329.32	329.32	641.84	641.84	534.87	534.87	O	16365.34	16365.34	bcbs	ppo
Injections of tendon attachment to bone	cpt	20551	16365.34	16365.34	329.32	329.32	641.84	641.84	534.87	534.87	O	16365.34	16365.34	bcbs	epo
"esophagitis, gastroenteritis and miscellaneous digestive disorders with mcc"	ms-drg	391	8351.98	8351.98	6959.33	6959.33	31444.44	31444.44	26203.7	26203.7	I	8351.98	8351.98	bcbs	hmo
"esophagitis, gastroenteritis and miscellaneous digestive disorders with mcc"	ms-drg	391	8351.98	8351.98	6959.33	6959.33	31444.44	31444.44	26203.7	26203.7	I	8351.98	8351.98	bcbs	hmo
"esophagitis, gastroenteritis and miscellaneous digestive disorders with mcc"	ms-drg	391	8351.98	8351.98	6959.33	6959.33	31444.44	31444.44	26203.7	26203.7	I	8351.98	8351.98	bcbs	pos
"esophagitis, gastroenteritis and miscellaneous digestive disorders with mcc"	ms-drg	391	8351.98	8351.98	6959.33	6959.33	31444.44	31444.44	26203.7	26203.7	I	8351.98	8351.98	bcbs	ppo
"esophagitis, gastroenteritis and miscellaneous digestive disorders with mcc"	ms-drg	391	8351.98	8351.98	6959.33	6959.33	31444.44	31444.44	26203.7	26203.7	I	8351.98	8351.98	bcbs	epo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	6339.29	6339.29	bcbs	hmo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	6339.29	6339.29	bcbs	hmo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	6339.29	6339.29	bcbs	pos
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	6339.29	6339.29	bcbs	ppo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	6339.29	6339.29	bcbs	epo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	11750.65	11750.65	bcbs	hmo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	11750.65	11750.65	bcbs	hmo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	11750.65	11750.65	bcbs	pos
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	11750.65	11750.65	bcbs	ppo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	11750.65	11750.65	bcbs	epo
inflammatory bowel disease with mcc	ms-drg	385	23283.56	23283.56	10201.78	10201.78	42057.36	42057.36	35047.8	35047.8	I	23283.56	23283.56	bcbs	hmo
inflammatory bowel disease with mcc	ms-drg	385	23283.56	23283.56	10201.78	10201.78	42057.36	42057.36	35047.8	35047.8	I	23283.56	23283.56	bcbs	hmo
inflammatory bowel disease with mcc	ms-drg	385	23283.56	23283.56	10201.78	10201.78	42057.36	42057.36	35047.8	35047.8	I	23283.56	23283.56	bcbs	pos
inflammatory bowel disease with mcc	ms-drg	385	23283.56	23283.56	10201.78	10201.78	42057.36	42057.36	35047.8	35047.8	I	23283.56	23283.56	bcbs	ppo
inflammatory bowel disease with mcc	ms-drg	385	23283.56	23283.56	10201.78	10201.78	42057.36	42057.36	35047.8	35047.8	I	23283.56	23283.56	bcbs	epo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	877.03	877.03	bcbs	hmo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	877.03	877.03	bcbs	hmo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	877.03	877.03	bcbs	pos
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	877.03	877.03	bcbs	ppo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	877.03	877.03	bcbs	epo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	8605.42	8605.42	bcbs	hmo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	8605.42	8605.42	bcbs	hmo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	8605.42	8605.42	bcbs	pos
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	8605.42	8605.42	bcbs	ppo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	8605.42	8605.42	bcbs	epo
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance	cpt	20611	1560.4	1560.4	329.25	329.25	1023.7	1023.7	853.08	853.08	O	1560.4	1560.4	bcbs	hmo
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance	cpt	20611	1560.4	1560.4	329.25	329.25	1023.7	1023.7	853.08	853.08	O	1560.4	1560.4	bcbs	hmo
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance	cpt	20611	1560.4	1560.4	329.25	329.25	1023.7	1023.7	853.08	853.08	O	1560.4	1560.4	bcbs	pos
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance	cpt	20611	1560.4	1560.4	329.25	329.25	1023.7	1023.7	853.08	853.08	O	1560.4	1560.4	bcbs	ppo
Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance	cpt	20611	1560.4	1560.4	329.25	329.25	1023.7	1023.7	853.08	853.08	O	1560.4	1560.4	bcbs	epo
Aspiration and injection treatment of bone cyst	cpt	20615	1290.38	1290.38	1290.38	1290.38	1548.46	1548.46	1290.38	1290.38	O	1290.38	1290.38	bcbs	hmo
Aspiration and injection treatment of bone cyst	cpt	20615	1290.38	1290.38	1290.38	1290.38	1548.46	1548.46	1290.38	1290.38	O	1290.38	1290.38	bcbs	hmo
Aspiration and injection treatment of bone cyst	cpt	20615	1290.38	1290.38	1290.38	1290.38	1548.46	1548.46	1290.38	1290.38	O	1290.38	1290.38	bcbs	pos
Aspiration and injection treatment of bone cyst	cpt	20615	1290.38	1290.38	1290.38	1290.38	1548.46	1548.46	1290.38	1290.38	O	1290.38	1290.38	bcbs	ppo
Aspiration and injection treatment of bone cyst	cpt	20615	1290.38	1290.38	1290.38	1290.38	1548.46	1548.46	1290.38	1290.38	O	1290.38	1290.38	bcbs	epo
Removal of deep bone implant	cpt	20680	5259.68	5259.68	1627.49	1627.49	19506.22	19506.22	16255.18	16255.18	O	5259.68	5259.68	bcbs	hmo
Removal of deep bone implant	cpt	20680	5259.68	5259.68	1627.49	1627.49	19506.22	19506.22	16255.18	16255.18	O	5259.68	5259.68	bcbs	hmo
Removal of deep bone implant	cpt	20680	5259.68	5259.68	1627.49	1627.49	19506.22	19506.22	16255.18	16255.18	O	5259.68	5259.68	bcbs	pos
Removal of deep bone implant	cpt	20680	5259.68	5259.68	1627.49	1627.49	19506.22	19506.22	16255.18	16255.18	O	5259.68	5259.68	bcbs	ppo
Removal of deep bone implant	cpt	20680	5259.68	5259.68	1627.49	1627.49	19506.22	19506.22	16255.18	16255.18	O	5259.68	5259.68	bcbs	epo
gastrointestinal hemorrhage with mcc	ms-drg	377	17273.54	17273.54	7149.07	7149.07	36153.05	36153.05	30127.54	30127.54	I	17273.54	17273.54	bcbs	hmo
gastrointestinal hemorrhage with mcc	ms-drg	377	17273.54	17273.54	7149.07	7149.07	36153.05	36153.05	30127.54	30127.54	I	17273.54	17273.54	bcbs	hmo
gastrointestinal hemorrhage with mcc	ms-drg	377	17273.54	17273.54	7149.07	7149.07	36153.05	36153.05	30127.54	30127.54	I	17273.54	17273.54	bcbs	pos
gastrointestinal hemorrhage with mcc	ms-drg	377	17273.54	17273.54	7149.07	7149.07	36153.05	36153.05	30127.54	30127.54	I	17273.54	17273.54	bcbs	ppo
gastrointestinal hemorrhage with mcc	ms-drg	377	17273.54	17273.54	7149.07	7149.07	36153.05	36153.05	30127.54	30127.54	I	17273.54	17273.54	bcbs	epo
digestive malignancy with cc	ms-drg	375	10903.77	10903.77	5416.71	5416.71	29958.38	29958.38	24965.32	24965.32	I	10903.77	10903.77	bcbs	hmo
digestive malignancy with cc	ms-drg	375	10903.77	10903.77	5416.71	5416.71	29958.38	29958.38	24965.32	24965.32	I	10903.77	10903.77	bcbs	hmo
digestive malignancy with cc	ms-drg	375	10903.77	10903.77	5416.71	5416.71	29958.38	29958.38	24965.32	24965.32	I	10903.77	10903.77	bcbs	pos
digestive malignancy with cc	ms-drg	375	10903.77	10903.77	5416.71	5416.71	29958.38	29958.38	24965.32	24965.32	I	10903.77	10903.77	bcbs	ppo
digestive malignancy with cc	ms-drg	375	10903.77	10903.77	5416.71	5416.71	29958.38	29958.38	24965.32	24965.32	I	10903.77	10903.77	bcbs	epo
other digestive system o.r. procedures with cc	ms-drg	357	21321.98	21321.98	6683.22	6683.22	62148.72	62148.72	51790.6	51790.6	I	21321.98	21321.98	bcbs	hmo
other digestive system o.r. procedures with cc	ms-drg	357	21321.98	21321.98	6683.22	6683.22	62148.72	62148.72	51790.6	51790.6	I	21321.98	21321.98	bcbs	hmo
other digestive system o.r. procedures with cc	ms-drg	357	21321.98	21321.98	6683.22	6683.22	62148.72	62148.72	51790.6	51790.6	I	21321.98	21321.98	bcbs	pos
other digestive system o.r. procedures with cc	ms-drg	357	21321.98	21321.98	6683.22	6683.22	62148.72	62148.72	51790.6	51790.6	I	21321.98	21321.98	bcbs	ppo
other digestive system o.r. procedures with cc	ms-drg	357	21321.98	21321.98	6683.22	6683.22	62148.72	62148.72	51790.6	51790.6	I	21321.98	21321.98	bcbs	epo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	19392.75	19392.75	bcbs	hmo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	19392.75	19392.75	bcbs	hmo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	19392.75	19392.75	bcbs	pos
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	19392.75	19392.75	bcbs	ppo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	19392.75	19392.75	bcbs	epo
inguinal and femoral hernia procedures without cc/mcc	ms-drg	352	7123.35	7123.35	7123.35	7123.35	32227.27	32227.27	26856.06	26856.06	I	7123.35	7123.35	bcbs	hmo
inguinal and femoral hernia procedures without cc/mcc	ms-drg	352	7123.35	7123.35	7123.35	7123.35	32227.27	32227.27	26856.06	26856.06	I	7123.35	7123.35	bcbs	hmo
inguinal and femoral hernia procedures without cc/mcc	ms-drg	352	7123.35	7123.35	7123.35	7123.35	32227.27	32227.27	26856.06	26856.06	I	7123.35	7123.35	bcbs	pos
inguinal and femoral hernia procedures without cc/mcc	ms-drg	352	7123.35	7123.35	7123.35	7123.35	32227.27	32227.27	26856.06	26856.06	I	7123.35	7123.35	bcbs	ppo
inguinal and femoral hernia procedures without cc/mcc	ms-drg	352	7123.35	7123.35	7123.35	7123.35	32227.27	32227.27	26856.06	26856.06	I	7123.35	7123.35	bcbs	epo
anal and stomal procedures with cc	ms-drg	348	9112.31	9112.31	8845.51	8845.51	42943.86	42943.86	35786.55	35786.55	I	8991.14	8991.14	bcbs	hmo
anal and stomal procedures with cc	ms-drg	348	9112.31	9112.31	8845.51	8845.51	42943.86	42943.86	35786.55	35786.55	I	8991.14	8991.14	bcbs	hmo
anal and stomal procedures with cc	ms-drg	348	9112.31	9112.31	8845.51	8845.51	42943.86	42943.86	35786.55	35786.55	I	8991.14	8991.14	bcbs	pos
anal and stomal procedures with cc	ms-drg	348	9112.31	9112.31	8845.51	8845.51	42943.86	42943.86	35786.55	35786.55	I	8991.14	8991.14	bcbs	ppo
anal and stomal procedures with cc	ms-drg	348	9112.31	9112.31	8845.51	8845.51	42943.86	42943.86	35786.55	35786.55	I	8991.14	8991.14	bcbs	epo
minor small and large bowel procedures without cc/mcc	ms-drg	346	12647.52	12647.52	6210.98	6210.98	33068.78	33068.78	27557.32	27557.32	I	12647.52	12647.52	bcbs	hmo
minor small and large bowel procedures without cc/mcc	ms-drg	346	12647.52	12647.52	6210.98	6210.98	33068.78	33068.78	27557.32	27557.32	I	12647.52	12647.52	bcbs	hmo
minor small and large bowel procedures without cc/mcc	ms-drg	346	12647.52	12647.52	6210.98	6210.98	33068.78	33068.78	27557.32	27557.32	I	12647.52	12647.52	bcbs	pos
minor small and large bowel procedures without cc/mcc	ms-drg	346	12647.52	12647.52	6210.98	6210.98	33068.78	33068.78	27557.32	27557.32	I	12647.52	12647.52	bcbs	ppo
minor small and large bowel procedures without cc/mcc	ms-drg	346	12647.52	12647.52	6210.98	6210.98	33068.78	33068.78	27557.32	27557.32	I	12647.52	12647.52	bcbs	epo
appendectomy without complicated principal diagnosis without cc/mcc	ms-drg	343	9395.5	9395.5	5698.84	5698.84	36435.43	36435.43	30362.86	30362.86	I	9395.5	9395.5	bcbs	hmo
appendectomy without complicated principal diagnosis without cc/mcc	ms-drg	343	9395.5	9395.5	5698.84	5698.84	36435.43	36435.43	30362.86	30362.86	I	9395.5	9395.5	bcbs	hmo
appendectomy without complicated principal diagnosis without cc/mcc	ms-drg	343	9395.5	9395.5	5698.84	5698.84	36435.43	36435.43	30362.86	30362.86	I	9395.5	9395.5	bcbs	pos
appendectomy without complicated principal diagnosis without cc/mcc	ms-drg	343	9395.5	9395.5	5698.84	5698.84	36435.43	36435.43	30362.86	30362.86	I	9395.5	9395.5	bcbs	ppo
appendectomy without complicated principal diagnosis without cc/mcc	ms-drg	343	9395.5	9395.5	5698.84	5698.84	36435.43	36435.43	30362.86	30362.86	I	9395.5	9395.5	bcbs	epo
appendectomy with complicated principal diagnosis without cc/mcc	ms-drg	340	14044.53	14044.53	7272.25	7272.25	43215.56	43215.56	36012.97	36012.97	I	14044.53	14044.53	bcbs	hmo
appendectomy with complicated principal diagnosis without cc/mcc	ms-drg	340	14044.53	14044.53	7272.25	7272.25	43215.56	43215.56	36012.97	36012.97	I	14044.53	14044.53	bcbs	hmo
appendectomy with complicated principal diagnosis without cc/mcc	ms-drg	340	14044.53	14044.53	7272.25	7272.25	43215.56	43215.56	36012.97	36012.97	I	14044.53	14044.53	bcbs	pos
appendectomy with complicated principal diagnosis without cc/mcc	ms-drg	340	14044.53	14044.53	7272.25	7272.25	43215.56	43215.56	36012.97	36012.97	I	14044.53	14044.53	bcbs	ppo
appendectomy with complicated principal diagnosis without cc/mcc	ms-drg	340	14044.53	14044.53	7272.25	7272.25	43215.56	43215.56	36012.97	36012.97	I	14044.53	14044.53	bcbs	epo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	18204.75	18204.75	bcbs	hmo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	18204.75	18204.75	bcbs	hmo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	18204.75	18204.75	bcbs	pos
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	18204.75	18204.75	bcbs	ppo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	18204.75	18204.75	bcbs	epo
peritoneal adhesiolysis with cc	ms-drg	336	21438.99	21438.99	13955.86	13955.86	80455.5	80455.5	67046.25	67046.25	I	21438.99	21438.99	bcbs	hmo
peritoneal adhesiolysis with cc	ms-drg	336	21438.99	21438.99	13955.86	13955.86	80455.5	80455.5	67046.25	67046.25	I	21438.99	21438.99	bcbs	hmo
peritoneal adhesiolysis with cc	ms-drg	336	21438.99	21438.99	13955.86	13955.86	80455.5	80455.5	67046.25	67046.25	I	21438.99	21438.99	bcbs	pos
peritoneal adhesiolysis with cc	ms-drg	336	21438.99	21438.99	13955.86	13955.86	80455.5	80455.5	67046.25	67046.25	I	21438.99	21438.99	bcbs	ppo
peritoneal adhesiolysis with cc	ms-drg	336	21438.99	21438.99	13955.86	13955.86	80455.5	80455.5	67046.25	67046.25	I	21438.99	21438.99	bcbs	epo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	11874.88	11874.88	bcbs	hmo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	11874.88	11874.88	bcbs	hmo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	11874.88	11874.88	bcbs	pos
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	11874.88	11874.88	bcbs	ppo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	11874.88	11874.88	bcbs	epo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	25078.08	25078.08	bcbs	hmo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	25078.08	25078.08	bcbs	hmo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	25078.08	25078.08	bcbs	pos
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	25078.08	25078.08	bcbs	ppo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	25078.08	25078.08	bcbs	epo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	36464.38	36464.38	bcbs	hmo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	36464.38	36464.38	bcbs	hmo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	36464.38	36464.38	bcbs	pos
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	36464.38	36464.38	bcbs	ppo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	36464.38	36464.38	bcbs	epo
"stomach, esophageal and duodenal procedures without cc/mcc"	ms-drg	328	13958.64	13958.64	5175.14	5175.14	49664.04	49664.04	41386.7	41386.7	I	13958.64	13958.64	bcbs	hmo
"stomach, esophageal and duodenal procedures without cc/mcc"	ms-drg	328	13958.64	13958.64	5175.14	5175.14	49664.04	49664.04	41386.7	41386.7	I	13958.64	13958.64	bcbs	hmo
"stomach, esophageal and duodenal procedures without cc/mcc"	ms-drg	328	13958.64	13958.64	5175.14	5175.14	49664.04	49664.04	41386.7	41386.7	I	13958.64	13958.64	bcbs	pos
"stomach, esophageal and duodenal procedures without cc/mcc"	ms-drg	328	13958.64	13958.64	5175.14	5175.14	49664.04	49664.04	41386.7	41386.7	I	13958.64	13958.64	bcbs	ppo
"stomach, esophageal and duodenal procedures without cc/mcc"	ms-drg	328	13958.64	13958.64	5175.14	5175.14	49664.04	49664.04	41386.7	41386.7	I	13958.64	13958.64	bcbs	epo
other circulatory system diagnoses with mcc	ms-drg	314	22467.12	22467.12	10250.63	10250.63	60337.15	60337.15	50280.96	50280.96	I	22467.12	22467.12	bcbs	hmo
other circulatory system diagnoses with mcc	ms-drg	314	22467.12	22467.12	10250.63	10250.63	60337.15	60337.15	50280.96	50280.96	I	22467.12	22467.12	bcbs	hmo
other circulatory system diagnoses with mcc	ms-drg	314	22467.12	22467.12	10250.63	10250.63	60337.15	60337.15	50280.96	50280.96	I	22467.12	22467.12	bcbs	pos
other circulatory system diagnoses with mcc	ms-drg	314	22467.12	22467.12	10250.63	10250.63	60337.15	60337.15	50280.96	50280.96	I	22467.12	22467.12	bcbs	ppo
other circulatory system diagnoses with mcc	ms-drg	314	22467.12	22467.12	10250.63	10250.63	60337.15	60337.15	50280.96	50280.96	I	22467.12	22467.12	bcbs	epo
chest pain	ms-drg	313	5722.44	5722.44	3212.87	3212.87	19324.42	19324.42	16103.68	16103.68	I	5722.44	5722.44	bcbs	hmo
chest pain	ms-drg	313	5722.44	5722.44	3212.87	3212.87	19324.42	19324.42	16103.68	16103.68	I	5722.44	5722.44	bcbs	hmo
chest pain	ms-drg	313	5722.44	5722.44	3212.87	3212.87	19324.42	19324.42	16103.68	16103.68	I	5722.44	5722.44	bcbs	pos
chest pain	ms-drg	313	5722.44	5722.44	3212.87	3212.87	19324.42	19324.42	16103.68	16103.68	I	5722.44	5722.44	bcbs	ppo
chest pain	ms-drg	313	5722.44	5722.44	3212.87	3212.87	19324.42	19324.42	16103.68	16103.68	I	5722.44	5722.44	bcbs	epo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	6298.42	6298.42	bcbs	hmo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	6298.42	6298.42	bcbs	hmo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	6298.42	6298.42	bcbs	pos
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	6298.42	6298.42	bcbs	ppo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	6298.42	6298.42	bcbs	epo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	6298.42	6298.42	bcbs	hmo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	6298.42	6298.42	bcbs	hmo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	6298.42	6298.42	bcbs	pos
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	6298.42	6298.42	bcbs	ppo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	6298.42	6298.42	bcbs	epo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	6328.13	6328.13	bcbs	hmo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	6328.13	6328.13	bcbs	hmo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	6328.13	6328.13	bcbs	pos
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	6328.13	6328.13	bcbs	ppo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	6328.13	6328.13	bcbs	epo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5976.75	5976.75	bcbs	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5976.75	5976.75	bcbs	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5976.75	5976.75	bcbs	pos
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5976.75	5976.75	bcbs	ppo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5976.75	5976.75	bcbs	epo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	8412.43	8412.43	bcbs	hmo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	8412.43	8412.43	bcbs	hmo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	8412.43	8412.43	bcbs	pos
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	8412.43	8412.43	bcbs	ppo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	8412.43	8412.43	bcbs	epo
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall	cpt	22902	3796.56	3796.56	1196.5	1196.5	19428.76	19428.76	16190.63	16190.63	O	3796.56	3796.56	bcbs	hmo
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall	cpt	22902	3796.56	3796.56	1196.5	1196.5	19428.76	19428.76	16190.63	16190.63	O	3796.56	3796.56	bcbs	hmo
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall	cpt	22902	3796.56	3796.56	1196.5	1196.5	19428.76	19428.76	16190.63	16190.63	O	3796.56	3796.56	bcbs	pos
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall	cpt	22902	3796.56	3796.56	1196.5	1196.5	19428.76	19428.76	16190.63	16190.63	O	3796.56	3796.56	bcbs	ppo
Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall	cpt	22902	3796.56	3796.56	1196.5	1196.5	19428.76	19428.76	16190.63	16190.63	O	3796.56	3796.56	bcbs	epo
"Procedure on abdomen, muscle or bone"	cpt	22999	8063.39	8063.39	4294.86	4294.86	32700.88	32700.88	27250.73	27250.73	O	8063.39	8063.39	bcbs	hmo
"Procedure on abdomen, muscle or bone"	cpt	22999	8063.39	8063.39	4294.86	4294.86	32700.88	32700.88	27250.73	27250.73	O	8063.39	8063.39	bcbs	hmo
"Procedure on abdomen, muscle or bone"	cpt	22999	8063.39	8063.39	4294.86	4294.86	32700.88	32700.88	27250.73	27250.73	O	8063.39	8063.39	bcbs	pos
"Procedure on abdomen, muscle or bone"	cpt	22999	8063.39	8063.39	4294.86	4294.86	32700.88	32700.88	27250.73	27250.73	O	8063.39	8063.39	bcbs	ppo
"Procedure on abdomen, muscle or bone"	cpt	22999	8063.39	8063.39	4294.86	4294.86	32700.88	32700.88	27250.73	27250.73	O	8063.39	8063.39	bcbs	epo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	13610.5	13610.5	bcbs	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	13610.5	13610.5	bcbs	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	13610.5	13610.5	bcbs	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	13610.5	13610.5	bcbs	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	13610.5	13610.5	bcbs	epo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	11462.98	11462.98	bcbs	hmo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	11462.98	11462.98	bcbs	hmo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	11462.98	11462.98	bcbs	pos
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	11462.98	11462.98	bcbs	ppo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	11462.98	11462.98	bcbs	epo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	23670.85	23670.85	bcbs	hmo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	23670.85	23670.85	bcbs	hmo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	23670.85	23670.85	bcbs	pos
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	23670.85	23670.85	bcbs	ppo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	23670.85	23670.85	bcbs	epo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	1560.4	1560.4	bcbs	hmo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	1560.4	1560.4	bcbs	hmo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	1560.4	1560.4	bcbs	pos
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	1560.4	1560.4	bcbs	ppo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	1560.4	1560.4	bcbs	epo
"Repair of torn tendons of shoulder (rotator cuff), open procedure, chronic or old"	cpt	23412	9091.8	9091.8	9091.8	9091.8	37389.38	37389.38	31157.82	31157.82	O	9091.8	9091.8	bcbs	hmo
"Repair of torn tendons of shoulder (rotator cuff), open procedure, chronic or old"	cpt	23412	9091.8	9091.8	9091.8	9091.8	37389.38	37389.38	31157.82	31157.82	O	9091.8	9091.8	bcbs	hmo
"Repair of torn tendons of shoulder (rotator cuff), open procedure, chronic or old"	cpt	23412	9091.8	9091.8	9091.8	9091.8	37389.38	37389.38	31157.82	31157.82	O	9091.8	9091.8	bcbs	pos
"Repair of torn tendons of shoulder (rotator cuff), open procedure, chronic or old"	cpt	23412	9091.8	9091.8	9091.8	9091.8	37389.38	37389.38	31157.82	31157.82	O	9091.8	9091.8	bcbs	ppo
"Repair of torn tendons of shoulder (rotator cuff), open procedure, chronic or old"	cpt	23412	9091.8	9091.8	9091.8	9091.8	37389.38	37389.38	31157.82	31157.82	O	9091.8	9091.8	bcbs	epo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	13020.2	13020.2	bcbs	hmo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	13020.2	13020.2	bcbs	hmo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	13020.2	13020.2	bcbs	pos
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	13020.2	13020.2	bcbs	ppo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	13020.2	13020.2	bcbs	epo
"acute myocardial infarction, discharged alive with mcc"	ms-drg	280	19765.14	19765.14	8442.33	8442.33	60541.62	60541.62	50451.35	50451.35	I	19765.14	19765.14	bcbs	hmo
"acute myocardial infarction, discharged alive with mcc"	ms-drg	280	19765.14	19765.14	8442.33	8442.33	60541.62	60541.62	50451.35	50451.35	I	19765.14	19765.14	bcbs	hmo
"acute myocardial infarction, discharged alive with mcc"	ms-drg	280	19765.14	19765.14	8442.33	8442.33	60541.62	60541.62	50451.35	50451.35	I	19765.14	19765.14	bcbs	pos
"acute myocardial infarction, discharged alive with mcc"	ms-drg	280	19765.14	19765.14	8442.33	8442.33	60541.62	60541.62	50451.35	50451.35	I	19765.14	19765.14	bcbs	ppo
"acute myocardial infarction, discharged alive with mcc"	ms-drg	280	19765.14	19765.14	8442.33	8442.33	60541.62	60541.62	50451.35	50451.35	I	19765.14	19765.14	bcbs	epo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	34817.44	34817.44	bcbs	hmo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	34817.44	34817.44	bcbs	hmo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	34817.44	34817.44	bcbs	pos
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	34817.44	34817.44	bcbs	ppo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	34817.44	34817.44	bcbs	epo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	43254.05	43254.05	bcbs	hmo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	43254.05	43254.05	bcbs	hmo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	43254.05	43254.05	bcbs	pos
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	43254.05	43254.05	bcbs	ppo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	43254.05	43254.05	bcbs	epo
Closed treatment of shoulder dislocation with manipulation under anesthesia	cpt	23655	2522.8	2522.8	2522.8	2522.8	4501.7	4501.7	3751.42	3751.42	O	2522.8	2522.8	bcbs	hmo
Closed treatment of shoulder dislocation with manipulation under anesthesia	cpt	23655	2522.8	2522.8	2522.8	2522.8	4501.7	4501.7	3751.42	3751.42	O	2522.8	2522.8	bcbs	hmo
Closed treatment of shoulder dislocation with manipulation under anesthesia	cpt	23655	2522.8	2522.8	2522.8	2522.8	4501.7	4501.7	3751.42	3751.42	O	2522.8	2522.8	bcbs	pos
Closed treatment of shoulder dislocation with manipulation under anesthesia	cpt	23655	2522.8	2522.8	2522.8	2522.8	4501.7	4501.7	3751.42	3751.42	O	2522.8	2522.8	bcbs	ppo
Closed treatment of shoulder dislocation with manipulation under anesthesia	cpt	23655	2522.8	2522.8	2522.8	2522.8	4501.7	4501.7	3751.42	3751.42	O	2522.8	2522.8	bcbs	epo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	26746.13	26746.13	bcbs	hmo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	26746.13	26746.13	bcbs	hmo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	26746.13	26746.13	bcbs	pos
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	26746.13	26746.13	bcbs	ppo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	26746.13	26746.13	bcbs	epo
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	19270.14	19270.14	bcbs	hmo
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	19270.14	19270.14	bcbs	hmo
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	19270.14	19270.14	bcbs	pos
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	19270.14	19270.14	bcbs	ppo
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	19270.14	19270.14	bcbs	epo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	23415.96	23415.96	bcbs	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	23415.96	23415.96	bcbs	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	23415.96	23415.96	bcbs	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	23415.96	23415.96	bcbs	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	23415.96	23415.96	bcbs	epo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	36253.66	36253.66	bcbs	hmo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	36253.66	36253.66	bcbs	hmo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	36253.66	36253.66	bcbs	pos
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	36253.66	36253.66	bcbs	ppo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	36253.66	36253.66	bcbs	epo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	20821.91	20821.91	bcbs	hmo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	20821.91	20821.91	bcbs	hmo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	20821.91	20821.91	bcbs	pos
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	20821.91	20821.91	bcbs	ppo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	20821.91	20821.91	bcbs	epo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	36670.41	36670.41	bcbs	hmo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	36670.41	36670.41	bcbs	hmo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	36670.41	36670.41	bcbs	pos
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	36670.41	36670.41	bcbs	ppo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	36670.41	36670.41	bcbs	epo
Incision or the tendon covering on the top side of the wrist	cpt	25000	3749.59	3749.59	1250.16	1250.16	17430.41	17430.41	14525.34	14525.34	O	3749.59	3749.59	bcbs	hmo
Incision or the tendon covering on the top side of the wrist	cpt	25000	3749.59	3749.59	1250.16	1250.16	17430.41	17430.41	14525.34	14525.34	O	3749.59	3749.59	bcbs	hmo
Incision or the tendon covering on the top side of the wrist	cpt	25000	3749.59	3749.59	1250.16	1250.16	17430.41	17430.41	14525.34	14525.34	O	3749.59	3749.59	bcbs	pos
Incision or the tendon covering on the top side of the wrist	cpt	25000	3749.59	3749.59	1250.16	1250.16	17430.41	17430.41	14525.34	14525.34	O	3749.59	3749.59	bcbs	ppo
Incision or the tendon covering on the top side of the wrist	cpt	25000	3749.59	3749.59	1250.16	1250.16	17430.41	17430.41	14525.34	14525.34	O	3749.59	3749.59	bcbs	epo
"Removal of cyst at wrist, initial or primary"	cpt	25111	2879.76	2879.76	1136.27	1136.27	17644.34	17644.34	14703.62	14703.62	O	2879.76	2879.76	bcbs	hmo
"Removal of cyst at wrist, initial or primary"	cpt	25111	2879.76	2879.76	1136.27	1136.27	17644.34	17644.34	14703.62	14703.62	O	2879.76	2879.76	bcbs	hmo
"Removal of cyst at wrist, initial or primary"	cpt	25111	2879.76	2879.76	1136.27	1136.27	17644.34	17644.34	14703.62	14703.62	O	2879.76	2879.76	bcbs	pos
"Removal of cyst at wrist, initial or primary"	cpt	25111	2879.76	2879.76	1136.27	1136.27	17644.34	17644.34	14703.62	14703.62	O	2879.76	2879.76	bcbs	ppo
"Removal of cyst at wrist, initial or primary"	cpt	25111	2879.76	2879.76	1136.27	1136.27	17644.34	17644.34	14703.62	14703.62	O	2879.76	2879.76	bcbs	epo
coronary bypass without cardiac catheterization with mcc	ms-drg	235	50073.04	50073.04	34443.24	34443.24	225842.78	225842.78	188202.32	188202.32	I	50073.04	50073.04	bcbs	hmo
coronary bypass without cardiac catheterization with mcc	ms-drg	235	50073.04	50073.04	34443.24	34443.24	225842.78	225842.78	188202.32	188202.32	I	50073.04	50073.04	bcbs	hmo
coronary bypass without cardiac catheterization with mcc	ms-drg	235	50073.04	50073.04	34443.24	34443.24	225842.78	225842.78	188202.32	188202.32	I	50073.04	50073.04	bcbs	pos
coronary bypass without cardiac catheterization with mcc	ms-drg	235	50073.04	50073.04	34443.24	34443.24	225842.78	225842.78	188202.32	188202.32	I	50073.04	50073.04	bcbs	ppo
coronary bypass without cardiac catheterization with mcc	ms-drg	235	50073.04	50073.04	34443.24	34443.24	225842.78	225842.78	188202.32	188202.32	I	50073.04	50073.04	bcbs	epo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	52095.13	52095.13	bcbs	hmo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	52095.13	52095.13	bcbs	hmo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	52095.13	52095.13	bcbs	pos
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	52095.13	52095.13	bcbs	ppo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	52095.13	52095.13	bcbs	epo
other cardiothoracic procedures with mcc	ms-drg	228	89820.91	89820.91	36345.66	36345.66	120556.57	120556.57	100463.81	100463.81	I	89820.91	89820.91	bcbs	hmo
other cardiothoracic procedures with mcc	ms-drg	228	89820.91	89820.91	36345.66	36345.66	120556.57	120556.57	100463.81	100463.81	I	89820.91	89820.91	bcbs	hmo
other cardiothoracic procedures with mcc	ms-drg	228	89820.91	89820.91	36345.66	36345.66	120556.57	120556.57	100463.81	100463.81	I	89820.91	89820.91	bcbs	pos
other cardiothoracic procedures with mcc	ms-drg	228	89820.91	89820.91	36345.66	36345.66	120556.57	120556.57	100463.81	100463.81	I	89820.91	89820.91	bcbs	ppo
other cardiothoracic procedures with mcc	ms-drg	228	89820.91	89820.91	36345.66	36345.66	120556.57	120556.57	100463.81	100463.81	I	89820.91	89820.91	bcbs	epo
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments	cpt	25608	7889.33	7889.33	4927.02	4927.02	34718.63	34718.63	28932.19	28932.19	O	7889.33	7889.33	bcbs	hmo
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments	cpt	25608	7889.33	7889.33	4927.02	4927.02	34718.63	34718.63	28932.19	28932.19	O	7889.33	7889.33	bcbs	hmo
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments	cpt	25608	7889.33	7889.33	4927.02	4927.02	34718.63	34718.63	28932.19	28932.19	O	7889.33	7889.33	bcbs	pos
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments	cpt	25608	7889.33	7889.33	4927.02	4927.02	34718.63	34718.63	28932.19	28932.19	O	7889.33	7889.33	bcbs	ppo
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments	cpt	25608	7889.33	7889.33	4927.02	4927.02	34718.63	34718.63	28932.19	28932.19	O	7889.33	7889.33	bcbs	epo
Open treatment of broken wrist	cpt	25652	7889.33	7889.33	4903.68	4903.68	37667.29	37667.29	31389.41	31389.41	O	7889.33	7889.33	bcbs	hmo
Open treatment of broken wrist	cpt	25652	7889.33	7889.33	4903.68	4903.68	37667.29	37667.29	31389.41	31389.41	O	7889.33	7889.33	bcbs	hmo
Open treatment of broken wrist	cpt	25652	7889.33	7889.33	4903.68	4903.68	37667.29	37667.29	31389.41	31389.41	O	7889.33	7889.33	bcbs	pos
Open treatment of broken wrist	cpt	25652	7889.33	7889.33	4903.68	4903.68	37667.29	37667.29	31389.41	31389.41	O	7889.33	7889.33	bcbs	ppo
Open treatment of broken wrist	cpt	25652	7889.33	7889.33	4903.68	4903.68	37667.29	37667.29	31389.41	31389.41	O	7889.33	7889.33	bcbs	epo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	54699.55	54699.55	bcbs	hmo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	54699.55	54699.55	bcbs	hmo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	54699.55	54699.55	bcbs	pos
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	54699.55	54699.55	bcbs	ppo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	54699.55	54699.55	bcbs	epo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	26637.75	26637.75	bcbs	hmo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	26637.75	26637.75	bcbs	hmo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	26637.75	26637.75	bcbs	pos
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	26637.75	26637.75	bcbs	ppo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	26637.75	26637.75	bcbs	epo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	3554.71	3554.71	bcbs	hmo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	3554.71	3554.71	bcbs	hmo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	3554.71	3554.71	bcbs	pos
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	3554.71	3554.71	bcbs	ppo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	3554.71	3554.71	bcbs	epo
respiratory signs and symptoms	ms-drg	204	5762.49	5762.49	3725.66	3725.66	11897.69	11897.69	9914.74	9914.74	I	3725.66	3725.66	bcbs	hmo
respiratory signs and symptoms	ms-drg	204	5762.49	5762.49	3725.66	3725.66	11897.69	11897.69	9914.74	9914.74	I	3725.66	3725.66	bcbs	hmo
respiratory signs and symptoms	ms-drg	204	5762.49	5762.49	3725.66	3725.66	11897.69	11897.69	9914.74	9914.74	I	3725.66	3725.66	bcbs	pos
respiratory signs and symptoms	ms-drg	204	5762.49	5762.49	3725.66	3725.66	11897.69	11897.69	9914.74	9914.74	I	3725.66	3725.66	bcbs	ppo
respiratory signs and symptoms	ms-drg	204	5762.49	5762.49	3725.66	3725.66	11897.69	11897.69	9914.74	9914.74	I	3725.66	3725.66	bcbs	epo
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	7954.58	7954.58	bcbs	hmo
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	7954.58	7954.58	bcbs	hmo
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	7954.58	7954.58	bcbs	pos
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	7954.58	7954.58	bcbs	ppo
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	7954.58	7954.58	bcbs	epo
interstitial lung disease with mcc	ms-drg	196	16052.47	16052.47	10645.76	10645.76	50645.26	50645.26	42204.38	42204.38	I	16052.47	16052.47	bcbs	hmo
interstitial lung disease with mcc	ms-drg	196	16052.47	16052.47	10645.76	10645.76	50645.26	50645.26	42204.38	42204.38	I	16052.47	16052.47	bcbs	hmo
interstitial lung disease with mcc	ms-drg	196	16052.47	16052.47	10645.76	10645.76	50645.26	50645.26	42204.38	42204.38	I	16052.47	16052.47	bcbs	pos
interstitial lung disease with mcc	ms-drg	196	16052.47	16052.47	10645.76	10645.76	50645.26	50645.26	42204.38	42204.38	I	16052.47	16052.47	bcbs	ppo
interstitial lung disease with mcc	ms-drg	196	16052.47	16052.47	10645.76	10645.76	50645.26	50645.26	42204.38	42204.38	I	16052.47	16052.47	bcbs	epo
Removal (less than 1.5 centimeters) muscle growth of hand or finger	cpt	26116	3848.24	3848.24	3848.24	3848.24	20450.2	20450.2	17041.83	17041.83	O	3848.24	3848.24	bcbs	hmo
Removal (less than 1.5 centimeters) muscle growth of hand or finger	cpt	26116	3848.24	3848.24	3848.24	3848.24	20450.2	20450.2	17041.83	17041.83	O	3848.24	3848.24	bcbs	hmo
Removal (less than 1.5 centimeters) muscle growth of hand or finger	cpt	26116	3848.24	3848.24	3848.24	3848.24	20450.2	20450.2	17041.83	17041.83	O	3848.24	3848.24	bcbs	pos
Removal (less than 1.5 centimeters) muscle growth of hand or finger	cpt	26116	3848.24	3848.24	3848.24	3848.24	20450.2	20450.2	17041.83	17041.83	O	3848.24	3848.24	bcbs	ppo
Removal (less than 1.5 centimeters) muscle growth of hand or finger	cpt	26116	3848.24	3848.24	3848.24	3848.24	20450.2	20450.2	17041.83	17041.83	O	3848.24	3848.24	bcbs	epo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	8418.87	8418.87	bcbs	hmo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	8418.87	8418.87	bcbs	hmo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	8418.87	8418.87	bcbs	pos
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	8418.87	8418.87	bcbs	ppo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	8418.87	8418.87	bcbs	epo
"Insertion of hardware to broken finger, accessed through the skin"	cpt	26608	10600.32	10600.32	2425.05	2425.05	22144.12	22144.12	18453.43	18453.43	O	10600.32	10600.32	bcbs	hmo
"Insertion of hardware to broken finger, accessed through the skin"	cpt	26608	10600.32	10600.32	2425.05	2425.05	22144.12	22144.12	18453.43	18453.43	O	10600.32	10600.32	bcbs	hmo
"Insertion of hardware to broken finger, accessed through the skin"	cpt	26608	10600.32	10600.32	2425.05	2425.05	22144.12	22144.12	18453.43	18453.43	O	10600.32	10600.32	bcbs	pos
"Insertion of hardware to broken finger, accessed through the skin"	cpt	26608	10600.32	10600.32	2425.05	2425.05	22144.12	22144.12	18453.43	18453.43	O	10600.32	10600.32	bcbs	ppo
"Insertion of hardware to broken finger, accessed through the skin"	cpt	26608	10600.32	10600.32	2425.05	2425.05	22144.12	22144.12	18453.43	18453.43	O	10600.32	10600.32	bcbs	epo
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers	cpt	26615	5398.71	5398.71	2297.73	2297.73	24889.74	24889.74	20741.45	20741.45	O	5398.71	5398.71	bcbs	hmo
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers	cpt	26615	5398.71	5398.71	2297.73	2297.73	24889.74	24889.74	20741.45	20741.45	O	5398.71	5398.71	bcbs	hmo
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers	cpt	26615	5398.71	5398.71	2297.73	2297.73	24889.74	24889.74	20741.45	20741.45	O	5398.71	5398.71	bcbs	pos
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers	cpt	26615	5398.71	5398.71	2297.73	2297.73	24889.74	24889.74	20741.45	20741.45	O	5398.71	5398.71	bcbs	ppo
Open treatment of fracture of bone in the midportion of the hand between the wrist and fingers	cpt	26615	5398.71	5398.71	2297.73	2297.73	24889.74	24889.74	20741.45	20741.45	O	5398.71	5398.71	bcbs	epo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9428.53	9428.53	bcbs	hmo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9428.53	9428.53	bcbs	hmo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9428.53	9428.53	bcbs	pos
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9428.53	9428.53	bcbs	ppo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	9428.53	9428.53	bcbs	epo
"Insertion of hardware to broken finger or thumb, accessed through the skin"	cpt	26756	5946.93	5946.93	5946.93	5946.93	18011.06	18011.06	15009.22	15009.22	O	5946.93	5946.93	bcbs	hmo
"Insertion of hardware to broken finger or thumb, accessed through the skin"	cpt	26756	5946.93	5946.93	5946.93	5946.93	18011.06	18011.06	15009.22	15009.22	O	5946.93	5946.93	bcbs	hmo
"Insertion of hardware to broken finger or thumb, accessed through the skin"	cpt	26756	5946.93	5946.93	5946.93	5946.93	18011.06	18011.06	15009.22	15009.22	O	5946.93	5946.93	bcbs	pos
"Insertion of hardware to broken finger or thumb, accessed through the skin"	cpt	26756	5946.93	5946.93	5946.93	5946.93	18011.06	18011.06	15009.22	15009.22	O	5946.93	5946.93	bcbs	ppo
"Insertion of hardware to broken finger or thumb, accessed through the skin"	cpt	26756	5946.93	5946.93	5946.93	5946.93	18011.06	18011.06	15009.22	15009.22	O	5946.93	5946.93	bcbs	epo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	17066.39	17066.39	bcbs	hmo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	17066.39	17066.39	bcbs	hmo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	17066.39	17066.39	bcbs	pos
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	17066.39	17066.39	bcbs	ppo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	17066.39	17066.39	bcbs	epo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	6150.25	6150.25	bcbs	hmo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	6150.25	6150.25	bcbs	hmo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	6150.25	6150.25	bcbs	pos
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	6150.25	6150.25	bcbs	ppo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	6150.25	6150.25	bcbs	epo
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	7503.57	7503.57	bcbs	hmo
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	7503.57	7503.57	bcbs	hmo
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	7503.57	7503.57	bcbs	pos
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	7503.57	7503.57	bcbs	ppo
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	7503.57	7503.57	bcbs	epo
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	9844.32	9844.32	bcbs	hmo
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	9844.32	9844.32	bcbs	hmo
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	9844.32	9844.32	bcbs	pos
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	9844.32	9844.32	bcbs	ppo
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	9844.32	9844.32	bcbs	epo
pleural effusion with mcc	ms-drg	186	9570.63	9570.63	9567.47	9567.47	47108.65	47108.65	39257.21	39257.21	I	9567.47	9567.47	bcbs	hmo
pleural effusion with mcc	ms-drg	186	9570.63	9570.63	9567.47	9567.47	47108.65	47108.65	39257.21	39257.21	I	9567.47	9567.47	bcbs	hmo
pleural effusion with mcc	ms-drg	186	9570.63	9570.63	9567.47	9567.47	47108.65	47108.65	39257.21	39257.21	I	9567.47	9567.47	bcbs	pos
pleural effusion with mcc	ms-drg	186	9570.63	9570.63	9567.47	9567.47	47108.65	47108.65	39257.21	39257.21	I	9567.47	9567.47	bcbs	ppo
pleural effusion with mcc	ms-drg	186	9570.63	9570.63	9567.47	9567.47	47108.65	47108.65	39257.21	39257.21	I	9567.47	9567.47	bcbs	epo
major chest trauma with cc	ms-drg	184	16158.85	16158.85	6519.09	6519.09	29643.79	29643.79	24703.16	24703.16	I	16158.85	16158.85	bcbs	hmo
major chest trauma with cc	ms-drg	184	16158.85	16158.85	6519.09	6519.09	29643.79	29643.79	24703.16	24703.16	I	16158.85	16158.85	bcbs	hmo
major chest trauma with cc	ms-drg	184	16158.85	16158.85	6519.09	6519.09	29643.79	29643.79	24703.16	24703.16	I	16158.85	16158.85	bcbs	pos
major chest trauma with cc	ms-drg	184	16158.85	16158.85	6519.09	6519.09	29643.79	29643.79	24703.16	24703.16	I	16158.85	16158.85	bcbs	ppo
major chest trauma with cc	ms-drg	184	16158.85	16158.85	6519.09	6519.09	29643.79	29643.79	24703.16	24703.16	I	16158.85	16158.85	bcbs	epo
respiratory infections and inflammations without cc/mcc	ms-drg	179	9651.21	9651.21	3828.24	3828.24	10946.44	10946.44	9122.03	9122.03	I	9651.21	9651.21	bcbs	hmo
respiratory infections and inflammations without cc/mcc	ms-drg	179	9651.21	9651.21	3828.24	3828.24	10946.44	10946.44	9122.03	9122.03	I	9651.21	9651.21	bcbs	hmo
respiratory infections and inflammations without cc/mcc	ms-drg	179	9651.21	9651.21	3828.24	3828.24	10946.44	10946.44	9122.03	9122.03	I	9651.21	9651.21	bcbs	pos
respiratory infections and inflammations without cc/mcc	ms-drg	179	9651.21	9651.21	3828.24	3828.24	10946.44	10946.44	9122.03	9122.03	I	9651.21	9651.21	bcbs	ppo
respiratory infections and inflammations without cc/mcc	ms-drg	179	9651.21	9651.21	3828.24	3828.24	10946.44	10946.44	9122.03	9122.03	I	9651.21	9651.21	bcbs	epo
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	17495.91	17495.91	bcbs	hmo
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	17495.91	17495.91	bcbs	hmo
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	17495.91	17495.91	bcbs	pos
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	17495.91	17495.91	bcbs	ppo
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	17495.91	17495.91	bcbs	epo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	20820.38	20820.38	bcbs	hmo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	20820.38	20820.38	bcbs	hmo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	20820.38	20820.38	bcbs	pos
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	20820.38	20820.38	bcbs	ppo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	20820.38	20820.38	bcbs	epo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	12434.84	12434.84	bcbs	hmo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	12434.84	12434.84	bcbs	hmo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	12434.84	12434.84	bcbs	pos
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	12434.84	12434.84	bcbs	ppo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	12434.84	12434.84	bcbs	epo
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	9498.01	9498.01	bcbs	hmo
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	9498.01	9498.01	bcbs	hmo
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	9498.01	9498.01	bcbs	pos
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	9498.01	9498.01	bcbs	ppo
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	9498.01	9498.01	bcbs	epo
other respiratory system o.r. procedures without cc/mcc	ms-drg	168	11218.51	11218.51	11218.51	11218.51	45937.34	45937.34	38281.12	38281.12	I	11218.51	11218.51	bcbs	hmo
other respiratory system o.r. procedures without cc/mcc	ms-drg	168	11218.51	11218.51	11218.51	11218.51	45937.34	45937.34	38281.12	38281.12	I	11218.51	11218.51	bcbs	hmo
other respiratory system o.r. procedures without cc/mcc	ms-drg	168	11218.51	11218.51	11218.51	11218.51	45937.34	45937.34	38281.12	38281.12	I	11218.51	11218.51	bcbs	pos
other respiratory system o.r. procedures without cc/mcc	ms-drg	168	11218.51	11218.51	11218.51	11218.51	45937.34	45937.34	38281.12	38281.12	I	11218.51	11218.51	bcbs	ppo
other respiratory system o.r. procedures without cc/mcc	ms-drg	168	11218.51	11218.51	11218.51	11218.51	45937.34	45937.34	38281.12	38281.12	I	11218.51	11218.51	bcbs	epo
other respiratory system o.r. procedures with cc	ms-drg	167	18925.13	18925.13	5702.35	5702.35	57441.06	57441.06	47867.55	47867.55	I	18925.13	18925.13	bcbs	hmo
other respiratory system o.r. procedures with cc	ms-drg	167	18925.13	18925.13	5702.35	5702.35	57441.06	57441.06	47867.55	47867.55	I	18925.13	18925.13	bcbs	hmo
other respiratory system o.r. procedures with cc	ms-drg	167	18925.13	18925.13	5702.35	5702.35	57441.06	57441.06	47867.55	47867.55	I	18925.13	18925.13	bcbs	pos
other respiratory system o.r. procedures with cc	ms-drg	167	18925.13	18925.13	5702.35	5702.35	57441.06	57441.06	47867.55	47867.55	I	18925.13	18925.13	bcbs	ppo
other respiratory system o.r. procedures with cc	ms-drg	167	18925.13	18925.13	5702.35	5702.35	57441.06	57441.06	47867.55	47867.55	I	18925.13	18925.13	bcbs	epo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	22244.9	22244.9	bcbs	hmo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	22244.9	22244.9	bcbs	hmo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	22244.9	22244.9	bcbs	pos
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	22244.9	22244.9	bcbs	ppo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	22244.9	22244.9	bcbs	epo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	25248.79	25248.79	bcbs	hmo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	25248.79	25248.79	bcbs	hmo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	25248.79	25248.79	bcbs	pos
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	25248.79	25248.79	bcbs	ppo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	25248.79	25248.79	bcbs	epo
otitis media and uri without mcc	ms-drg	153	5161.07	5161.07	1899.95	1899.95	22377.64	22377.64	18648.03	18648.03	I	4058.06	4058.06	bcbs	hmo
otitis media and uri without mcc	ms-drg	153	5161.07	5161.07	1899.95	1899.95	22377.64	22377.64	18648.03	18648.03	I	4058.06	4058.06	bcbs	hmo
otitis media and uri without mcc	ms-drg	153	5161.07	5161.07	1899.95	1899.95	22377.64	22377.64	18648.03	18648.03	I	4058.06	4058.06	bcbs	pos
otitis media and uri without mcc	ms-drg	153	5161.07	5161.07	1899.95	1899.95	22377.64	22377.64	18648.03	18648.03	I	4058.06	4058.06	bcbs	ppo
otitis media and uri without mcc	ms-drg	153	5161.07	5161.07	1899.95	1899.95	22377.64	22377.64	18648.03	18648.03	I	4058.06	4058.06	bcbs	epo
neurological eye disorders	ms-drg	123	8425.13	8425.13	5364.25	5364.25	15278.22	15278.22	12731.85	12731.85	I	8425.13	8425.13	bcbs	hmo
neurological eye disorders	ms-drg	123	8425.13	8425.13	5364.25	5364.25	15278.22	15278.22	12731.85	12731.85	I	8425.13	8425.13	bcbs	hmo
neurological eye disorders	ms-drg	123	8425.13	8425.13	5364.25	5364.25	15278.22	15278.22	12731.85	12731.85	I	8425.13	8425.13	bcbs	pos
neurological eye disorders	ms-drg	123	8425.13	8425.13	5364.25	5364.25	15278.22	15278.22	12731.85	12731.85	I	8425.13	8425.13	bcbs	ppo
neurological eye disorders	ms-drg	123	8425.13	8425.13	5364.25	5364.25	15278.22	15278.22	12731.85	12731.85	I	8425.13	8425.13	bcbs	epo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4464.61	4464.61	bcbs	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4464.61	4464.61	bcbs	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4464.61	4464.61	bcbs	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4464.61	4464.61	bcbs	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4464.61	4464.61	bcbs	epo
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27792	7125.29	7125.29	4890.06	4890.06	32793.31	32793.31	27327.76	27327.76	O	7125.29	7125.29	bcbs	hmo
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27792	7125.29	7125.29	4890.06	4890.06	32793.31	32793.31	27327.76	27327.76	O	7125.29	7125.29	bcbs	hmo
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27792	7125.29	7125.29	4890.06	4890.06	32793.31	32793.31	27327.76	27327.76	O	7125.29	7125.29	bcbs	pos
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27792	7125.29	7125.29	4890.06	4890.06	32793.31	32793.31	27327.76	27327.76	O	7125.29	7125.29	bcbs	ppo
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27792	7125.29	7125.29	4890.06	4890.06	32793.31	32793.31	27327.76	27327.76	O	7125.29	7125.29	bcbs	epo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	8027.81	8027.81	bcbs	hmo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	8027.81	8027.81	bcbs	hmo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	8027.81	8027.81	bcbs	pos
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	8027.81	8027.81	bcbs	ppo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	8027.81	8027.81	bcbs	epo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1355.6	1355.6	1355.6	1355.6	6346.06	6346.06	5288.38	5288.38	O	1355.6	1355.6	bcbs	hmo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1355.6	1355.6	1355.6	1355.6	6346.06	6346.06	5288.38	5288.38	O	1355.6	1355.6	bcbs	hmo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1355.6	1355.6	1355.6	1355.6	6346.06	6346.06	5288.38	5288.38	O	1355.6	1355.6	bcbs	pos
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1355.6	1355.6	1355.6	1355.6	6346.06	6346.06	5288.38	5288.38	O	1355.6	1355.6	bcbs	ppo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1355.6	1355.6	1355.6	1355.6	6346.06	6346.06	5288.38	5288.38	O	1355.6	1355.6	bcbs	epo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	18636.78	18636.78	bcbs	hmo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	18636.78	18636.78	bcbs	hmo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	18636.78	18636.78	bcbs	pos
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	18636.78	18636.78	bcbs	ppo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	18636.78	18636.78	bcbs	epo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	19198.5	19198.5	bcbs	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	19198.5	19198.5	bcbs	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	19198.5	19198.5	bcbs	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	19198.5	19198.5	bcbs	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	19198.5	19198.5	bcbs	epo
Incision of tissues of muscle compartment of foot and/or toe	cpt	28008	3179.01	3179.01	2425.05	2425.05	14330.89	14330.89	11942.41	11942.41	O	3179.01	3179.01	bcbs	hmo
Incision of tissues of muscle compartment of foot and/or toe	cpt	28008	3179.01	3179.01	2425.05	2425.05	14330.89	14330.89	11942.41	11942.41	O	3179.01	3179.01	bcbs	hmo
Incision of tissues of muscle compartment of foot and/or toe	cpt	28008	3179.01	3179.01	2425.05	2425.05	14330.89	14330.89	11942.41	11942.41	O	3179.01	3179.01	bcbs	pos
Incision of tissues of muscle compartment of foot and/or toe	cpt	28008	3179.01	3179.01	2425.05	2425.05	14330.89	14330.89	11942.41	11942.41	O	3179.01	3179.01	bcbs	ppo
Incision of tissues of muscle compartment of foot and/or toe	cpt	28008	3179.01	3179.01	2425.05	2425.05	14330.89	14330.89	11942.41	11942.41	O	3179.01	3179.01	bcbs	epo
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe	cpt	28043	3841.83	3841.83	3841.83	3841.83	17389.02	17389.02	14490.85	14490.85	O	3841.83	3841.83	bcbs	hmo
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe	cpt	28043	3841.83	3841.83	3841.83	3841.83	17389.02	17389.02	14490.85	14490.85	O	3841.83	3841.83	bcbs	hmo
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe	cpt	28043	3841.83	3841.83	3841.83	3841.83	17389.02	17389.02	14490.85	14490.85	O	3841.83	3841.83	bcbs	pos
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe	cpt	28043	3841.83	3841.83	3841.83	3841.83	17389.02	17389.02	14490.85	14490.85	O	3841.83	3841.83	bcbs	ppo
Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe	cpt	28043	3841.83	3841.83	3841.83	3841.83	17389.02	17389.02	14490.85	14490.85	O	3841.83	3841.83	bcbs	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	79.34	79.34	bcbs	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	79.34	79.34	bcbs	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	79.34	79.34	bcbs	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	79.34	79.34	bcbs	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	79.34	79.34	bcbs	epo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	125.2	125.2	bcbs	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	125.2	125.2	bcbs	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	125.2	125.2	bcbs	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	125.2	125.2	bcbs	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	125.2	125.2	bcbs	epo
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	2997.13	2997.13	bcbs	hmo
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	2997.13	2997.13	bcbs	hmo
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	2997.13	2997.13	bcbs	pos
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	2997.13	2997.13	bcbs	ppo
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	2997.13	2997.13	bcbs	epo
Vaccine administration	revCode	771	5297.03	5297.03	5297.03	5297.03	12608.57	12608.57	10507.14	10507.14	O	5297.03	5297.03	bcbs	hmo
Vaccine administration	revCode	771	5297.03	5297.03	5297.03	5297.03	12608.57	12608.57	10507.14	10507.14	O	5297.03	5297.03	bcbs	hmo
Vaccine administration	revCode	771	5297.03	5297.03	5297.03	5297.03	12608.57	12608.57	10507.14	10507.14	O	5297.03	5297.03	bcbs	pos
Vaccine administration	revCode	771	5297.03	5297.03	5297.03	5297.03	12608.57	12608.57	10507.14	10507.14	O	5297.03	5297.03	bcbs	ppo
Vaccine administration	revCode	771	5297.03	5297.03	5297.03	5297.03	12608.57	12608.57	10507.14	10507.14	O	5297.03	5297.03	bcbs	epo
"Correction of bunion, with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)"	cpt	28297	5382.42	5382.42	5382.42	5382.42	47414.83	47414.83	39512.36	39512.36	O	5382.42	5382.42	bcbs	hmo
"Correction of bunion, with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)"	cpt	28297	5382.42	5382.42	5382.42	5382.42	47414.83	47414.83	39512.36	39512.36	O	5382.42	5382.42	bcbs	hmo
"Correction of bunion, with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)"	cpt	28297	5382.42	5382.42	5382.42	5382.42	47414.83	47414.83	39512.36	39512.36	O	5382.42	5382.42	bcbs	pos
"Correction of bunion, with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)"	cpt	28297	5382.42	5382.42	5382.42	5382.42	47414.83	47414.83	39512.36	39512.36	O	5382.42	5382.42	bcbs	ppo
"Correction of bunion, with fusion of the midfoot (metatarsal) bone and the hindfoot bone (tarsal)"	cpt	28297	5382.42	5382.42	5382.42	5382.42	47414.83	47414.83	39512.36	39512.36	O	5382.42	5382.42	bcbs	epo
Open treatment of fracture of the mid portion of the foot	cpt	28485	5392.47	5392.47	5392.47	5392.47	30910.43	30910.43	25758.69	25758.69	O	5392.47	5392.47	bcbs	hmo
Open treatment of fracture of the mid portion of the foot	cpt	28485	5392.47	5392.47	5392.47	5392.47	30910.43	30910.43	25758.69	25758.69	O	5392.47	5392.47	bcbs	hmo
Open treatment of fracture of the mid portion of the foot	cpt	28485	5392.47	5392.47	5392.47	5392.47	30910.43	30910.43	25758.69	25758.69	O	5392.47	5392.47	bcbs	pos
Open treatment of fracture of the mid portion of the foot	cpt	28485	5392.47	5392.47	5392.47	5392.47	30910.43	30910.43	25758.69	25758.69	O	5392.47	5392.47	bcbs	ppo
Open treatment of fracture of the mid portion of the foot	cpt	28485	5392.47	5392.47	5392.47	5392.47	30910.43	30910.43	25758.69	25758.69	O	5392.47	5392.47	bcbs	epo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	3098.67	3098.67	bcbs	hmo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	3098.67	3098.67	bcbs	hmo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	3098.67	3098.67	bcbs	pos
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	3098.67	3098.67	bcbs	ppo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	3098.67	3098.67	bcbs	epo
Fusion of multiple foot joints without a bone incision	cpt	28730	5382.42	5382.42	5382.42	5382.42	60056.7	60056.7	50047.25	50047.25	O	5382.42	5382.42	bcbs	hmo
Fusion of multiple foot joints without a bone incision	cpt	28730	5382.42	5382.42	5382.42	5382.42	60056.7	60056.7	50047.25	50047.25	O	5382.42	5382.42	bcbs	hmo
Fusion of multiple foot joints without a bone incision	cpt	28730	5382.42	5382.42	5382.42	5382.42	60056.7	60056.7	50047.25	50047.25	O	5382.42	5382.42	bcbs	pos
Fusion of multiple foot joints without a bone incision	cpt	28730	5382.42	5382.42	5382.42	5382.42	60056.7	60056.7	50047.25	50047.25	O	5382.42	5382.42	bcbs	ppo
Fusion of multiple foot joints without a bone incision	cpt	28730	5382.42	5382.42	5382.42	5382.42	60056.7	60056.7	50047.25	50047.25	O	5382.42	5382.42	bcbs	epo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	3117.13	3117.13	bcbs	hmo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	3117.13	3117.13	bcbs	hmo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	3117.13	3117.13	bcbs	pos
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	3117.13	3117.13	bcbs	ppo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	3117.13	3117.13	bcbs	epo
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2204.19	2204.19	bcbs	hmo
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2204.19	2204.19	bcbs	hmo
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2204.19	2204.19	bcbs	pos
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2204.19	2204.19	bcbs	ppo
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2204.19	2204.19	bcbs	epo
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	4124.85	4124.85	bcbs	hmo
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	4124.85	4124.85	bcbs	hmo
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	4124.85	4124.85	bcbs	pos
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	4124.85	4124.85	bcbs	ppo
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	4124.85	4124.85	bcbs	epo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2600.43	2600.43	bcbs	hmo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2600.43	2600.43	bcbs	hmo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2600.43	2600.43	bcbs	pos
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2600.43	2600.43	bcbs	ppo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2600.43	2600.43	bcbs	epo
General	revCode	720	1775.61	1775.61	613.92	613.92	7965.11	7965.11	6637.59	6637.59	O	613.92	613.92	bcbs	hmo
General	revCode	720	1775.61	1775.61	613.92	613.92	7965.11	7965.11	6637.59	6637.59	O	613.92	613.92	bcbs	hmo
General	revCode	720	1775.61	1775.61	613.92	613.92	7965.11	7965.11	6637.59	6637.59	O	613.92	613.92	bcbs	pos
General	revCode	720	1775.61	1775.61	613.92	613.92	7965.11	7965.11	6637.59	6637.59	O	613.92	613.92	bcbs	ppo
General	revCode	720	1775.61	1775.61	613.92	613.92	7965.11	7965.11	6637.59	6637.59	O	613.92	613.92	bcbs	epo
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	540.19	540.19	102.7	102.7	519.73	519.73	433.11	433.11	O	540.19	540.19	bcbs	hmo
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	540.19	540.19	102.7	102.7	519.73	519.73	433.11	433.11	O	540.19	540.19	bcbs	hmo
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	540.19	540.19	102.7	102.7	519.73	519.73	433.11	433.11	O	540.19	540.19	bcbs	pos
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	540.19	540.19	102.7	102.7	519.73	519.73	433.11	433.11	O	540.19	540.19	bcbs	ppo
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	540.19	540.19	102.7	102.7	519.73	519.73	433.11	433.11	O	540.19	540.19	bcbs	epo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9961.73	9961.73	bcbs	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9961.73	9961.73	bcbs	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9961.73	9961.73	bcbs	pos
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9961.73	9961.73	bcbs	ppo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	9961.73	9961.73	bcbs	epo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	5378.65	5378.65	bcbs	hmo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	5378.65	5378.65	bcbs	hmo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	5378.65	5378.65	bcbs	pos
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	5378.65	5378.65	bcbs	ppo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	5378.65	5378.65	bcbs	epo
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	5297.03	5297.03	bcbs	hmo
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	5297.03	5297.03	bcbs	hmo
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	5297.03	5297.03	bcbs	pos
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	5297.03	5297.03	bcbs	ppo
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	5297.03	5297.03	bcbs	epo
Partial removal of shoulder joint lining using an endoscope	cpt	29820	16567.36	16567.36	16567.36	16567.36	43962.49	43962.49	36635.41	36635.41	O	16567.36	16567.36	bcbs	hmo
Partial removal of shoulder joint lining using an endoscope	cpt	29820	16567.36	16567.36	16567.36	16567.36	43962.49	43962.49	36635.41	36635.41	O	16567.36	16567.36	bcbs	hmo
Partial removal of shoulder joint lining using an endoscope	cpt	29820	16567.36	16567.36	16567.36	16567.36	43962.49	43962.49	36635.41	36635.41	O	16567.36	16567.36	bcbs	pos
Partial removal of shoulder joint lining using an endoscope	cpt	29820	16567.36	16567.36	16567.36	16567.36	43962.49	43962.49	36635.41	36635.41	O	16567.36	16567.36	bcbs	ppo
Partial removal of shoulder joint lining using an endoscope	cpt	29820	16567.36	16567.36	16567.36	16567.36	43962.49	43962.49	36635.41	36635.41	O	16567.36	16567.36	bcbs	epo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	5550.48	5550.48	bcbs	hmo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	5550.48	5550.48	bcbs	hmo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	5550.48	5550.48	bcbs	pos
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	5550.48	5550.48	bcbs	ppo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	5550.48	5550.48	bcbs	epo
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	3393.18	3393.18	bcbs	hmo
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	3393.18	3393.18	bcbs	hmo
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	3393.18	3393.18	bcbs	pos
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	3393.18	3393.18	bcbs	ppo
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	3393.18	3393.18	bcbs	epo
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	3269.92	3269.92	bcbs	hmo
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	3269.92	3269.92	bcbs	hmo
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	3269.92	3269.92	bcbs	pos
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	3269.92	3269.92	bcbs	ppo
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	3269.92	3269.92	bcbs	epo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	3561.8	3561.8	bcbs	hmo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	3561.8	3561.8	bcbs	hmo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	3561.8	3561.8	bcbs	pos
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	3561.8	3561.8	bcbs	ppo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	3561.8	3561.8	bcbs	epo
Stress test	revCode	482	3200.73	3200.73	3200.73	3200.73	17952.22	17952.22	14960.18	14960.18	O	3200.73	3200.73	bcbs	hmo
Stress test	revCode	482	3200.73	3200.73	3200.73	3200.73	17952.22	17952.22	14960.18	14960.18	O	3200.73	3200.73	bcbs	hmo
Stress test	revCode	482	3200.73	3200.73	3200.73	3200.73	17952.22	17952.22	14960.18	14960.18	O	3200.73	3200.73	bcbs	pos
Stress test	revCode	482	3200.73	3200.73	3200.73	3200.73	17952.22	17952.22	14960.18	14960.18	O	3200.73	3200.73	bcbs	ppo
Stress test	revCode	482	3200.73	3200.73	3200.73	3200.73	17952.22	17952.22	14960.18	14960.18	O	3200.73	3200.73	bcbs	epo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9091.8	9091.8	bcbs	hmo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9091.8	9091.8	bcbs	hmo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9091.8	9091.8	bcbs	pos
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9091.8	9091.8	bcbs	ppo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9091.8	9091.8	bcbs	epo
Cardiac cath lab	revCode	481	25638.87	25638.87	25638.87	25638.87	79574.21	79574.21	66311.84	66311.84	O	25638.87	25638.87	bcbs	hmo
Cardiac cath lab	revCode	481	25638.87	25638.87	25638.87	25638.87	79574.21	79574.21	66311.84	66311.84	O	25638.87	25638.87	bcbs	hmo
Cardiac cath lab	revCode	481	25638.87	25638.87	25638.87	25638.87	79574.21	79574.21	66311.84	66311.84	O	25638.87	25638.87	bcbs	pos
Cardiac cath lab	revCode	481	25638.87	25638.87	25638.87	25638.87	79574.21	79574.21	66311.84	66311.84	O	25638.87	25638.87	bcbs	ppo
Cardiac cath lab	revCode	481	25638.87	25638.87	25638.87	25638.87	79574.21	79574.21	66311.84	66311.84	O	25638.87	25638.87	bcbs	epo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	10836	10836	bcbs	hmo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	10836	10836	bcbs	hmo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	10836	10836	bcbs	pos
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	10836	10836	bcbs	ppo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	10836	10836	bcbs	epo
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	5536.39	5536.39	bcbs	hmo
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	5536.39	5536.39	bcbs	hmo
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	5536.39	5536.39	bcbs	pos
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	5536.39	5536.39	bcbs	ppo
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	5536.39	5536.39	bcbs	epo
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	6950.29	6950.29	bcbs	hmo
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	6950.29	6950.29	bcbs	hmo
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	6950.29	6950.29	bcbs	pos
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	6950.29	6950.29	bcbs	ppo
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	6950.29	6950.29	bcbs	epo
Release or removal of shoulder scar tissue using an endoscope	cpt	29825	5550.48	5550.48	2405.65	2405.65	31991.54	31991.54	26659.62	26659.62	O	5550.48	5550.48	bcbs	hmo
Release or removal of shoulder scar tissue using an endoscope	cpt	29825	5550.48	5550.48	2405.65	2405.65	31991.54	31991.54	26659.62	26659.62	O	5550.48	5550.48	bcbs	hmo
Release or removal of shoulder scar tissue using an endoscope	cpt	29825	5550.48	5550.48	2405.65	2405.65	31991.54	31991.54	26659.62	26659.62	O	5550.48	5550.48	bcbs	pos
Release or removal of shoulder scar tissue using an endoscope	cpt	29825	5550.48	5550.48	2405.65	2405.65	31991.54	31991.54	26659.62	26659.62	O	5550.48	5550.48	bcbs	ppo
Release or removal of shoulder scar tissue using an endoscope	cpt	29825	5550.48	5550.48	2405.65	2405.65	31991.54	31991.54	26659.62	26659.62	O	5550.48	5550.48	bcbs	epo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1904.3	1904.3	bcbs	hmo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1904.3	1904.3	bcbs	hmo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1904.3	1904.3	bcbs	pos
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1904.3	1904.3	bcbs	ppo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1904.3	1904.3	bcbs	epo
Evaluation or reevaluation	revCode	444	1984.88	1984.88	1984.88	1984.88	20680.18	20680.18	17233.48	17233.48	O	1984.88	1984.88	bcbs	hmo
Evaluation or reevaluation	revCode	444	1984.88	1984.88	1984.88	1984.88	20680.18	20680.18	17233.48	17233.48	O	1984.88	1984.88	bcbs	hmo
Evaluation or reevaluation	revCode	444	1984.88	1984.88	1984.88	1984.88	20680.18	20680.18	17233.48	17233.48	O	1984.88	1984.88	bcbs	pos
Evaluation or reevaluation	revCode	444	1984.88	1984.88	1984.88	1984.88	20680.18	20680.18	17233.48	17233.48	O	1984.88	1984.88	bcbs	ppo
Evaluation or reevaluation	revCode	444	1984.88	1984.88	1984.88	1984.88	20680.18	20680.18	17233.48	17233.48	O	1984.88	1984.88	bcbs	epo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	15196.01	15196.01	bcbs	hmo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	15196.01	15196.01	bcbs	hmo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	15196.01	15196.01	bcbs	pos
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	15196.01	15196.01	bcbs	ppo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	15196.01	15196.01	bcbs	epo
Visit charge	revCode	441	2154.59	2154.59	2154.59	2154.59	25292.77	25292.77	21077.31	21077.31	O	2154.59	2154.59	bcbs	hmo
Visit charge	revCode	441	2154.59	2154.59	2154.59	2154.59	25292.77	25292.77	21077.31	21077.31	O	2154.59	2154.59	bcbs	hmo
Visit charge	revCode	441	2154.59	2154.59	2154.59	2154.59	25292.77	25292.77	21077.31	21077.31	O	2154.59	2154.59	bcbs	pos
Visit charge	revCode	441	2154.59	2154.59	2154.59	2154.59	25292.77	25292.77	21077.31	21077.31	O	2154.59	2154.59	bcbs	ppo
Visit charge	revCode	441	2154.59	2154.59	2154.59	2154.59	25292.77	25292.77	21077.31	21077.31	O	2154.59	2154.59	bcbs	epo
General	revCode	440	3038.1	3038.1	3038.1	3038.1	15181.22	15181.22	12651.02	12651.02	O	3038.1	3038.1	bcbs	hmo
General	revCode	440	3038.1	3038.1	3038.1	3038.1	15181.22	15181.22	12651.02	12651.02	O	3038.1	3038.1	bcbs	hmo
General	revCode	440	3038.1	3038.1	3038.1	3038.1	15181.22	15181.22	12651.02	12651.02	O	3038.1	3038.1	bcbs	pos
General	revCode	440	3038.1	3038.1	3038.1	3038.1	15181.22	15181.22	12651.02	12651.02	O	3038.1	3038.1	bcbs	ppo
General	revCode	440	3038.1	3038.1	3038.1	3038.1	15181.22	15181.22	12651.02	12651.02	O	3038.1	3038.1	bcbs	epo
Release of shoulder biceps tendon using an endoscope	cpt	29828	6466.87	6466.87	5299.29	5299.29	38752.94	38752.94	32294.12	32294.12	O	6466.87	6466.87	bcbs	hmo
Release of shoulder biceps tendon using an endoscope	cpt	29828	6466.87	6466.87	5299.29	5299.29	38752.94	38752.94	32294.12	32294.12	O	6466.87	6466.87	bcbs	hmo
Release of shoulder biceps tendon using an endoscope	cpt	29828	6466.87	6466.87	5299.29	5299.29	38752.94	38752.94	32294.12	32294.12	O	6466.87	6466.87	bcbs	pos
Release of shoulder biceps tendon using an endoscope	cpt	29828	6466.87	6466.87	5299.29	5299.29	38752.94	38752.94	32294.12	32294.12	O	6466.87	6466.87	bcbs	ppo
Release of shoulder biceps tendon using an endoscope	cpt	29828	6466.87	6466.87	5299.29	5299.29	38752.94	38752.94	32294.12	32294.12	O	6466.87	6466.87	bcbs	epo
Irrigation and drainage of knee joint for infection using an endoscope	cpt	29871	7386.83	7386.83	7386.83	7386.83	26394.78	26394.78	21995.65	21995.65	O	7386.83	7386.83	bcbs	hmo
Irrigation and drainage of knee joint for infection using an endoscope	cpt	29871	7386.83	7386.83	7386.83	7386.83	26394.78	26394.78	21995.65	21995.65	O	7386.83	7386.83	bcbs	hmo
Irrigation and drainage of knee joint for infection using an endoscope	cpt	29871	7386.83	7386.83	7386.83	7386.83	26394.78	26394.78	21995.65	21995.65	O	7386.83	7386.83	bcbs	pos
Irrigation and drainage of knee joint for infection using an endoscope	cpt	29871	7386.83	7386.83	7386.83	7386.83	26394.78	26394.78	21995.65	21995.65	O	7386.83	7386.83	bcbs	ppo
Irrigation and drainage of knee joint for infection using an endoscope	cpt	29871	7386.83	7386.83	7386.83	7386.83	26394.78	26394.78	21995.65	21995.65	O	7386.83	7386.83	bcbs	epo
Evaluation or reevaluation	revCode	434	3544.16	3544.16	163.86	163.86	3960	3960	3300	3300	O	3544.16	3544.16	bcbs	hmo
Evaluation or reevaluation	revCode	434	3544.16	3544.16	163.86	163.86	3960	3960	3300	3300	O	3544.16	3544.16	bcbs	hmo
Evaluation or reevaluation	revCode	434	3544.16	3544.16	163.86	163.86	3960	3960	3300	3300	O	3544.16	3544.16	bcbs	pos
Evaluation or reevaluation	revCode	434	3544.16	3544.16	163.86	163.86	3960	3960	3300	3300	O	3544.16	3544.16	bcbs	ppo
Evaluation or reevaluation	revCode	434	3544.16	3544.16	163.86	163.86	3960	3960	3300	3300	O	3544.16	3544.16	bcbs	epo
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1682.68	1682.68	bcbs	hmo
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1682.68	1682.68	bcbs	hmo
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1682.68	1682.68	bcbs	pos
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1682.68	1682.68	bcbs	ppo
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1682.68	1682.68	bcbs	epo
Partial removal of knee joint lining using an endoscope	cpt	29875	5454.29	5454.29	3862.17	3862.17	24288.23	24288.23	20240.19	20240.19	O	5454.29	5454.29	bcbs	hmo
Partial removal of knee joint lining using an endoscope	cpt	29875	5454.29	5454.29	3862.17	3862.17	24288.23	24288.23	20240.19	20240.19	O	5454.29	5454.29	bcbs	hmo
Partial removal of knee joint lining using an endoscope	cpt	29875	5454.29	5454.29	3862.17	3862.17	24288.23	24288.23	20240.19	20240.19	O	5454.29	5454.29	bcbs	pos
Partial removal of knee joint lining using an endoscope	cpt	29875	5454.29	5454.29	3862.17	3862.17	24288.23	24288.23	20240.19	20240.19	O	5454.29	5454.29	bcbs	ppo
Partial removal of knee joint lining using an endoscope	cpt	29875	5454.29	5454.29	3862.17	3862.17	24288.23	24288.23	20240.19	20240.19	O	5454.29	5454.29	bcbs	epo
General	revCode	430	5297.03	5297.03	5297.03	5297.03	51730.08	51730.08	43108.4	43108.4	O	5297.03	5297.03	bcbs	hmo
General	revCode	430	5297.03	5297.03	5297.03	5297.03	51730.08	51730.08	43108.4	43108.4	O	5297.03	5297.03	bcbs	hmo
General	revCode	430	5297.03	5297.03	5297.03	5297.03	51730.08	51730.08	43108.4	43108.4	O	5297.03	5297.03	bcbs	pos
General	revCode	430	5297.03	5297.03	5297.03	5297.03	51730.08	51730.08	43108.4	43108.4	O	5297.03	5297.03	bcbs	ppo
General	revCode	430	5297.03	5297.03	5297.03	5297.03	51730.08	51730.08	43108.4	43108.4	O	5297.03	5297.03	bcbs	epo
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	1044.94	1044.94	bcbs	hmo
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	1044.94	1044.94	bcbs	hmo
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	1044.94	1044.94	bcbs	pos
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	1044.94	1044.94	bcbs	ppo
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	1044.94	1044.94	bcbs	epo
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3098.67	3098.67	bcbs	hmo
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3098.67	3098.67	bcbs	hmo
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3098.67	3098.67	bcbs	pos
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3098.67	3098.67	bcbs	ppo
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3098.67	3098.67	bcbs	epo
Inhalation services	revCode	412	3459.25	3459.25	3459.25	3459.25	19060.43	19060.43	15883.69	15883.69	O	3459.25	3459.25	bcbs	hmo
Inhalation services	revCode	412	3459.25	3459.25	3459.25	3459.25	19060.43	19060.43	15883.69	15883.69	O	3459.25	3459.25	bcbs	hmo
Inhalation services	revCode	412	3459.25	3459.25	3459.25	3459.25	19060.43	19060.43	15883.69	15883.69	O	3459.25	3459.25	bcbs	pos
Inhalation services	revCode	412	3459.25	3459.25	3459.25	3459.25	19060.43	19060.43	15883.69	15883.69	O	3459.25	3459.25	bcbs	ppo
Inhalation services	revCode	412	3459.25	3459.25	3459.25	3459.25	19060.43	19060.43	15883.69	15883.69	O	3459.25	3459.25	bcbs	epo
General	revCode	410	2904.35	2904.35	2904.35	2904.35	17900.93	17900.93	14917.44	14917.44	O	2904.35	2904.35	bcbs	hmo
General	revCode	410	2904.35	2904.35	2904.35	2904.35	17900.93	17900.93	14917.44	14917.44	O	2904.35	2904.35	bcbs	hmo
General	revCode	410	2904.35	2904.35	2904.35	2904.35	17900.93	17900.93	14917.44	14917.44	O	2904.35	2904.35	bcbs	pos
General	revCode	410	2904.35	2904.35	2904.35	2904.35	17900.93	17900.93	14917.44	14917.44	O	2904.35	2904.35	bcbs	ppo
General	revCode	410	2904.35	2904.35	2904.35	2904.35	17900.93	17900.93	14917.44	14917.44	O	2904.35	2904.35	bcbs	epo
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	1255.56	1255.56	bcbs	hmo
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	1255.56	1255.56	bcbs	hmo
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	1255.56	1255.56	bcbs	pos
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	1255.56	1255.56	bcbs	ppo
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	1255.56	1255.56	bcbs	epo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	6335.66	6335.66	bcbs	hmo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	6335.66	6335.66	bcbs	hmo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	6335.66	6335.66	bcbs	pos
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	6335.66	6335.66	bcbs	ppo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	6335.66	6335.66	bcbs	epo
"Administration (e.g., transfusions)"	revCode	391	1796.52	1796.52	1796.52	1796.52	8394	8394	6995	6995	O	1796.52	1796.52	bcbs	hmo
"Administration (e.g., transfusions)"	revCode	391	1796.52	1796.52	1796.52	1796.52	8394	8394	6995	6995	O	1796.52	1796.52	bcbs	hmo
"Administration (e.g., transfusions)"	revCode	391	1796.52	1796.52	1796.52	1796.52	8394	8394	6995	6995	O	1796.52	1796.52	bcbs	pos
"Administration (e.g., transfusions)"	revCode	391	1796.52	1796.52	1796.52	1796.52	8394	8394	6995	6995	O	1796.52	1796.52	bcbs	ppo
"Administration (e.g., transfusions)"	revCode	391	1796.52	1796.52	1796.52	1796.52	8394	8394	6995	6995	O	1796.52	1796.52	bcbs	epo
General	revCode	390	1880.71	1880.71	1880.71	1880.71	12481.22	12481.22	10401.02	10401.02	O	1880.71	1880.71	bcbs	hmo
General	revCode	390	1880.71	1880.71	1880.71	1880.71	12481.22	12481.22	10401.02	10401.02	O	1880.71	1880.71	bcbs	hmo
General	revCode	390	1880.71	1880.71	1880.71	1880.71	12481.22	12481.22	10401.02	10401.02	O	1880.71	1880.71	bcbs	pos
General	revCode	390	1880.71	1880.71	1880.71	1880.71	12481.22	12481.22	10401.02	10401.02	O	1880.71	1880.71	bcbs	ppo
General	revCode	390	1880.71	1880.71	1880.71	1880.71	12481.22	12481.22	10401.02	10401.02	O	1880.71	1880.71	bcbs	epo
Incident to radiology	revCode	371	22052.47	22052.47	22052.47	22052.47	66615.74	66615.74	55513.12	55513.12	O	22052.47	22052.47	bcbs	hmo
Incident to radiology	revCode	371	22052.47	22052.47	22052.47	22052.47	66615.74	66615.74	55513.12	55513.12	O	22052.47	22052.47	bcbs	hmo
Incident to radiology	revCode	371	22052.47	22052.47	22052.47	22052.47	66615.74	66615.74	55513.12	55513.12	O	22052.47	22052.47	bcbs	pos
Incident to radiology	revCode	371	22052.47	22052.47	22052.47	22052.47	66615.74	66615.74	55513.12	55513.12	O	22052.47	22052.47	bcbs	ppo
Incident to radiology	revCode	371	22052.47	22052.47	22052.47	22052.47	66615.74	66615.74	55513.12	55513.12	O	22052.47	22052.47	bcbs	epo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	8866.84	8866.84	bcbs	hmo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	8866.84	8866.84	bcbs	hmo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	8866.84	8866.84	bcbs	pos
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	8866.84	8866.84	bcbs	ppo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	8866.84	8866.84	bcbs	epo
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	8642.34	8642.34	bcbs	hmo
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	8642.34	8642.34	bcbs	hmo
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	8642.34	8642.34	bcbs	pos
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	8642.34	8642.34	bcbs	ppo
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	8642.34	8642.34	bcbs	epo
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	2997.13	2997.13	bcbs	hmo
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	2997.13	2997.13	bcbs	hmo
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	2997.13	2997.13	bcbs	pos
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	2997.13	2997.13	bcbs	ppo
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	2997.13	2997.13	bcbs	epo
"Removal of polyps in nose, extensive or complex"	cpt	30115	7551.65	7551.65	4819.51	4819.51	49945.48	49945.48	41621.23	41621.23	O	7551.65	7551.65	bcbs	hmo
"Removal of polyps in nose, extensive or complex"	cpt	30115	7551.65	7551.65	4819.51	4819.51	49945.48	49945.48	41621.23	41621.23	O	7551.65	7551.65	bcbs	hmo
"Removal of polyps in nose, extensive or complex"	cpt	30115	7551.65	7551.65	4819.51	4819.51	49945.48	49945.48	41621.23	41621.23	O	7551.65	7551.65	bcbs	pos
"Removal of polyps in nose, extensive or complex"	cpt	30115	7551.65	7551.65	4819.51	4819.51	49945.48	49945.48	41621.23	41621.23	O	7551.65	7551.65	bcbs	ppo
"Removal of polyps in nose, extensive or complex"	cpt	30115	7551.65	7551.65	4819.51	4819.51	49945.48	49945.48	41621.23	41621.23	O	7551.65	7551.65	bcbs	epo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2909.63	2909.63	bcbs	hmo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2909.63	2909.63	bcbs	hmo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2909.63	2909.63	bcbs	pos
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2909.63	2909.63	bcbs	ppo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2909.63	2909.63	bcbs	epo
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	1916.73	1916.73	bcbs	hmo
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	1916.73	1916.73	bcbs	hmo
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	1916.73	1916.73	bcbs	pos
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	1916.73	1916.73	bcbs	ppo
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	1916.73	1916.73	bcbs	epo
Partial removal of nasal sinus using an endoscope	cpt	31254	6790.97	6790.97	4819.51	4819.51	43785.56	43785.56	36487.97	36487.97	O	6790.97	6790.97	bcbs	hmo
Partial removal of nasal sinus using an endoscope	cpt	31254	6790.97	6790.97	4819.51	4819.51	43785.56	43785.56	36487.97	36487.97	O	6790.97	6790.97	bcbs	hmo
Partial removal of nasal sinus using an endoscope	cpt	31254	6790.97	6790.97	4819.51	4819.51	43785.56	43785.56	36487.97	36487.97	O	6790.97	6790.97	bcbs	pos
Partial removal of nasal sinus using an endoscope	cpt	31254	6790.97	6790.97	4819.51	4819.51	43785.56	43785.56	36487.97	36487.97	O	6790.97	6790.97	bcbs	ppo
Partial removal of nasal sinus using an endoscope	cpt	31254	6790.97	6790.97	4819.51	4819.51	43785.56	43785.56	36487.97	36487.97	O	6790.97	6790.97	bcbs	epo
"Removal of nasal sinus tissue using an endoscope, maxillary sinus"	cpt	31267	6790.97	6790.97	4819.51	4819.51	34277.41	34277.41	28564.51	28564.51	O	6790.97	6790.97	bcbs	hmo
"Removal of nasal sinus tissue using an endoscope, maxillary sinus"	cpt	31267	6790.97	6790.97	4819.51	4819.51	34277.41	34277.41	28564.51	28564.51	O	6790.97	6790.97	bcbs	hmo
"Removal of nasal sinus tissue using an endoscope, maxillary sinus"	cpt	31267	6790.97	6790.97	4819.51	4819.51	34277.41	34277.41	28564.51	28564.51	O	6790.97	6790.97	bcbs	pos
"Removal of nasal sinus tissue using an endoscope, maxillary sinus"	cpt	31267	6790.97	6790.97	4819.51	4819.51	34277.41	34277.41	28564.51	28564.51	O	6790.97	6790.97	bcbs	ppo
"Removal of nasal sinus tissue using an endoscope, maxillary sinus"	cpt	31267	6790.97	6790.97	4819.51	4819.51	34277.41	34277.41	28564.51	28564.51	O	6790.97	6790.97	bcbs	epo
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	3200.73	3200.73	bcbs	hmo
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	3200.73	3200.73	bcbs	hmo
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	3200.73	3200.73	bcbs	pos
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	3200.73	3200.73	bcbs	ppo
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	3200.73	3200.73	bcbs	epo
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3200.73	3200.73	bcbs	hmo
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3200.73	3200.73	bcbs	hmo
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3200.73	3200.73	bcbs	pos
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3200.73	3200.73	bcbs	ppo
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3200.73	3200.73	bcbs	epo
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	3913.9	3913.9	bcbs	hmo
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	3913.9	3913.9	bcbs	hmo
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	3913.9	3913.9	bcbs	pos
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	3913.9	3913.9	bcbs	ppo
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	3913.9	3913.9	bcbs	epo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	2756.03	2756.03	bcbs	hmo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	2756.03	2756.03	bcbs	hmo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	2756.03	2756.03	bcbs	pos
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	2756.03	2756.03	bcbs	ppo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	2756.03	2756.03	bcbs	epo
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3576.75	3576.75	bcbs	hmo
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3576.75	3576.75	bcbs	hmo
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3576.75	3576.75	bcbs	pos
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3576.75	3576.75	bcbs	ppo
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3576.75	3576.75	bcbs	epo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2899.33	2899.33	bcbs	hmo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2899.33	2899.33	bcbs	hmo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2899.33	2899.33	bcbs	pos
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2899.33	2899.33	bcbs	ppo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2899.33	2899.33	bcbs	epo
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	6718.4	6718.4	bcbs	hmo
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	6718.4	6718.4	bcbs	hmo
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	6718.4	6718.4	bcbs	pos
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	6718.4	6718.4	bcbs	ppo
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	6718.4	6718.4	bcbs	epo
Histology	revCode	312	1249.79	1249.79	1249.79	1249.79	5404.87	5404.87	4504.06	4504.06	O	1249.79	1249.79	bcbs	hmo
Histology	revCode	312	1249.79	1249.79	1249.79	1249.79	5404.87	5404.87	4504.06	4504.06	O	1249.79	1249.79	bcbs	hmo
Histology	revCode	312	1249.79	1249.79	1249.79	1249.79	5404.87	5404.87	4504.06	4504.06	O	1249.79	1249.79	bcbs	pos
Histology	revCode	312	1249.79	1249.79	1249.79	1249.79	5404.87	5404.87	4504.06	4504.06	O	1249.79	1249.79	bcbs	ppo
Histology	revCode	312	1249.79	1249.79	1249.79	1249.79	5404.87	5404.87	4504.06	4504.06	O	1249.79	1249.79	bcbs	epo
General	revCode	310	8642.34	8642.34	1829.25	1829.25	24781.55	24781.55	20651.29	20651.29	O	8642.34	8642.34	bcbs	hmo
General	revCode	310	8642.34	8642.34	1829.25	1829.25	24781.55	24781.55	20651.29	20651.29	O	8642.34	8642.34	bcbs	hmo
General	revCode	310	8642.34	8642.34	1829.25	1829.25	24781.55	24781.55	20651.29	20651.29	O	8642.34	8642.34	bcbs	pos
General	revCode	310	8642.34	8642.34	1829.25	1829.25	24781.55	24781.55	20651.29	20651.29	O	8642.34	8642.34	bcbs	ppo
General	revCode	310	8642.34	8642.34	1829.25	1829.25	24781.55	24781.55	20651.29	20651.29	O	8642.34	8642.34	bcbs	epo
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	3532.41	3532.41	bcbs	hmo
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	3532.41	3532.41	bcbs	hmo
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	3532.41	3532.41	bcbs	pos
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	3532.41	3532.41	bcbs	ppo
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	3532.41	3532.41	bcbs	epo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	3043.23	3043.23	bcbs	hmo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	3043.23	3043.23	bcbs	hmo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	3043.23	3043.23	bcbs	pos
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	3043.23	3043.23	bcbs	ppo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	3043.23	3043.23	bcbs	epo
General	revCode	280	3034.45	3034.45	3034.45	3034.45	12935.92	12935.92	10779.93	10779.93	O	3034.45	3034.45	bcbs	hmo
General	revCode	280	3034.45	3034.45	3034.45	3034.45	12935.92	12935.92	10779.93	10779.93	O	3034.45	3034.45	bcbs	hmo
General	revCode	280	3034.45	3034.45	3034.45	3034.45	12935.92	12935.92	10779.93	10779.93	O	3034.45	3034.45	bcbs	pos
General	revCode	280	3034.45	3034.45	3034.45	3034.45	12935.92	12935.92	10779.93	10779.93	O	3034.45	3034.45	bcbs	ppo
General	revCode	280	3034.45	3034.45	3034.45	3034.45	12935.92	12935.92	10779.93	10779.93	O	3034.45	3034.45	bcbs	epo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	13825.2	13825.2	bcbs	hmo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	13825.2	13825.2	bcbs	hmo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	13825.2	13825.2	bcbs	pos
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	13825.2	13825.2	bcbs	ppo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	13825.2	13825.2	bcbs	epo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	13825.2	13825.2	bcbs	hmo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	13825.2	13825.2	bcbs	hmo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	13825.2	13825.2	bcbs	pos
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	13825.2	13825.2	bcbs	ppo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	13825.2	13825.2	bcbs	epo
"Removal and replacement of defibrillator pulse generator, multiple wires (leads)"	cpt	33264	28598.55	28598.55	19829.15	19829.15	91681.37	91681.37	76401.14	76401.14	O	19829.15	19829.15	bcbs	hmo
"Removal and replacement of defibrillator pulse generator, multiple wires (leads)"	cpt	33264	28598.55	28598.55	19829.15	19829.15	91681.37	91681.37	76401.14	76401.14	O	19829.15	19829.15	bcbs	hmo
"Removal and replacement of defibrillator pulse generator, multiple wires (leads)"	cpt	33264	28598.55	28598.55	19829.15	19829.15	91681.37	91681.37	76401.14	76401.14	O	19829.15	19829.15	bcbs	pos
"Removal and replacement of defibrillator pulse generator, multiple wires (leads)"	cpt	33264	28598.55	28598.55	19829.15	19829.15	91681.37	91681.37	76401.14	76401.14	O	19829.15	19829.15	bcbs	ppo
"Removal and replacement of defibrillator pulse generator, multiple wires (leads)"	cpt	33264	28598.55	28598.55	19829.15	19829.15	91681.37	91681.37	76401.14	76401.14	O	19829.15	19829.15	bcbs	epo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3525.48	3525.48	bcbs	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3525.48	3525.48	bcbs	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3525.48	3525.48	bcbs	pos
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3525.48	3525.48	bcbs	ppo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3525.48	3525.48	bcbs	epo
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation	cpt	36225	5763.06	5763.06	3779.86	3779.86	16929.42	16929.42	14107.85	14107.85	O	5763.06	5763.06	bcbs	hmo
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation	cpt	36225	5763.06	5763.06	3779.86	3779.86	16929.42	16929.42	14107.85	14107.85	O	5763.06	5763.06	bcbs	hmo
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation	cpt	36225	5763.06	5763.06	3779.86	3779.86	16929.42	16929.42	14107.85	14107.85	O	5763.06	5763.06	bcbs	pos
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation	cpt	36225	5763.06	5763.06	3779.86	3779.86	16929.42	16929.42	14107.85	14107.85	O	5763.06	5763.06	bcbs	ppo
Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation	cpt	36225	5763.06	5763.06	3779.86	3779.86	16929.42	16929.42	14107.85	14107.85	O	5763.06	5763.06	bcbs	epo
General	revCode	260	5297.03	5297.03	5297.03	5297.03	16233.73	16233.73	13528.11	13528.11	O	5297.03	5297.03	bcbs	hmo
General	revCode	260	5297.03	5297.03	5297.03	5297.03	16233.73	16233.73	13528.11	13528.11	O	5297.03	5297.03	bcbs	hmo
General	revCode	260	5297.03	5297.03	5297.03	5297.03	16233.73	16233.73	13528.11	13528.11	O	5297.03	5297.03	bcbs	pos
General	revCode	260	5297.03	5297.03	5297.03	5297.03	16233.73	16233.73	13528.11	13528.11	O	5297.03	5297.03	bcbs	ppo
General	revCode	260	5297.03	5297.03	5297.03	5297.03	16233.73	16233.73	13528.11	13528.11	O	5297.03	5297.03	bcbs	epo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	9091.33	9091.33	bcbs	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	9091.33	9091.33	bcbs	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	9091.33	9091.33	bcbs	pos
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	9091.33	9091.33	bcbs	ppo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	9091.33	9091.33	bcbs	epo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5809.49	5809.49	bcbs	hmo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5809.49	5809.49	bcbs	hmo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5809.49	5809.49	bcbs	pos
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5809.49	5809.49	bcbs	ppo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5809.49	5809.49	bcbs	epo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	3043.23	3043.23	bcbs	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	3043.23	3043.23	bcbs	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	3043.23	3043.23	bcbs	pos
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	3043.23	3043.23	bcbs	ppo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	3043.23	3043.23	bcbs	epo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	2579.59	2579.59	bcbs	hmo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	2579.59	2579.59	bcbs	hmo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	2579.59	2579.59	bcbs	pos
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	2579.59	2579.59	bcbs	ppo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	2579.59	2579.59	bcbs	epo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	4337.53	4337.53	bcbs	hmo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	4337.53	4337.53	bcbs	hmo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	4337.53	4337.53	bcbs	pos
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	4337.53	4337.53	bcbs	ppo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	4337.53	4337.53	bcbs	epo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	7599.47	7599.47	bcbs	hmo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	7599.47	7599.47	bcbs	hmo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	7599.47	7599.47	bcbs	pos
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	7599.47	7599.47	bcbs	ppo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	7599.47	7599.47	bcbs	epo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	6037.32	6037.32	bcbs	hmo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	6037.32	6037.32	bcbs	hmo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	6037.32	6037.32	bcbs	pos
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	6037.32	6037.32	bcbs	ppo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	6037.32	6037.32	bcbs	epo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	13720.75	13720.75	bcbs	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	13720.75	13720.75	bcbs	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	13720.75	13720.75	bcbs	pos
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	13720.75	13720.75	bcbs	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	13720.75	13720.75	bcbs	epo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	3874.3	3874.3	bcbs	hmo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	3874.3	3874.3	bcbs	hmo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	3874.3	3874.3	bcbs	pos
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	3874.3	3874.3	bcbs	ppo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	3874.3	3874.3	bcbs	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	116.97	116.97	bcbs	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	116.97	116.97	bcbs	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	116.97	116.97	bcbs	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	116.97	116.97	bcbs	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	116.97	116.97	bcbs	epo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	877.03	877.03	bcbs	hmo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	877.03	877.03	bcbs	hmo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	877.03	877.03	bcbs	pos
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	877.03	877.03	bcbs	ppo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	877.03	877.03	bcbs	epo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10872.3	10872.3	bcbs	hmo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10872.3	10872.3	bcbs	hmo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10872.3	10872.3	bcbs	pos
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10872.3	10872.3	bcbs	ppo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10872.3	10872.3	bcbs	epo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	8152.79	8152.79	bcbs	hmo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	8152.79	8152.79	bcbs	hmo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	8152.79	8152.79	bcbs	pos
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	8152.79	8152.79	bcbs	ppo
inj mvasi 10 mg	cpt	Q5107	8152.79	8152.79	376.97	376.97	23673.43	23673.43	19727.86	19727.86	O	8152.79	8152.79	bcbs	epo
apligraf	cpt	Q4101	2485.7	2485.7	1437.55	1437.55	20100.16	20100.16	16750.13	16750.13	O	2485.7	2485.7	bcbs	hmo
apligraf	cpt	Q4101	2485.7	2485.7	1437.55	1437.55	20100.16	20100.16	16750.13	16750.13	O	2485.7	2485.7	bcbs	hmo
apligraf	cpt	Q4101	2485.7	2485.7	1437.55	1437.55	20100.16	20100.16	16750.13	16750.13	O	2485.7	2485.7	bcbs	pos
apligraf	cpt	Q4101	2485.7	2485.7	1437.55	1437.55	20100.16	20100.16	16750.13	16750.13	O	2485.7	2485.7	bcbs	ppo
apligraf	cpt	Q4101	2485.7	2485.7	1437.55	1437.55	20100.16	20100.16	16750.13	16750.13	O	2485.7	2485.7	bcbs	epo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	801.75	801.75	bcbs	hmo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	801.75	801.75	bcbs	hmo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	801.75	801.75	bcbs	pos
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	801.75	801.75	bcbs	ppo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	801.75	801.75	bcbs	epo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	2209.95	2209.95	bcbs	hmo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	2209.95	2209.95	bcbs	hmo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	2209.95	2209.95	bcbs	pos
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	2209.95	2209.95	bcbs	ppo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	2209.95	2209.95	bcbs	epo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	2178.24	2178.24	bcbs	hmo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	2178.24	2178.24	bcbs	hmo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	2178.24	2178.24	bcbs	pos
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	2178.24	2178.24	bcbs	ppo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	2178.24	2178.24	bcbs	epo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1751.84	1751.84	bcbs	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1751.84	1751.84	bcbs	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1751.84	1751.84	bcbs	pos
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1751.84	1751.84	bcbs	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1751.84	1751.84	bcbs	epo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	2178.24	2178.24	bcbs	hmo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	2178.24	2178.24	bcbs	hmo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	2178.24	2178.24	bcbs	pos
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	2178.24	2178.24	bcbs	ppo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	2178.24	2178.24	bcbs	epo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	2337.61	2337.61	bcbs	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	2337.61	2337.61	bcbs	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	2337.61	2337.61	bcbs	pos
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	2337.61	2337.61	bcbs	ppo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	2337.61	2337.61	bcbs	epo
implt neurostim elctr each	cpt	L8680	8962.99	8962.99	8962.99	8962.99	15490.97	15490.97	12909.14	12909.14	O	8962.99	8962.99	bcbs	hmo
implt neurostim elctr each	cpt	L8680	8962.99	8962.99	8962.99	8962.99	15490.97	15490.97	12909.14	12909.14	O	8962.99	8962.99	bcbs	hmo
implt neurostim elctr each	cpt	L8680	8962.99	8962.99	8962.99	8962.99	15490.97	15490.97	12909.14	12909.14	O	8962.99	8962.99	bcbs	pos
implt neurostim elctr each	cpt	L8680	8962.99	8962.99	8962.99	8962.99	15490.97	15490.97	12909.14	12909.14	O	8962.99	8962.99	bcbs	ppo
implt neurostim elctr each	cpt	L8680	8962.99	8962.99	8962.99	8962.99	15490.97	15490.97	12909.14	12909.14	O	8962.99	8962.99	bcbs	epo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	2178.24	2178.24	bcbs	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	2178.24	2178.24	bcbs	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	2178.24	2178.24	bcbs	pos
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	2178.24	2178.24	bcbs	ppo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	2178.24	2178.24	bcbs	epo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	529.29	529.29	bcbs	hmo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	529.29	529.29	bcbs	hmo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	529.29	529.29	bcbs	pos
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	529.29	529.29	bcbs	ppo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	529.29	529.29	bcbs	epo
so acro/clav can web pre ots	cpt	L3670	16498.51	16498.51	5299.29	5299.29	37379.68	37379.68	31149.73	31149.73	O	16498.51	16498.51	bcbs	hmo
so acro/clav can web pre ots	cpt	L3670	16498.51	16498.51	5299.29	5299.29	37379.68	37379.68	31149.73	31149.73	O	16498.51	16498.51	bcbs	hmo
so acro/clav can web pre ots	cpt	L3670	16498.51	16498.51	5299.29	5299.29	37379.68	37379.68	31149.73	31149.73	O	16498.51	16498.51	bcbs	pos
so acro/clav can web pre ots	cpt	L3670	16498.51	16498.51	5299.29	5299.29	37379.68	37379.68	31149.73	31149.73	O	16498.51	16498.51	bcbs	ppo
so acro/clav can web pre ots	cpt	L3670	16498.51	16498.51	5299.29	5299.29	37379.68	37379.68	31149.73	31149.73	O	16498.51	16498.51	bcbs	epo
so 8 ab rstr can/web pre ots	cpt	L3660	9596.97	9596.97	4859.91	4859.91	40126.92	40126.92	33439.1	33439.1	O	9596.97	9596.97	bcbs	hmo
so 8 ab rstr can/web pre ots	cpt	L3660	9596.97	9596.97	4859.91	4859.91	40126.92	40126.92	33439.1	33439.1	O	9596.97	9596.97	bcbs	hmo
so 8 ab rstr can/web pre ots	cpt	L3660	9596.97	9596.97	4859.91	4859.91	40126.92	40126.92	33439.1	33439.1	O	9596.97	9596.97	bcbs	pos
so 8 ab rstr can/web pre ots	cpt	L3660	9596.97	9596.97	4859.91	4859.91	40126.92	40126.92	33439.1	33439.1	O	9596.97	9596.97	bcbs	ppo
so 8 ab rstr can/web pre ots	cpt	L3660	9596.97	9596.97	4859.91	4859.91	40126.92	40126.92	33439.1	33439.1	O	9596.97	9596.97	bcbs	epo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	572.85	572.85	bcbs	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	572.85	572.85	bcbs	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	572.85	572.85	bcbs	pos
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	572.85	572.85	bcbs	ppo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	572.85	572.85	bcbs	epo
Injection of chemical agent into multiple incompetent veins of one leg	cpt	36471	12086.89	12086.89	240.32	240.32	499.13	499.13	415.94	415.94	O	12086.89	12086.89	bcbs	hmo
Injection of chemical agent into multiple incompetent veins of one leg	cpt	36471	12086.89	12086.89	240.32	240.32	499.13	499.13	415.94	415.94	O	12086.89	12086.89	bcbs	hmo
Injection of chemical agent into multiple incompetent veins of one leg	cpt	36471	12086.89	12086.89	240.32	240.32	499.13	499.13	415.94	415.94	O	12086.89	12086.89	bcbs	pos
Injection of chemical agent into multiple incompetent veins of one leg	cpt	36471	12086.89	12086.89	240.32	240.32	499.13	499.13	415.94	415.94	O	12086.89	12086.89	bcbs	ppo
Injection of chemical agent into multiple incompetent veins of one leg	cpt	36471	12086.89	12086.89	240.32	240.32	499.13	499.13	415.94	415.94	O	12086.89	12086.89	bcbs	epo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	10340.17	10340.17	bcbs	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	10340.17	10340.17	bcbs	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	10340.17	10340.17	bcbs	pos
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	10340.17	10340.17	bcbs	ppo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	10340.17	10340.17	bcbs	epo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	12086.89	12086.89	bcbs	hmo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	12086.89	12086.89	bcbs	hmo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	12086.89	12086.89	bcbs	pos
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	12086.89	12086.89	bcbs	ppo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	12086.89	12086.89	bcbs	epo
inj trastuzumab excl biosimi	cpt	J9355	11920.99	11920.99	4839.22	4839.22	26839.2	26839.2	22366	22366	O	8614.56	8614.56	bcbs	hmo
inj trastuzumab excl biosimi	cpt	J9355	11920.99	11920.99	4839.22	4839.22	26839.2	26839.2	22366	22366	O	8614.56	8614.56	bcbs	hmo
inj trastuzumab excl biosimi	cpt	J9355	11920.99	11920.99	4839.22	4839.22	26839.2	26839.2	22366	22366	O	8614.56	8614.56	bcbs	pos
inj trastuzumab excl biosimi	cpt	J9355	11920.99	11920.99	4839.22	4839.22	26839.2	26839.2	22366	22366	O	8614.56	8614.56	bcbs	ppo
inj trastuzumab excl biosimi	cpt	J9355	11920.99	11920.99	4839.22	4839.22	26839.2	26839.2	22366	22366	O	8614.56	8614.56	bcbs	epo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	16776.17	16776.17	bcbs	hmo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	16776.17	16776.17	bcbs	hmo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	16776.17	16776.17	bcbs	pos
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	16776.17	16776.17	bcbs	ppo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	16776.17	16776.17	bcbs	epo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	4400.88	4400.88	bcbs	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	4400.88	4400.88	bcbs	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	4400.88	4400.88	bcbs	pos
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	4400.88	4400.88	bcbs	ppo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	4400.88	4400.88	bcbs	epo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	4264.13	4264.13	bcbs	hmo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	4264.13	4264.13	bcbs	hmo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	4264.13	4264.13	bcbs	pos
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	4264.13	4264.13	bcbs	ppo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	4264.13	4264.13	bcbs	epo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	11042.46	11042.46	bcbs	hmo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	11042.46	11042.46	bcbs	hmo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	11042.46	11042.46	bcbs	pos
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	11042.46	11042.46	bcbs	ppo
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	11042.46	11042.46	bcbs	epo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	17466.44	17466.44	bcbs	hmo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	17466.44	17466.44	bcbs	hmo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	17466.44	17466.44	bcbs	pos
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	17466.44	17466.44	bcbs	ppo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	17466.44	17466.44	bcbs	epo
panitumumab injection	cpt	J9303	6492.39	6492.39	5037.32	5037.32	28415.21	28415.21	23679.34	23679.34	O	6492.39	6492.39	bcbs	hmo
panitumumab injection	cpt	J9303	6492.39	6492.39	5037.32	5037.32	28415.21	28415.21	23679.34	23679.34	O	6492.39	6492.39	bcbs	hmo
panitumumab injection	cpt	J9303	6492.39	6492.39	5037.32	5037.32	28415.21	28415.21	23679.34	23679.34	O	6492.39	6492.39	bcbs	pos
panitumumab injection	cpt	J9303	6492.39	6492.39	5037.32	5037.32	28415.21	28415.21	23679.34	23679.34	O	6492.39	6492.39	bcbs	ppo
panitumumab injection	cpt	J9303	6492.39	6492.39	5037.32	5037.32	28415.21	28415.21	23679.34	23679.34	O	6492.39	6492.39	bcbs	epo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	3788.28	3788.28	bcbs	hmo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	3788.28	3788.28	bcbs	hmo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	3788.28	3788.28	bcbs	pos
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	3788.28	3788.28	bcbs	ppo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	3788.28	3788.28	bcbs	epo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	4695.23	4695.23	bcbs	hmo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	4695.23	4695.23	bcbs	hmo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	4695.23	4695.23	bcbs	pos
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	4695.23	4695.23	bcbs	ppo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	4695.23	4695.23	bcbs	epo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	8596.32	8596.32	bcbs	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	8596.32	8596.32	bcbs	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	8596.32	8596.32	bcbs	pos
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	8596.32	8596.32	bcbs	ppo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	8596.32	8596.32	bcbs	epo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	834	834	bcbs	hmo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	834	834	bcbs	hmo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	834	834	bcbs	pos
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	834	834	bcbs	ppo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	834	834	bcbs	epo
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	978.69	978.69	bcbs	hmo
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	978.69	978.69	bcbs	hmo
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	978.69	978.69	bcbs	pos
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	978.69	978.69	bcbs	ppo
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	978.69	978.69	bcbs	epo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	2702.31	2702.31	bcbs	hmo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	2702.31	2702.31	bcbs	hmo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	2702.31	2702.31	bcbs	pos
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	2702.31	2702.31	bcbs	ppo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	2702.31	2702.31	bcbs	epo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4967.42	4967.42	bcbs	hmo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4967.42	4967.42	bcbs	hmo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4967.42	4967.42	bcbs	pos
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4967.42	4967.42	bcbs	ppo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4967.42	4967.42	bcbs	epo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	1036.13	1036.13	bcbs	hmo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	1036.13	1036.13	bcbs	hmo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	1036.13	1036.13	bcbs	pos
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	1036.13	1036.13	bcbs	ppo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	1036.13	1036.13	bcbs	epo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	925.72	925.72	bcbs	hmo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	925.72	925.72	bcbs	hmo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	925.72	925.72	bcbs	pos
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	925.72	925.72	bcbs	ppo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	925.72	925.72	bcbs	epo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	1106.07	1106.07	bcbs	hmo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	1106.07	1106.07	bcbs	hmo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	1106.07	1106.07	bcbs	pos
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	1106.07	1106.07	bcbs	ppo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	1106.07	1106.07	bcbs	epo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	4465.16	4465.16	bcbs	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	4465.16	4465.16	bcbs	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	4465.16	4465.16	bcbs	pos
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	4465.16	4465.16	bcbs	ppo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	4465.16	4465.16	bcbs	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	1085.71	1085.71	bcbs	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	1085.71	1085.71	bcbs	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	1085.71	1085.71	bcbs	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	1085.71	1085.71	bcbs	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	1085.71	1085.71	bcbs	epo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4478.69	4478.69	bcbs	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4478.69	4478.69	bcbs	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4478.69	4478.69	bcbs	pos
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4478.69	4478.69	bcbs	ppo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4478.69	4478.69	bcbs	epo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	3237.54	3237.54	bcbs	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	3237.54	3237.54	bcbs	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	3237.54	3237.54	bcbs	pos
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	3237.54	3237.54	bcbs	ppo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	3237.54	3237.54	bcbs	epo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	299.23	299.23	bcbs	hmo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	299.23	299.23	bcbs	hmo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	299.23	299.23	bcbs	pos
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	299.23	299.23	bcbs	ppo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	299.23	299.23	bcbs	epo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	2537.15	2537.15	bcbs	hmo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	2537.15	2537.15	bcbs	hmo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	2537.15	2537.15	bcbs	pos
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	2537.15	2537.15	bcbs	ppo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	2537.15	2537.15	bcbs	epo
"inj., durvalumab, 10 mg"	cpt	J9173	5773.32	5773.32	2992.06	2992.06	10534.7	10534.7	8778.92	8778.92	O	3900.94	3900.94	bcbs	hmo
"inj., durvalumab, 10 mg"	cpt	J9173	5773.32	5773.32	2992.06	2992.06	10534.7	10534.7	8778.92	8778.92	O	3900.94	3900.94	bcbs	hmo
"inj., durvalumab, 10 mg"	cpt	J9173	5773.32	5773.32	2992.06	2992.06	10534.7	10534.7	8778.92	8778.92	O	3900.94	3900.94	bcbs	pos
"inj., durvalumab, 10 mg"	cpt	J9173	5773.32	5773.32	2992.06	2992.06	10534.7	10534.7	8778.92	8778.92	O	3900.94	3900.94	bcbs	ppo
"inj., durvalumab, 10 mg"	cpt	J9173	5773.32	5773.32	2992.06	2992.06	10534.7	10534.7	8778.92	8778.92	O	3900.94	3900.94	bcbs	epo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	434.81	434.81	bcbs	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	434.81	434.81	bcbs	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	434.81	434.81	bcbs	pos
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	434.81	434.81	bcbs	ppo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	434.81	434.81	bcbs	epo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	21516.54	21516.54	bcbs	hmo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	21516.54	21516.54	bcbs	hmo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	21516.54	21516.54	bcbs	pos
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	21516.54	21516.54	bcbs	ppo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	21516.54	21516.54	bcbs	epo
"Relocation of arm vein with connection to arm artery, open procedure, upper arm, cephalic vein"	cpt	36818	7503.88	7503.88	4006.52	4006.52	19449.97	19449.97	16208.31	16208.31	O	7503.88	7503.88	bcbs	hmo
"Relocation of arm vein with connection to arm artery, open procedure, upper arm, cephalic vein"	cpt	36818	7503.88	7503.88	4006.52	4006.52	19449.97	19449.97	16208.31	16208.31	O	7503.88	7503.88	bcbs	hmo
"Relocation of arm vein with connection to arm artery, open procedure, upper arm, cephalic vein"	cpt	36818	7503.88	7503.88	4006.52	4006.52	19449.97	19449.97	16208.31	16208.31	O	7503.88	7503.88	bcbs	pos
"Relocation of arm vein with connection to arm artery, open procedure, upper arm, cephalic vein"	cpt	36818	7503.88	7503.88	4006.52	4006.52	19449.97	19449.97	16208.31	16208.31	O	7503.88	7503.88	bcbs	ppo
"Relocation of arm vein with connection to arm artery, open procedure, upper arm, cephalic vein"	cpt	36818	7503.88	7503.88	4006.52	4006.52	19449.97	19449.97	16208.31	16208.31	O	7503.88	7503.88	bcbs	epo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	3343.78	3343.78	bcbs	hmo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	3343.78	3343.78	bcbs	hmo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	3343.78	3343.78	bcbs	pos
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	3343.78	3343.78	bcbs	ppo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	3343.78	3343.78	bcbs	epo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	1362.97	1362.97	bcbs	hmo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	1362.97	1362.97	bcbs	hmo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	1362.97	1362.97	bcbs	pos
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	1362.97	1362.97	bcbs	ppo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	1362.97	1362.97	bcbs	epo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	1629.98	1629.98	bcbs	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	1629.98	1629.98	bcbs	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	1629.98	1629.98	bcbs	pos
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	1629.98	1629.98	bcbs	ppo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	1629.98	1629.98	bcbs	epo
brentuximab vedotin inj	cpt	J9042	28140.84	28140.84	25901.14	25901.14	105462.79	105462.79	87885.66	87885.66	O	28140.84	28140.84	bcbs	hmo
brentuximab vedotin inj	cpt	J9042	28140.84	28140.84	25901.14	25901.14	105462.79	105462.79	87885.66	87885.66	O	28140.84	28140.84	bcbs	hmo
brentuximab vedotin inj	cpt	J9042	28140.84	28140.84	25901.14	25901.14	105462.79	105462.79	87885.66	87885.66	O	28140.84	28140.84	bcbs	pos
brentuximab vedotin inj	cpt	J9042	28140.84	28140.84	25901.14	25901.14	105462.79	105462.79	87885.66	87885.66	O	28140.84	28140.84	bcbs	ppo
brentuximab vedotin inj	cpt	J9042	28140.84	28140.84	25901.14	25901.14	105462.79	105462.79	87885.66	87885.66	O	28140.84	28140.84	bcbs	epo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8539.57	8539.57	bcbs	hmo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8539.57	8539.57	bcbs	hmo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8539.57	8539.57	bcbs	pos
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8539.57	8539.57	bcbs	ppo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8539.57	8539.57	bcbs	epo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	4353.14	4353.14	bcbs	hmo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	4353.14	4353.14	bcbs	hmo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	4353.14	4353.14	bcbs	pos
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	4353.14	4353.14	bcbs	ppo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	4353.14	4353.14	bcbs	epo
azacitidine injection	cpt	J9025	10639.2	10639.2	1384.01	1384.01	18628.44	18628.44	15523.7	15523.7	O	10639.2	10639.2	bcbs	hmo
azacitidine injection	cpt	J9025	10639.2	10639.2	1384.01	1384.01	18628.44	18628.44	15523.7	15523.7	O	10639.2	10639.2	bcbs	hmo
azacitidine injection	cpt	J9025	10639.2	10639.2	1384.01	1384.01	18628.44	18628.44	15523.7	15523.7	O	10639.2	10639.2	bcbs	pos
azacitidine injection	cpt	J9025	10639.2	10639.2	1384.01	1384.01	18628.44	18628.44	15523.7	15523.7	O	10639.2	10639.2	bcbs	ppo
azacitidine injection	cpt	J9025	10639.2	10639.2	1384.01	1384.01	18628.44	18628.44	15523.7	15523.7	O	10639.2	10639.2	bcbs	epo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	3343.78	3343.78	bcbs	hmo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	3343.78	3343.78	bcbs	hmo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	3343.78	3343.78	bcbs	pos
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	3343.78	3343.78	bcbs	ppo
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	3343.78	3343.78	bcbs	epo
oral aprepitant	cpt	J8501	3731.15	3731.15	3688.73	3688.73	23183	23183	19319.17	19319.17	O	3731.15	3731.15	bcbs	hmo
oral aprepitant	cpt	J8501	3731.15	3731.15	3688.73	3688.73	23183	23183	19319.17	19319.17	O	3731.15	3731.15	bcbs	hmo
oral aprepitant	cpt	J8501	3731.15	3731.15	3688.73	3688.73	23183	23183	19319.17	19319.17	O	3731.15	3731.15	bcbs	pos
oral aprepitant	cpt	J8501	3731.15	3731.15	3688.73	3688.73	23183	23183	19319.17	19319.17	O	3731.15	3731.15	bcbs	ppo
oral aprepitant	cpt	J8501	3731.15	3731.15	3688.73	3688.73	23183	23183	19319.17	19319.17	O	3731.15	3731.15	bcbs	epo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	652.36	652.36	bcbs	hmo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	652.36	652.36	bcbs	hmo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	652.36	652.36	bcbs	pos
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	652.36	652.36	bcbs	ppo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	652.36	652.36	bcbs	epo
5% dextrose in lac ringers	cpt	J7121	1369.1	1369.1	149.16	149.16	3793.86	3793.86	3161.55	3161.55	O	802.27	802.27	bcbs	hmo
5% dextrose in lac ringers	cpt	J7121	1369.1	1369.1	149.16	149.16	3793.86	3793.86	3161.55	3161.55	O	802.27	802.27	bcbs	hmo
5% dextrose in lac ringers	cpt	J7121	1369.1	1369.1	149.16	149.16	3793.86	3793.86	3161.55	3161.55	O	802.27	802.27	bcbs	pos
5% dextrose in lac ringers	cpt	J7121	1369.1	1369.1	149.16	149.16	3793.86	3793.86	3161.55	3161.55	O	802.27	802.27	bcbs	ppo
5% dextrose in lac ringers	cpt	J7121	1369.1	1369.1	149.16	149.16	3793.86	3793.86	3161.55	3161.55	O	802.27	802.27	bcbs	epo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4018.73	4018.73	bcbs	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4018.73	4018.73	bcbs	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4018.73	4018.73	bcbs	pos
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4018.73	4018.73	bcbs	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4018.73	4018.73	bcbs	epo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	1137.02	1137.02	bcbs	hmo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	1137.02	1137.02	bcbs	hmo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	1137.02	1137.02	bcbs	pos
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	1137.02	1137.02	bcbs	ppo
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	1137.02	1137.02	bcbs	epo
5% dextrose/normal saline	cpt	J7042	3569.24	3569.24	571.3	571.3	5614.46	5614.46	4678.72	4678.72	O	3569.24	3569.24	bcbs	hmo
5% dextrose/normal saline	cpt	J7042	3569.24	3569.24	571.3	571.3	5614.46	5614.46	4678.72	4678.72	O	3569.24	3569.24	bcbs	hmo
5% dextrose/normal saline	cpt	J7042	3569.24	3569.24	571.3	571.3	5614.46	5614.46	4678.72	4678.72	O	3569.24	3569.24	bcbs	pos
5% dextrose/normal saline	cpt	J7042	3569.24	3569.24	571.3	571.3	5614.46	5614.46	4678.72	4678.72	O	3569.24	3569.24	bcbs	ppo
5% dextrose/normal saline	cpt	J7042	3569.24	3569.24	571.3	571.3	5614.46	5614.46	4678.72	4678.72	O	3569.24	3569.24	bcbs	epo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1497.07	1497.07	bcbs	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1497.07	1497.07	bcbs	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1497.07	1497.07	bcbs	pos
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1497.07	1497.07	bcbs	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1497.07	1497.07	bcbs	epo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	12086.89	12086.89	bcbs	hmo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	12086.89	12086.89	bcbs	hmo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	12086.89	12086.89	bcbs	pos
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	12086.89	12086.89	bcbs	ppo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	12086.89	12086.89	bcbs	epo
Blood vessel procedure	cpt	37799	12086.89	12086.89	12086.89	12086.89	25953.26	25953.26	21627.72	21627.72	O	12086.89	12086.89	bcbs	hmo
Blood vessel procedure	cpt	37799	12086.89	12086.89	12086.89	12086.89	25953.26	25953.26	21627.72	21627.72	O	12086.89	12086.89	bcbs	hmo
Blood vessel procedure	cpt	37799	12086.89	12086.89	12086.89	12086.89	25953.26	25953.26	21627.72	21627.72	O	12086.89	12086.89	bcbs	pos
Blood vessel procedure	cpt	37799	12086.89	12086.89	12086.89	12086.89	25953.26	25953.26	21627.72	21627.72	O	12086.89	12086.89	bcbs	ppo
Blood vessel procedure	cpt	37799	12086.89	12086.89	12086.89	12086.89	25953.26	25953.26	21627.72	21627.72	O	12086.89	12086.89	bcbs	epo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	8915.14	8915.14	bcbs	hmo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	8915.14	8915.14	bcbs	hmo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	8915.14	8915.14	bcbs	pos
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	8915.14	8915.14	bcbs	ppo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	8915.14	8915.14	bcbs	epo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	1401.36	1401.36	bcbs	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	1401.36	1401.36	bcbs	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	1401.36	1401.36	bcbs	pos
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	1401.36	1401.36	bcbs	ppo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	1401.36	1401.36	bcbs	epo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	4051.53	4051.53	bcbs	hmo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	4051.53	4051.53	bcbs	hmo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	4051.53	4051.53	bcbs	pos
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	4051.53	4051.53	bcbs	ppo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	4051.53	4051.53	bcbs	epo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	4483.23	4483.23	bcbs	hmo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	4483.23	4483.23	bcbs	hmo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	4483.23	4483.23	bcbs	pos
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	4483.23	4483.23	bcbs	ppo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	4483.23	4483.23	bcbs	epo
zoledronic acid 1mg	cpt	J3489	487.33	487.33	162.77	162.77	1039.22	1039.22	866.02	866.02	O	487.33	487.33	bcbs	hmo
zoledronic acid 1mg	cpt	J3489	487.33	487.33	162.77	162.77	1039.22	1039.22	866.02	866.02	O	487.33	487.33	bcbs	hmo
zoledronic acid 1mg	cpt	J3489	487.33	487.33	162.77	162.77	1039.22	1039.22	866.02	866.02	O	487.33	487.33	bcbs	pos
zoledronic acid 1mg	cpt	J3489	487.33	487.33	162.77	162.77	1039.22	1039.22	866.02	866.02	O	487.33	487.33	bcbs	ppo
zoledronic acid 1mg	cpt	J3489	487.33	487.33	162.77	162.77	1039.22	1039.22	866.02	866.02	O	487.33	487.33	bcbs	epo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	975.92	975.92	bcbs	hmo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	975.92	975.92	bcbs	hmo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	975.92	975.92	bcbs	pos
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	975.92	975.92	bcbs	ppo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	975.92	975.92	bcbs	epo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	8915.14	8915.14	bcbs	hmo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	8915.14	8915.14	bcbs	hmo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	8915.14	8915.14	bcbs	pos
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	8915.14	8915.14	bcbs	ppo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	8915.14	8915.14	bcbs	epo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	694.06	694.06	694.06	694.06	1418.72	1418.72	1182.27	1182.27	O	694.06	694.06	bcbs	hmo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	694.06	694.06	694.06	694.06	1418.72	1418.72	1182.27	1182.27	O	694.06	694.06	bcbs	hmo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	694.06	694.06	694.06	694.06	1418.72	1418.72	1182.27	1182.27	O	694.06	694.06	bcbs	pos
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	694.06	694.06	694.06	694.06	1418.72	1418.72	1182.27	1182.27	O	694.06	694.06	bcbs	ppo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	694.06	694.06	694.06	694.06	1418.72	1418.72	1182.27	1182.27	O	694.06	694.06	bcbs	epo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	1362.97	1362.97	bcbs	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	1362.97	1362.97	bcbs	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	1362.97	1362.97	bcbs	pos
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	1362.97	1362.97	bcbs	ppo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	1362.97	1362.97	bcbs	epo
"Removal of soft tissue at roof of mouth, simple"	cpt	42140	3378.8	3378.8	3378.8	3378.8	19919.93	19919.93	16599.94	16599.94	O	3378.8	3378.8	bcbs	hmo
"Removal of soft tissue at roof of mouth, simple"	cpt	42140	3378.8	3378.8	3378.8	3378.8	19919.93	19919.93	16599.94	16599.94	O	3378.8	3378.8	bcbs	hmo
"Removal of soft tissue at roof of mouth, simple"	cpt	42140	3378.8	3378.8	3378.8	3378.8	19919.93	19919.93	16599.94	16599.94	O	3378.8	3378.8	bcbs	pos
"Removal of soft tissue at roof of mouth, simple"	cpt	42140	3378.8	3378.8	3378.8	3378.8	19919.93	19919.93	16599.94	16599.94	O	3378.8	3378.8	bcbs	ppo
"Removal of soft tissue at roof of mouth, simple"	cpt	42140	3378.8	3378.8	3378.8	3378.8	19919.93	19919.93	16599.94	16599.94	O	3378.8	3378.8	bcbs	epo
Partial removal of salivary gland growth with release of facial nerve	cpt	42415	10684.99	10684.99	10684.99	10684.99	41713.18	41713.18	34760.98	34760.98	O	10684.99	10684.99	bcbs	hmo
Partial removal of salivary gland growth with release of facial nerve	cpt	42415	10684.99	10684.99	10684.99	10684.99	41713.18	41713.18	34760.98	34760.98	O	10684.99	10684.99	bcbs	hmo
Partial removal of salivary gland growth with release of facial nerve	cpt	42415	10684.99	10684.99	10684.99	10684.99	41713.18	41713.18	34760.98	34760.98	O	10684.99	10684.99	bcbs	pos
Partial removal of salivary gland growth with release of facial nerve	cpt	42415	10684.99	10684.99	10684.99	10684.99	41713.18	41713.18	34760.98	34760.98	O	10684.99	10684.99	bcbs	ppo
Partial removal of salivary gland growth with release of facial nerve	cpt	42415	10684.99	10684.99	10684.99	10684.99	41713.18	41713.18	34760.98	34760.98	O	10684.99	10684.99	bcbs	epo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	15987.99	15987.99	bcbs	hmo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	15987.99	15987.99	bcbs	hmo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	15987.99	15987.99	bcbs	pos
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	15987.99	15987.99	bcbs	ppo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	15987.99	15987.99	bcbs	epo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2213.69	2213.69	bcbs	hmo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2213.69	2213.69	bcbs	hmo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2213.69	2213.69	bcbs	pos
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2213.69	2213.69	bcbs	ppo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	2213.69	2213.69	bcbs	epo
hydroxyzine hcl injection	cpt	J3410	1086.21	1086.21	1086.21	1086.21	2616.41	2616.41	2180.34	2180.34	O	1086.21	1086.21	bcbs	hmo
hydroxyzine hcl injection	cpt	J3410	1086.21	1086.21	1086.21	1086.21	2616.41	2616.41	2180.34	2180.34	O	1086.21	1086.21	bcbs	hmo
hydroxyzine hcl injection	cpt	J3410	1086.21	1086.21	1086.21	1086.21	2616.41	2616.41	2180.34	2180.34	O	1086.21	1086.21	bcbs	pos
hydroxyzine hcl injection	cpt	J3410	1086.21	1086.21	1086.21	1086.21	2616.41	2616.41	2180.34	2180.34	O	1086.21	1086.21	bcbs	ppo
hydroxyzine hcl injection	cpt	J3410	1086.21	1086.21	1086.21	1086.21	2616.41	2616.41	2180.34	2180.34	O	1086.21	1086.21	bcbs	epo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	4236.59	4236.59	bcbs	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	4236.59	4236.59	bcbs	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	4236.59	4236.59	bcbs	pos
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	4236.59	4236.59	bcbs	ppo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	4236.59	4236.59	bcbs	epo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	3794.74	3794.74	bcbs	hmo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	3794.74	3794.74	bcbs	hmo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	3794.74	3794.74	bcbs	pos
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	3794.74	3794.74	bcbs	ppo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	3794.74	3794.74	bcbs	epo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	4701.08	4701.08	bcbs	hmo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	4701.08	4701.08	bcbs	hmo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	4701.08	4701.08	bcbs	pos
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	4701.08	4701.08	bcbs	ppo
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	4701.08	4701.08	bcbs	epo
chlorpromazine hcl injection	cpt	J3230	2332.93	2332.93	535.33	535.33	3739.15	3739.15	3115.96	3115.96	O	535.33	535.33	bcbs	hmo
chlorpromazine hcl injection	cpt	J3230	2332.93	2332.93	535.33	535.33	3739.15	3739.15	3115.96	3115.96	O	535.33	535.33	bcbs	hmo
chlorpromazine hcl injection	cpt	J3230	2332.93	2332.93	535.33	535.33	3739.15	3739.15	3115.96	3115.96	O	535.33	535.33	bcbs	pos
chlorpromazine hcl injection	cpt	J3230	2332.93	2332.93	535.33	535.33	3739.15	3739.15	3115.96	3115.96	O	535.33	535.33	bcbs	ppo
chlorpromazine hcl injection	cpt	J3230	2332.93	2332.93	535.33	535.33	3739.15	3739.15	3115.96	3115.96	O	535.33	535.33	bcbs	epo
terbutaline sulfate inj	cpt	J3105	603.59	603.59	197.68	197.68	3304.33	3304.33	2753.61	2753.61	O	603.59	603.59	bcbs	hmo
terbutaline sulfate inj	cpt	J3105	603.59	603.59	197.68	197.68	3304.33	3304.33	2753.61	2753.61	O	603.59	603.59	bcbs	hmo
terbutaline sulfate inj	cpt	J3105	603.59	603.59	197.68	197.68	3304.33	3304.33	2753.61	2753.61	O	603.59	603.59	bcbs	pos
terbutaline sulfate inj	cpt	J3105	603.59	603.59	197.68	197.68	3304.33	3304.33	2753.61	2753.61	O	603.59	603.59	bcbs	ppo
terbutaline sulfate inj	cpt	J3105	603.59	603.59	197.68	197.68	3304.33	3304.33	2753.61	2753.61	O	603.59	603.59	bcbs	epo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	6177.54	6177.54	bcbs	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	6177.54	6177.54	bcbs	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	6177.54	6177.54	bcbs	pos
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	6177.54	6177.54	bcbs	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	6177.54	6177.54	bcbs	epo
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)	cpt	44388	1116.17	1116.17	676.71	676.71	3362.39	3362.39	2801.99	2801.99	O	1116.17	1116.17	bcbs	hmo
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)	cpt	44388	1116.17	1116.17	676.71	676.71	3362.39	3362.39	2801.99	2801.99	O	1116.17	1116.17	bcbs	hmo
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)	cpt	44388	1116.17	1116.17	676.71	676.71	3362.39	3362.39	2801.99	2801.99	O	1116.17	1116.17	bcbs	pos
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)	cpt	44388	1116.17	1116.17	676.71	676.71	3362.39	3362.39	2801.99	2801.99	O	1116.17	1116.17	bcbs	ppo
Diagnostic examination of large bowel using an endoscope inserted through surgically created opening into large bowel from body wall (colostomy)	cpt	44388	1116.17	1116.17	676.71	676.71	3362.39	3362.39	2801.99	2801.99	O	1116.17	1116.17	bcbs	epo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	2009.92	2009.92	bcbs	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	2009.92	2009.92	bcbs	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	2009.92	2009.92	bcbs	pos
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	2009.92	2009.92	bcbs	ppo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	2009.92	2009.92	bcbs	epo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	2049.34	2049.34	bcbs	hmo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	2049.34	2049.34	bcbs	hmo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	2049.34	2049.34	bcbs	pos
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	2049.34	2049.34	bcbs	ppo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	2049.34	2049.34	bcbs	epo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	786.4	786.4	bcbs	hmo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	786.4	786.4	bcbs	hmo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	786.4	786.4	bcbs	pos
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	786.4	786.4	bcbs	ppo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	786.4	786.4	bcbs	epo
ropivacaine hcl injection	cpt	J2795	7567.25	7567.25	4940.62	4940.62	35964.18	35964.18	29970.15	29970.15	O	7567.25	7567.25	bcbs	hmo
ropivacaine hcl injection	cpt	J2795	7567.25	7567.25	4940.62	4940.62	35964.18	35964.18	29970.15	29970.15	O	7567.25	7567.25	bcbs	hmo
ropivacaine hcl injection	cpt	J2795	7567.25	7567.25	4940.62	4940.62	35964.18	35964.18	29970.15	29970.15	O	7567.25	7567.25	bcbs	pos
ropivacaine hcl injection	cpt	J2795	7567.25	7567.25	4940.62	4940.62	35964.18	35964.18	29970.15	29970.15	O	7567.25	7567.25	bcbs	ppo
ropivacaine hcl injection	cpt	J2795	7567.25	7567.25	4940.62	4940.62	35964.18	35964.18	29970.15	29970.15	O	7567.25	7567.25	bcbs	epo
rho d immune globulin inj	cpt	J2790	1331.33	1331.33	291.97	291.97	3727.37	3727.37	3106.14	3106.14	O	1331.33	1331.33	bcbs	hmo
rho d immune globulin inj	cpt	J2790	1331.33	1331.33	291.97	291.97	3727.37	3727.37	3106.14	3106.14	O	1331.33	1331.33	bcbs	hmo
rho d immune globulin inj	cpt	J2790	1331.33	1331.33	291.97	291.97	3727.37	3727.37	3106.14	3106.14	O	1331.33	1331.33	bcbs	pos
rho d immune globulin inj	cpt	J2790	1331.33	1331.33	291.97	291.97	3727.37	3727.37	3106.14	3106.14	O	1331.33	1331.33	bcbs	ppo
rho d immune globulin inj	cpt	J2790	1331.33	1331.33	291.97	291.97	3727.37	3727.37	3106.14	3106.14	O	1331.33	1331.33	bcbs	epo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1913.87	1913.87	bcbs	hmo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1913.87	1913.87	bcbs	hmo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1913.87	1913.87	bcbs	pos
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1913.87	1913.87	bcbs	ppo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1913.87	1913.87	bcbs	epo
"Removal of tissue abnormalities, tumors, or polyps of large bowel by hot biopsy forceps, using a flexible endoscope"	cpt	45384	1768	1768	848.56	848.56	5615.62	5615.62	4679.68	4679.68	O	1768	1768	bcbs	hmo
"Removal of tissue abnormalities, tumors, or polyps of large bowel by hot biopsy forceps, using a flexible endoscope"	cpt	45384	1768	1768	848.56	848.56	5615.62	5615.62	4679.68	4679.68	O	1768	1768	bcbs	hmo
"Removal of tissue abnormalities, tumors, or polyps of large bowel by hot biopsy forceps, using a flexible endoscope"	cpt	45384	1768	1768	848.56	848.56	5615.62	5615.62	4679.68	4679.68	O	1768	1768	bcbs	pos
"Removal of tissue abnormalities, tumors, or polyps of large bowel by hot biopsy forceps, using a flexible endoscope"	cpt	45384	1768	1768	848.56	848.56	5615.62	5615.62	4679.68	4679.68	O	1768	1768	bcbs	ppo
"Removal of tissue abnormalities, tumors, or polyps of large bowel by hot biopsy forceps, using a flexible endoscope"	cpt	45384	1768	1768	848.56	848.56	5615.62	5615.62	4679.68	4679.68	O	1768	1768	bcbs	epo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	2752.93	2752.93	bcbs	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	2752.93	2752.93	bcbs	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	2752.93	2752.93	bcbs	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	2752.93	2752.93	bcbs	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	2752.93	2752.93	bcbs	epo
ranitidine hydrochloride inj	cpt	J2780	5664.76	5664.76	834	834	14567.26	14567.26	12139.38	12139.38	O	834	834	bcbs	hmo
ranitidine hydrochloride inj	cpt	J2780	5664.76	5664.76	834	834	14567.26	14567.26	12139.38	12139.38	O	834	834	bcbs	hmo
ranitidine hydrochloride inj	cpt	J2780	5664.76	5664.76	834	834	14567.26	14567.26	12139.38	12139.38	O	834	834	bcbs	pos
ranitidine hydrochloride inj	cpt	J2780	5664.76	5664.76	834	834	14567.26	14567.26	12139.38	12139.38	O	834	834	bcbs	ppo
ranitidine hydrochloride inj	cpt	J2780	5664.76	5664.76	834	834	14567.26	14567.26	12139.38	12139.38	O	834	834	bcbs	epo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	1611.6	1611.6	bcbs	hmo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	1611.6	1611.6	bcbs	hmo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	1611.6	1611.6	bcbs	pos
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	1611.6	1611.6	bcbs	ppo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	1611.6	1611.6	bcbs	epo
Removal of multiple external benign growths (papillas or tags) of anus	cpt	46230	3621.48	3621.48	3621.48	3621.48	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	hmo
Removal of multiple external benign growths (papillas or tags) of anus	cpt	46230	3621.48	3621.48	3621.48	3621.48	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	hmo
Removal of multiple external benign growths (papillas or tags) of anus	cpt	46230	3621.48	3621.48	3621.48	3621.48	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	pos
Removal of multiple external benign growths (papillas or tags) of anus	cpt	46230	3621.48	3621.48	3621.48	3621.48	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	ppo
Removal of multiple external benign growths (papillas or tags) of anus	cpt	46230	3621.48	3621.48	3621.48	3621.48	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	epo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	7599.47	7599.47	bcbs	hmo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	7599.47	7599.47	bcbs	hmo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	7599.47	7599.47	bcbs	pos
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	7599.47	7599.47	bcbs	ppo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	7599.47	7599.47	bcbs	epo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	3333.89	3333.89	bcbs	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	3333.89	3333.89	bcbs	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	3333.89	3333.89	bcbs	pos
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	3333.89	3333.89	bcbs	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	3333.89	3333.89	bcbs	epo
piperacillin/tazobactam	cpt	J2543	4282.09	4282.09	389.58	389.58	13027.27	13027.27	10856.06	10856.06	O	3569.24	3569.24	bcbs	hmo
piperacillin/tazobactam	cpt	J2543	4282.09	4282.09	389.58	389.58	13027.27	13027.27	10856.06	10856.06	O	3569.24	3569.24	bcbs	hmo
piperacillin/tazobactam	cpt	J2543	4282.09	4282.09	389.58	389.58	13027.27	13027.27	10856.06	10856.06	O	3569.24	3569.24	bcbs	pos
piperacillin/tazobactam	cpt	J2543	4282.09	4282.09	389.58	389.58	13027.27	13027.27	10856.06	10856.06	O	3569.24	3569.24	bcbs	ppo
piperacillin/tazobactam	cpt	J2543	4282.09	4282.09	389.58	389.58	13027.27	13027.27	10856.06	10856.06	O	3569.24	3569.24	bcbs	epo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	21516.54	21516.54	bcbs	hmo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	21516.54	21516.54	bcbs	hmo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	21516.54	21516.54	bcbs	pos
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	21516.54	21516.54	bcbs	ppo
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	21516.54	21516.54	bcbs	epo
"Benzodiazepines levels, 1-12"	cpt	80346	2.35	2.35	2.35	2.35	100.16	100.16	83.47	83.47	O	2.35	2.35	bcbs	hmo
"Benzodiazepines levels, 1-12"	cpt	80346	2.35	2.35	2.35	2.35	100.16	100.16	83.47	83.47	O	2.35	2.35	bcbs	hmo
"Benzodiazepines levels, 1-12"	cpt	80346	2.35	2.35	2.35	2.35	100.16	100.16	83.47	83.47	O	2.35	2.35	bcbs	pos
"Benzodiazepines levels, 1-12"	cpt	80346	2.35	2.35	2.35	2.35	100.16	100.16	83.47	83.47	O	2.35	2.35	bcbs	ppo
"Benzodiazepines levels, 1-12"	cpt	80346	2.35	2.35	2.35	2.35	100.16	100.16	83.47	83.47	O	2.35	2.35	bcbs	epo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	2537.15	2537.15	bcbs	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	2537.15	2537.15	bcbs	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	2537.15	2537.15	bcbs	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	2537.15	2537.15	bcbs	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	2537.15	2537.15	bcbs	epo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	3554.71	3554.71	bcbs	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	3554.71	3554.71	bcbs	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	3554.71	3554.71	bcbs	pos
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	3554.71	3554.71	bcbs	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	3554.71	3554.71	bcbs	epo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	8443.07	8443.07	bcbs	hmo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	8443.07	8443.07	bcbs	hmo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	8443.07	8443.07	bcbs	pos
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	8443.07	8443.07	bcbs	ppo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	8443.07	8443.07	bcbs	epo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6466.87	6466.87	bcbs	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6466.87	6466.87	bcbs	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6466.87	6466.87	bcbs	pos
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6466.87	6466.87	bcbs	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6466.87	6466.87	bcbs	epo
orphenadrine injection	cpt	J2360	690.8	690.8	690.8	690.8	1357.74	1357.74	1131.45	1131.45	O	690.8	690.8	bcbs	hmo
orphenadrine injection	cpt	J2360	690.8	690.8	690.8	690.8	1357.74	1357.74	1131.45	1131.45	O	690.8	690.8	bcbs	hmo
orphenadrine injection	cpt	J2360	690.8	690.8	690.8	690.8	1357.74	1357.74	1131.45	1131.45	O	690.8	690.8	bcbs	pos
orphenadrine injection	cpt	J2360	690.8	690.8	690.8	690.8	1357.74	1357.74	1131.45	1131.45	O	690.8	690.8	bcbs	ppo
orphenadrine injection	cpt	J2360	690.8	690.8	690.8	690.8	1357.74	1357.74	1131.45	1131.45	O	690.8	690.8	bcbs	epo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1116.89	1116.89	bcbs	hmo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1116.89	1116.89	bcbs	hmo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1116.89	1116.89	bcbs	pos
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1116.89	1116.89	bcbs	ppo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1116.89	1116.89	bcbs	epo
omalizumab injection	cpt	J2357	1683.11	1683.11	879.24	879.24	6128.9	6128.9	5107.42	5107.42	O	879.24	879.24	bcbs	hmo
omalizumab injection	cpt	J2357	1683.11	1683.11	879.24	879.24	6128.9	6128.9	5107.42	5107.42	O	879.24	879.24	bcbs	hmo
omalizumab injection	cpt	J2357	1683.11	1683.11	879.24	879.24	6128.9	6128.9	5107.42	5107.42	O	879.24	879.24	bcbs	pos
omalizumab injection	cpt	J2357	1683.11	1683.11	879.24	879.24	6128.9	6128.9	5107.42	5107.42	O	879.24	879.24	bcbs	ppo
omalizumab injection	cpt	J2357	1683.11	1683.11	879.24	879.24	6128.9	6128.9	5107.42	5107.42	O	879.24	879.24	bcbs	epo
"octreotide injection, depot"	cpt	J2353	3083.65	3083.65	2805.19	2805.19	15357.98	15357.98	12798.32	12798.32	O	2805.19	2805.19	bcbs	hmo
"octreotide injection, depot"	cpt	J2353	3083.65	3083.65	2805.19	2805.19	15357.98	15357.98	12798.32	12798.32	O	2805.19	2805.19	bcbs	hmo
"octreotide injection, depot"	cpt	J2353	3083.65	3083.65	2805.19	2805.19	15357.98	15357.98	12798.32	12798.32	O	2805.19	2805.19	bcbs	pos
"octreotide injection, depot"	cpt	J2353	3083.65	3083.65	2805.19	2805.19	15357.98	15357.98	12798.32	12798.32	O	2805.19	2805.19	bcbs	ppo
"octreotide injection, depot"	cpt	J2353	3083.65	3083.65	2805.19	2805.19	15357.98	15357.98	12798.32	12798.32	O	2805.19	2805.19	bcbs	epo
"injection, ocrelizumab, 1 mg"	cpt	J2350	759.3	759.3	759.3	759.3	52446.04	52446.04	43705.03	43705.03	O	759.3	759.3	bcbs	hmo
"injection, ocrelizumab, 1 mg"	cpt	J2350	759.3	759.3	759.3	759.3	52446.04	52446.04	43705.03	43705.03	O	759.3	759.3	bcbs	hmo
"injection, ocrelizumab, 1 mg"	cpt	J2350	759.3	759.3	759.3	759.3	52446.04	52446.04	43705.03	43705.03	O	759.3	759.3	bcbs	pos
"injection, ocrelizumab, 1 mg"	cpt	J2350	759.3	759.3	759.3	759.3	52446.04	52446.04	43705.03	43705.03	O	759.3	759.3	bcbs	ppo
"injection, ocrelizumab, 1 mg"	cpt	J2350	759.3	759.3	759.3	759.3	52446.04	52446.04	43705.03	43705.03	O	759.3	759.3	bcbs	epo
Biopsy of abdomen using an endoscope	cpt	49321	7453.01	7453.01	4282.09	4282.09	31398.76	31398.76	26165.63	26165.63	O	6997.25	6997.25	bcbs	hmo
Biopsy of abdomen using an endoscope	cpt	49321	7453.01	7453.01	4282.09	4282.09	31398.76	31398.76	26165.63	26165.63	O	6997.25	6997.25	bcbs	hmo
Biopsy of abdomen using an endoscope	cpt	49321	7453.01	7453.01	4282.09	4282.09	31398.76	31398.76	26165.63	26165.63	O	6997.25	6997.25	bcbs	pos
Biopsy of abdomen using an endoscope	cpt	49321	7453.01	7453.01	4282.09	4282.09	31398.76	31398.76	26165.63	26165.63	O	6997.25	6997.25	bcbs	ppo
Biopsy of abdomen using an endoscope	cpt	49321	7453.01	7453.01	4282.09	4282.09	31398.76	31398.76	26165.63	26165.63	O	6997.25	6997.25	bcbs	epo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	1781.57	1781.57	bcbs	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	1781.57	1781.57	bcbs	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	1781.57	1781.57	bcbs	pos
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	1781.57	1781.57	bcbs	ppo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	1781.57	1781.57	bcbs	epo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	5122.02	5122.02	bcbs	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	5122.02	5122.02	bcbs	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	5122.02	5122.02	bcbs	pos
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	5122.02	5122.02	bcbs	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	5122.02	5122.02	bcbs	epo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	4701.08	4701.08	bcbs	hmo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	4701.08	4701.08	bcbs	hmo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	4701.08	4701.08	bcbs	pos
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	4701.08	4701.08	bcbs	ppo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	4701.08	4701.08	bcbs	epo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	7562.13	7562.13	bcbs	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	7562.13	7562.13	bcbs	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	7562.13	7562.13	bcbs	pos
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	7562.13	7562.13	bcbs	ppo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	7562.13	7562.13	bcbs	epo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	1971.28	1971.28	bcbs	hmo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	1971.28	1971.28	bcbs	hmo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	1971.28	1971.28	bcbs	pos
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	1971.28	1971.28	bcbs	ppo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	1971.28	1971.28	bcbs	epo
Repositioning of recurrent groin hernia using an endoscope	cpt	49651	7519.16	7519.16	3946.37	3946.37	32495.42	32495.42	27079.52	27079.52	O	7519.16	7519.16	bcbs	hmo
Repositioning of recurrent groin hernia using an endoscope	cpt	49651	7519.16	7519.16	3946.37	3946.37	32495.42	32495.42	27079.52	27079.52	O	7519.16	7519.16	bcbs	hmo
Repositioning of recurrent groin hernia using an endoscope	cpt	49651	7519.16	7519.16	3946.37	3946.37	32495.42	32495.42	27079.52	27079.52	O	7519.16	7519.16	bcbs	pos
Repositioning of recurrent groin hernia using an endoscope	cpt	49651	7519.16	7519.16	3946.37	3946.37	32495.42	32495.42	27079.52	27079.52	O	7519.16	7519.16	bcbs	ppo
Repositioning of recurrent groin hernia using an endoscope	cpt	49651	7519.16	7519.16	3946.37	3946.37	32495.42	32495.42	27079.52	27079.52	O	7519.16	7519.16	bcbs	epo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	1486.86	1486.86	bcbs	hmo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	1486.86	1486.86	bcbs	hmo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	1486.86	1486.86	bcbs	pos
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	1486.86	1486.86	bcbs	ppo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	1486.86	1486.86	bcbs	epo
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	7918.7	7918.7	bcbs	hmo
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	7918.7	7918.7	bcbs	hmo
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	7918.7	7918.7	bcbs	pos
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	7918.7	7918.7	bcbs	ppo
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	7918.7	7918.7	bcbs	epo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7600.98	7600.98	bcbs	hmo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7600.98	7600.98	bcbs	hmo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7600.98	7600.98	bcbs	pos
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7600.98	7600.98	bcbs	ppo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7600.98	7600.98	bcbs	epo
lidocaine injection	cpt	J2001	2164.03	2164.03	686.47	686.47	17322.78	17322.78	14435.65	14435.65	O	1510.68	1510.68	bcbs	hmo
lidocaine injection	cpt	J2001	2164.03	2164.03	686.47	686.47	17322.78	17322.78	14435.65	14435.65	O	1510.68	1510.68	bcbs	hmo
lidocaine injection	cpt	J2001	2164.03	2164.03	686.47	686.47	17322.78	17322.78	14435.65	14435.65	O	1510.68	1510.68	bcbs	pos
lidocaine injection	cpt	J2001	2164.03	2164.03	686.47	686.47	17322.78	17322.78	14435.65	14435.65	O	1510.68	1510.68	bcbs	ppo
lidocaine injection	cpt	J2001	2164.03	2164.03	686.47	686.47	17322.78	17322.78	14435.65	14435.65	O	1510.68	1510.68	bcbs	epo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	1160.73	1160.73	bcbs	hmo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	1160.73	1160.73	bcbs	hmo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	1160.73	1160.73	bcbs	pos
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	1160.73	1160.73	bcbs	ppo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	1160.73	1160.73	bcbs	epo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	4436.99	4436.99	bcbs	hmo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	4436.99	4436.99	bcbs	hmo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	4436.99	4436.99	bcbs	pos
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	4436.99	4436.99	bcbs	ppo
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	4436.99	4436.99	bcbs	epo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	11999.48	11999.48	bcbs	hmo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	11999.48	11999.48	bcbs	hmo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	11999.48	11999.48	bcbs	pos
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	11999.48	11999.48	bcbs	ppo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	11999.48	11999.48	bcbs	epo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1599.57	1599.57	bcbs	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1599.57	1599.57	bcbs	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1599.57	1599.57	bcbs	pos
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1599.57	1599.57	bcbs	ppo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1599.57	1599.57	bcbs	epo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	1409.32	1409.32	bcbs	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	1409.32	1409.32	bcbs	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	1409.32	1409.32	bcbs	pos
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	1409.32	1409.32	bcbs	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	1409.32	1409.32	bcbs	epo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	2904.35	2904.35	bcbs	hmo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	2904.35	2904.35	bcbs	hmo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	2904.35	2904.35	bcbs	pos
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	2904.35	2904.35	bcbs	ppo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	2904.35	2904.35	bcbs	epo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	7503.88	7503.88	bcbs	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	7503.88	7503.88	bcbs	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	7503.88	7503.88	bcbs	pos
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	7503.88	7503.88	bcbs	ppo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	7503.88	7503.88	bcbs	epo
Dilation of the bladder using an endoscope under general or spinal anesthesia	cpt	52260	4681.97	4681.97	4681.97	4681.97	13442.18	13442.18	11201.82	11201.82	O	4681.97	4681.97	bcbs	hmo
Dilation of the bladder using an endoscope under general or spinal anesthesia	cpt	52260	4681.97	4681.97	4681.97	4681.97	13442.18	13442.18	11201.82	11201.82	O	4681.97	4681.97	bcbs	hmo
Dilation of the bladder using an endoscope under general or spinal anesthesia	cpt	52260	4681.97	4681.97	4681.97	4681.97	13442.18	13442.18	11201.82	11201.82	O	4681.97	4681.97	bcbs	pos
Dilation of the bladder using an endoscope under general or spinal anesthesia	cpt	52260	4681.97	4681.97	4681.97	4681.97	13442.18	13442.18	11201.82	11201.82	O	4681.97	4681.97	bcbs	ppo
Dilation of the bladder using an endoscope under general or spinal anesthesia	cpt	52260	4681.97	4681.97	4681.97	4681.97	13442.18	13442.18	11201.82	11201.82	O	4681.97	4681.97	bcbs	epo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	132.26	132.26	bcbs	epo
haloperidol injection	cpt	J1630	943.3	943.3	215.49	215.49	4416.9	4416.9	3680.75	3680.75	O	215.49	215.49	bcbs	hmo
haloperidol injection	cpt	J1630	943.3	943.3	215.49	215.49	4416.9	4416.9	3680.75	3680.75	O	215.49	215.49	bcbs	hmo
haloperidol injection	cpt	J1630	943.3	943.3	215.49	215.49	4416.9	4416.9	3680.75	3680.75	O	215.49	215.49	bcbs	pos
haloperidol injection	cpt	J1630	943.3	943.3	215.49	215.49	4416.9	4416.9	3680.75	3680.75	O	215.49	215.49	bcbs	ppo
haloperidol injection	cpt	J1630	943.3	943.3	215.49	215.49	4416.9	4416.9	3680.75	3680.75	O	215.49	215.49	bcbs	epo
glucagon hydrochloride/1 mg	cpt	J1610	496.24	496.24	496.24	496.24	3696.37	3696.37	3080.31	3080.31	O	496.24	496.24	bcbs	hmo
glucagon hydrochloride/1 mg	cpt	J1610	496.24	496.24	496.24	496.24	3696.37	3696.37	3080.31	3080.31	O	496.24	496.24	bcbs	hmo
glucagon hydrochloride/1 mg	cpt	J1610	496.24	496.24	496.24	496.24	3696.37	3696.37	3080.31	3080.31	O	496.24	496.24	bcbs	pos
glucagon hydrochloride/1 mg	cpt	J1610	496.24	496.24	496.24	496.24	3696.37	3696.37	3080.31	3080.31	O	496.24	496.24	bcbs	ppo
glucagon hydrochloride/1 mg	cpt	J1610	496.24	496.24	496.24	496.24	3696.37	3696.37	3080.31	3080.31	O	496.24	496.24	bcbs	epo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	4436.99	4436.99	bcbs	hmo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	4436.99	4436.99	bcbs	hmo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	4436.99	4436.99	bcbs	pos
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	4436.99	4436.99	bcbs	ppo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	4436.99	4436.99	bcbs	epo
garamycin gentamicin inj	cpt	J1580	10542.6	10542.6	2021.39	2021.39	29695.73	29695.73	24746.44	24746.44	O	10499.65	10499.65	bcbs	hmo
garamycin gentamicin inj	cpt	J1580	10542.6	10542.6	2021.39	2021.39	29695.73	29695.73	24746.44	24746.44	O	10499.65	10499.65	bcbs	hmo
garamycin gentamicin inj	cpt	J1580	10542.6	10542.6	2021.39	2021.39	29695.73	29695.73	24746.44	24746.44	O	10499.65	10499.65	bcbs	pos
garamycin gentamicin inj	cpt	J1580	10542.6	10542.6	2021.39	2021.39	29695.73	29695.73	24746.44	24746.44	O	10499.65	10499.65	bcbs	ppo
garamycin gentamicin inj	cpt	J1580	10542.6	10542.6	2021.39	2021.39	29695.73	29695.73	24746.44	24746.44	O	10499.65	10499.65	bcbs	epo
"inj fosnetupitant, palonoset"	cpt	J1454	15309.39	15309.39	1039.51	1039.51	3498.12	3498.12	2915.1	2915.1	O	1039.51	1039.51	bcbs	hmo
"inj fosnetupitant, palonoset"	cpt	J1454	15309.39	15309.39	1039.51	1039.51	3498.12	3498.12	2915.1	2915.1	O	1039.51	1039.51	bcbs	hmo
"inj fosnetupitant, palonoset"	cpt	J1454	15309.39	15309.39	1039.51	1039.51	3498.12	3498.12	2915.1	2915.1	O	1039.51	1039.51	bcbs	pos
"inj fosnetupitant, palonoset"	cpt	J1454	15309.39	15309.39	1039.51	1039.51	3498.12	3498.12	2915.1	2915.1	O	1039.51	1039.51	bcbs	ppo
"inj fosnetupitant, palonoset"	cpt	J1454	15309.39	15309.39	1039.51	1039.51	3498.12	3498.12	2915.1	2915.1	O	1039.51	1039.51	bcbs	epo
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope	cpt	52352	4436.99	4436.99	2519.87	2519.87	23377.46	23377.46	19481.22	19481.22	O	4436.99	4436.99	bcbs	hmo
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope	cpt	52352	4436.99	4436.99	2519.87	2519.87	23377.46	23377.46	19481.22	19481.22	O	4436.99	4436.99	bcbs	hmo
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope	cpt	52352	4436.99	4436.99	2519.87	2519.87	23377.46	23377.46	19481.22	19481.22	O	4436.99	4436.99	bcbs	pos
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope	cpt	52352	4436.99	4436.99	2519.87	2519.87	23377.46	23377.46	19481.22	19481.22	O	4436.99	4436.99	bcbs	ppo
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope	cpt	52352	4436.99	4436.99	2519.87	2519.87	23377.46	23377.46	19481.22	19481.22	O	4436.99	4436.99	bcbs	epo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	272.76	272.76	bcbs	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	272.76	272.76	bcbs	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	272.76	272.76	bcbs	pos
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	272.76	272.76	bcbs	ppo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	272.76	272.76	bcbs	epo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	8848.19	8848.19	bcbs	hmo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	8848.19	8848.19	bcbs	hmo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	8848.19	8848.19	bcbs	pos
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	8848.19	8848.19	bcbs	ppo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	8848.19	8848.19	bcbs	epo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	2286.87	2286.87	bcbs	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	2286.87	2286.87	bcbs	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	2286.87	2286.87	bcbs	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	2286.87	2286.87	bcbs	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	2286.87	2286.87	bcbs	epo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	1152.77	1152.77	bcbs	hmo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	1152.77	1152.77	bcbs	hmo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	1152.77	1152.77	bcbs	pos
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	1152.77	1152.77	bcbs	ppo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	1152.77	1152.77	bcbs	epo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	1077.64	1077.64	bcbs	hmo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	1077.64	1077.64	bcbs	hmo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	1077.64	1077.64	bcbs	pos
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	1077.64	1077.64	bcbs	ppo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	1077.64	1077.64	bcbs	epo
ertapenem injection	cpt	J1335	2076.66	2076.66	148.68	148.68	1092.52	1092.52	910.43	910.43	O	561.42	561.42	bcbs	hmo
ertapenem injection	cpt	J1335	2076.66	2076.66	148.68	148.68	1092.52	1092.52	910.43	910.43	O	561.42	561.42	bcbs	hmo
ertapenem injection	cpt	J1335	2076.66	2076.66	148.68	148.68	1092.52	1092.52	910.43	910.43	O	561.42	561.42	bcbs	pos
ertapenem injection	cpt	J1335	2076.66	2076.66	148.68	148.68	1092.52	1092.52	910.43	910.43	O	561.42	561.42	bcbs	ppo
ertapenem injection	cpt	J1335	2076.66	2076.66	148.68	148.68	1092.52	1092.52	910.43	910.43	O	561.42	561.42	bcbs	epo
eculizumab injection	cpt	J1300	12812.83	12812.83	12812.83	12812.83	94062.3	94062.3	78385.25	78385.25	O	12812.83	12812.83	bcbs	hmo
eculizumab injection	cpt	J1300	12812.83	12812.83	12812.83	12812.83	94062.3	94062.3	78385.25	78385.25	O	12812.83	12812.83	bcbs	hmo
eculizumab injection	cpt	J1300	12812.83	12812.83	12812.83	12812.83	94062.3	94062.3	78385.25	78385.25	O	12812.83	12812.83	bcbs	pos
eculizumab injection	cpt	J1300	12812.83	12812.83	12812.83	12812.83	94062.3	94062.3	78385.25	78385.25	O	12812.83	12812.83	bcbs	ppo
eculizumab injection	cpt	J1300	12812.83	12812.83	12812.83	12812.83	94062.3	94062.3	78385.25	78385.25	O	12812.83	12812.83	bcbs	epo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	1044.94	1044.94	bcbs	hmo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	1044.94	1044.94	bcbs	hmo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	1044.94	1044.94	bcbs	pos
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	1044.94	1044.94	bcbs	ppo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	1044.94	1044.94	bcbs	epo
Removal of fluid accumulation in one testicle and sperm reservoir	cpt	55040	5192.86	5192.86	2710.43	2710.43	18536.92	18536.92	15447.43	15447.43	O	5192.86	5192.86	bcbs	hmo
Removal of fluid accumulation in one testicle and sperm reservoir	cpt	55040	5192.86	5192.86	2710.43	2710.43	18536.92	18536.92	15447.43	15447.43	O	5192.86	5192.86	bcbs	hmo
Removal of fluid accumulation in one testicle and sperm reservoir	cpt	55040	5192.86	5192.86	2710.43	2710.43	18536.92	18536.92	15447.43	15447.43	O	5192.86	5192.86	bcbs	pos
Removal of fluid accumulation in one testicle and sperm reservoir	cpt	55040	5192.86	5192.86	2710.43	2710.43	18536.92	18536.92	15447.43	15447.43	O	5192.86	5192.86	bcbs	ppo
Removal of fluid accumulation in one testicle and sperm reservoir	cpt	55040	5192.86	5192.86	2710.43	2710.43	18536.92	18536.92	15447.43	15447.43	O	5192.86	5192.86	bcbs	epo
Incision and drainage of abscess in scrotal sac of testicle	cpt	55100	686.2	686.2	686.2	686.2	1178.7	1178.7	982.25	982.25	O	686.2	686.2	bcbs	hmo
Incision and drainage of abscess in scrotal sac of testicle	cpt	55100	686.2	686.2	686.2	686.2	1178.7	1178.7	982.25	982.25	O	686.2	686.2	bcbs	hmo
Incision and drainage of abscess in scrotal sac of testicle	cpt	55100	686.2	686.2	686.2	686.2	1178.7	1178.7	982.25	982.25	O	686.2	686.2	bcbs	pos
Incision and drainage of abscess in scrotal sac of testicle	cpt	55100	686.2	686.2	686.2	686.2	1178.7	1178.7	982.25	982.25	O	686.2	686.2	bcbs	ppo
Incision and drainage of abscess in scrotal sac of testicle	cpt	55100	686.2	686.2	686.2	686.2	1178.7	1178.7	982.25	982.25	O	686.2	686.2	bcbs	epo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1366.77	1366.77	bcbs	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1366.77	1366.77	bcbs	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1366.77	1366.77	bcbs	pos
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1366.77	1366.77	bcbs	ppo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1366.77	1366.77	bcbs	epo
Spermatic cord procedure using an endoscope	cpt	55559	7519.16	7519.16	4282.09	4282.09	32160.6	32160.6	26800.5	26800.5	O	7519.16	7519.16	bcbs	hmo
Spermatic cord procedure using an endoscope	cpt	55559	7519.16	7519.16	4282.09	4282.09	32160.6	32160.6	26800.5	26800.5	O	7519.16	7519.16	bcbs	hmo
Spermatic cord procedure using an endoscope	cpt	55559	7519.16	7519.16	4282.09	4282.09	32160.6	32160.6	26800.5	26800.5	O	7519.16	7519.16	bcbs	pos
Spermatic cord procedure using an endoscope	cpt	55559	7519.16	7519.16	4282.09	4282.09	32160.6	32160.6	26800.5	26800.5	O	7519.16	7519.16	bcbs	ppo
Spermatic cord procedure using an endoscope	cpt	55559	7519.16	7519.16	4282.09	4282.09	32160.6	32160.6	26800.5	26800.5	O	7519.16	7519.16	bcbs	epo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7125.29	7125.29	bcbs	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7125.29	7125.29	bcbs	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7125.29	7125.29	bcbs	pos
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7125.29	7125.29	bcbs	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	7125.29	7125.29	bcbs	epo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4460.63	4460.63	bcbs	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4460.63	4460.63	bcbs	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4460.63	4460.63	bcbs	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4460.63	4460.63	bcbs	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4460.63	4460.63	bcbs	epo
Removal or destruction of cervix with electrical cautery	cpt	57522	2364.21	2364.21	2218.48	2218.48	17203.74	17203.74	14336.45	14336.45	O	2364.21	2364.21	bcbs	hmo
Removal or destruction of cervix with electrical cautery	cpt	57522	2364.21	2364.21	2218.48	2218.48	17203.74	17203.74	14336.45	14336.45	O	2364.21	2364.21	bcbs	hmo
Removal or destruction of cervix with electrical cautery	cpt	57522	2364.21	2364.21	2218.48	2218.48	17203.74	17203.74	14336.45	14336.45	O	2364.21	2364.21	bcbs	pos
Removal or destruction of cervix with electrical cautery	cpt	57522	2364.21	2364.21	2218.48	2218.48	17203.74	17203.74	14336.45	14336.45	O	2364.21	2364.21	bcbs	ppo
Removal or destruction of cervix with electrical cautery	cpt	57522	2364.21	2364.21	2218.48	2218.48	17203.74	17203.74	14336.45	14336.45	O	2364.21	2364.21	bcbs	epo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1180.35	1180.35	bcbs	hmo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1180.35	1180.35	bcbs	hmo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1180.35	1180.35	bcbs	pos
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1180.35	1180.35	bcbs	ppo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1180.35	1180.35	bcbs	epo
Biopsy and/or removal of polyp of the uterus using an endoscope	cpt	58558	5405.17	5405.17	2093.55	2093.55	24489.84	24489.84	20408.2	20408.2	O	5405.17	5405.17	bcbs	hmo
Biopsy and/or removal of polyp of the uterus using an endoscope	cpt	58558	5405.17	5405.17	2093.55	2093.55	24489.84	24489.84	20408.2	20408.2	O	5405.17	5405.17	bcbs	hmo
Biopsy and/or removal of polyp of the uterus using an endoscope	cpt	58558	5405.17	5405.17	2093.55	2093.55	24489.84	24489.84	20408.2	20408.2	O	5405.17	5405.17	bcbs	pos
Biopsy and/or removal of polyp of the uterus using an endoscope	cpt	58558	5405.17	5405.17	2093.55	2093.55	24489.84	24489.84	20408.2	20408.2	O	5405.17	5405.17	bcbs	ppo
Biopsy and/or removal of polyp of the uterus using an endoscope	cpt	58558	5405.17	5405.17	2093.55	2093.55	24489.84	24489.84	20408.2	20408.2	O	5405.17	5405.17	bcbs	epo
Examination of uterus with destruction of uterine lining using an endoscope	cpt	58563	6142.86	6142.86	4033.08	4033.08	27275.76	27275.76	22729.8	22729.8	O	6142.86	6142.86	bcbs	hmo
Examination of uterus with destruction of uterine lining using an endoscope	cpt	58563	6142.86	6142.86	4033.08	4033.08	27275.76	27275.76	22729.8	22729.8	O	6142.86	6142.86	bcbs	hmo
Examination of uterus with destruction of uterine lining using an endoscope	cpt	58563	6142.86	6142.86	4033.08	4033.08	27275.76	27275.76	22729.8	22729.8	O	6142.86	6142.86	bcbs	pos
Examination of uterus with destruction of uterine lining using an endoscope	cpt	58563	6142.86	6142.86	4033.08	4033.08	27275.76	27275.76	22729.8	22729.8	O	6142.86	6142.86	bcbs	ppo
Examination of uterus with destruction of uterine lining using an endoscope	cpt	58563	6142.86	6142.86	4033.08	4033.08	27275.76	27275.76	22729.8	22729.8	O	6142.86	6142.86	bcbs	epo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1583.41	1583.41	bcbs	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1583.41	1583.41	bcbs	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1583.41	1583.41	bcbs	pos
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1583.41	1583.41	bcbs	ppo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1583.41	1583.41	bcbs	epo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	8548.35	8548.35	bcbs	hmo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	8548.35	8548.35	bcbs	hmo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	8548.35	8548.35	bcbs	pos
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	8548.35	8548.35	bcbs	ppo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	8548.35	8548.35	bcbs	epo
daptomycin injection	cpt	J0878	269.44	269.44	214.57	214.57	1334.95	1334.95	1112.46	1112.46	O	240.65	240.65	bcbs	hmo
daptomycin injection	cpt	J0878	269.44	269.44	214.57	214.57	1334.95	1334.95	1112.46	1112.46	O	240.65	240.65	bcbs	hmo
daptomycin injection	cpt	J0878	269.44	269.44	214.57	214.57	1334.95	1334.95	1112.46	1112.46	O	240.65	240.65	bcbs	pos
daptomycin injection	cpt	J0878	269.44	269.44	214.57	214.57	1334.95	1334.95	1112.46	1112.46	O	240.65	240.65	bcbs	ppo
daptomycin injection	cpt	J0878	269.44	269.44	214.57	214.57	1334.95	1334.95	1112.46	1112.46	O	240.65	240.65	bcbs	epo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1796.84	1796.84	bcbs	hmo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1796.84	1796.84	bcbs	hmo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1796.84	1796.84	bcbs	pos
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1796.84	1796.84	bcbs	ppo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1796.84	1796.84	bcbs	epo
Removal of ovaries and/or tubes using an endoscope	cpt	58661	5642.61	5642.61	3975.41	3975.41	24783.68	24783.68	20653.07	20653.07	O	5642.61	5642.61	bcbs	hmo
Removal of ovaries and/or tubes using an endoscope	cpt	58661	5642.61	5642.61	3975.41	3975.41	24783.68	24783.68	20653.07	20653.07	O	5642.61	5642.61	bcbs	hmo
Removal of ovaries and/or tubes using an endoscope	cpt	58661	5642.61	5642.61	3975.41	3975.41	24783.68	24783.68	20653.07	20653.07	O	5642.61	5642.61	bcbs	pos
Removal of ovaries and/or tubes using an endoscope	cpt	58661	5642.61	5642.61	3975.41	3975.41	24783.68	24783.68	20653.07	20653.07	O	5642.61	5642.61	bcbs	ppo
Removal of ovaries and/or tubes using an endoscope	cpt	58661	5642.61	5642.61	3975.41	3975.41	24783.68	24783.68	20653.07	20653.07	O	5642.61	5642.61	bcbs	epo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	5642.61	5642.61	bcbs	hmo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	5642.61	5642.61	bcbs	hmo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	5642.61	5642.61	bcbs	pos
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	5642.61	5642.61	bcbs	ppo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	5642.61	5642.61	bcbs	epo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	3225.81	3225.81	bcbs	hmo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	3225.81	3225.81	bcbs	hmo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	3225.81	3225.81	bcbs	pos
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	3225.81	3225.81	bcbs	ppo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	3225.81	3225.81	bcbs	epo
Destruction of ovaries using an endoscope	cpt	58670	8912.42	8912.42	3969.52	3969.52	20520.59	20520.59	17100.49	17100.49	O	8912.42	8912.42	bcbs	hmo
Destruction of ovaries using an endoscope	cpt	58670	8912.42	8912.42	3969.52	3969.52	20520.59	20520.59	17100.49	17100.49	O	8912.42	8912.42	bcbs	hmo
Destruction of ovaries using an endoscope	cpt	58670	8912.42	8912.42	3969.52	3969.52	20520.59	20520.59	17100.49	17100.49	O	8912.42	8912.42	bcbs	pos
Destruction of ovaries using an endoscope	cpt	58670	8912.42	8912.42	3969.52	3969.52	20520.59	20520.59	17100.49	17100.49	O	8912.42	8912.42	bcbs	ppo
Destruction of ovaries using an endoscope	cpt	58670	8912.42	8912.42	3969.52	3969.52	20520.59	20520.59	17100.49	17100.49	O	8912.42	8912.42	bcbs	epo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	625.44	625.44	bcbs	hmo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	625.44	625.44	bcbs	hmo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	625.44	625.44	bcbs	pos
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	625.44	625.44	bcbs	ppo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	625.44	625.44	bcbs	epo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	1619.11	1619.11	bcbs	hmo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	1619.11	1619.11	bcbs	hmo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	1619.11	1619.11	bcbs	pos
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	1619.11	1619.11	bcbs	ppo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	1619.11	1619.11	bcbs	epo
cefoxitin sodium injection	cpt	J0694	3621.48	3621.48	2076.66	2076.66	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	hmo
cefoxitin sodium injection	cpt	J0694	3621.48	3621.48	2076.66	2076.66	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	hmo
cefoxitin sodium injection	cpt	J0694	3621.48	3621.48	2076.66	2076.66	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	pos
cefoxitin sodium injection	cpt	J0694	3621.48	3621.48	2076.66	2076.66	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	ppo
cefoxitin sodium injection	cpt	J0694	3621.48	3621.48	2076.66	2076.66	20338.74	20338.74	16948.95	16948.95	O	3621.48	3621.48	bcbs	epo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	6336.31	6336.31	bcbs	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	6336.31	6336.31	bcbs	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	6336.31	6336.31	bcbs	pos
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	6336.31	6336.31	bcbs	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	6336.31	6336.31	bcbs	epo
Spinal tap for diagnosis	cpt	62270	1296.62	1296.62	645.92	645.92	5996.98	5996.98	4997.48	4997.48	O	1036.13	1036.13	bcbs	hmo
Spinal tap for diagnosis	cpt	62270	1296.62	1296.62	645.92	645.92	5996.98	5996.98	4997.48	4997.48	O	1036.13	1036.13	bcbs	hmo
Spinal tap for diagnosis	cpt	62270	1296.62	1296.62	645.92	645.92	5996.98	5996.98	4997.48	4997.48	O	1036.13	1036.13	bcbs	pos
Spinal tap for diagnosis	cpt	62270	1296.62	1296.62	645.92	645.92	5996.98	5996.98	4997.48	4997.48	O	1036.13	1036.13	bcbs	ppo
Spinal tap for diagnosis	cpt	62270	1296.62	1296.62	645.92	645.92	5996.98	5996.98	4997.48	4997.48	O	1036.13	1036.13	bcbs	epo
Diagnostic spinal tap of lower spine using imaging guidance	cpt	62328	1036.13	1036.13	553.72	553.72	1690.81	1690.81	1409.01	1409.01	O	1036.13	1036.13	bcbs	hmo
Diagnostic spinal tap of lower spine using imaging guidance	cpt	62328	1036.13	1036.13	553.72	553.72	1690.81	1690.81	1409.01	1409.01	O	1036.13	1036.13	bcbs	hmo
Diagnostic spinal tap of lower spine using imaging guidance	cpt	62328	1036.13	1036.13	553.72	553.72	1690.81	1690.81	1409.01	1409.01	O	1036.13	1036.13	bcbs	pos
Diagnostic spinal tap of lower spine using imaging guidance	cpt	62328	1036.13	1036.13	553.72	553.72	1690.81	1690.81	1409.01	1409.01	O	1036.13	1036.13	bcbs	ppo
Diagnostic spinal tap of lower spine using imaging guidance	cpt	62328	1036.13	1036.13	553.72	553.72	1690.81	1690.81	1409.01	1409.01	O	1036.13	1036.13	bcbs	epo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4353.14	4353.14	bcbs	hmo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4353.14	4353.14	bcbs	hmo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4353.14	4353.14	bcbs	pos
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4353.14	4353.14	bcbs	ppo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4353.14	4353.14	bcbs	epo
calcium gluconate injection	cpt	J0610	2009.92	2009.92	1163.18	1163.18	8819.08	8819.08	7349.23	7349.23	O	2009.92	2009.92	bcbs	hmo
calcium gluconate injection	cpt	J0610	2009.92	2009.92	1163.18	1163.18	8819.08	8819.08	7349.23	7349.23	O	2009.92	2009.92	bcbs	hmo
calcium gluconate injection	cpt	J0610	2009.92	2009.92	1163.18	1163.18	8819.08	8819.08	7349.23	7349.23	O	2009.92	2009.92	bcbs	pos
calcium gluconate injection	cpt	J0610	2009.92	2009.92	1163.18	1163.18	8819.08	8819.08	7349.23	7349.23	O	2009.92	2009.92	bcbs	ppo
calcium gluconate injection	cpt	J0610	2009.92	2009.92	1163.18	1163.18	8819.08	8819.08	7349.23	7349.23	O	2009.92	2009.92	bcbs	epo
dicyclomine injection	cpt	J0500	516.37	516.37	380.4	380.4	7372.99	7372.99	6144.16	6144.16	O	516.37	516.37	bcbs	hmo
dicyclomine injection	cpt	J0500	516.37	516.37	380.4	380.4	7372.99	7372.99	6144.16	6144.16	O	516.37	516.37	bcbs	hmo
dicyclomine injection	cpt	J0500	516.37	516.37	380.4	380.4	7372.99	7372.99	6144.16	6144.16	O	516.37	516.37	bcbs	pos
dicyclomine injection	cpt	J0500	516.37	516.37	380.4	380.4	7372.99	7372.99	6144.16	6144.16	O	516.37	516.37	bcbs	ppo
dicyclomine injection	cpt	J0500	516.37	516.37	380.4	380.4	7372.99	7372.99	6144.16	6144.16	O	516.37	516.37	bcbs	epo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	1106.07	1106.07	bcbs	hmo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	1106.07	1106.07	bcbs	hmo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	1106.07	1106.07	bcbs	pos
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	1106.07	1106.07	bcbs	ppo
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	1106.07	1106.07	bcbs	epo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	1180.35	1180.35	bcbs	hmo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	1180.35	1180.35	bcbs	hmo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	1180.35	1180.35	bcbs	pos
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	1180.35	1180.35	bcbs	ppo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	1180.35	1180.35	bcbs	epo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	7532.57	7532.57	bcbs	hmo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	7532.57	7532.57	bcbs	hmo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	7532.57	7532.57	bcbs	pos
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	7532.57	7532.57	bcbs	ppo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	7532.57	7532.57	bcbs	epo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	9785.8	9785.8	bcbs	hmo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	9785.8	9785.8	bcbs	hmo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	9785.8	9785.8	bcbs	pos
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	9785.8	9785.8	bcbs	ppo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	9785.8	9785.8	bcbs	epo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	6436.14	6436.14	bcbs	hmo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	6436.14	6436.14	bcbs	hmo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	6436.14	6436.14	bcbs	pos
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	6436.14	6436.14	bcbs	ppo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	6436.14	6436.14	bcbs	epo
ampicillin sulbactam 1.5 gm	cpt	J0295	7147.22	7147.22	586.06	586.06	8236.51	8236.51	6863.76	6863.76	O	1002.03	1002.03	bcbs	hmo
ampicillin sulbactam 1.5 gm	cpt	J0295	7147.22	7147.22	586.06	586.06	8236.51	8236.51	6863.76	6863.76	O	1002.03	1002.03	bcbs	hmo
ampicillin sulbactam 1.5 gm	cpt	J0295	7147.22	7147.22	586.06	586.06	8236.51	8236.51	6863.76	6863.76	O	1002.03	1002.03	bcbs	pos
ampicillin sulbactam 1.5 gm	cpt	J0295	7147.22	7147.22	586.06	586.06	8236.51	8236.51	6863.76	6863.76	O	1002.03	1002.03	bcbs	ppo
ampicillin sulbactam 1.5 gm	cpt	J0295	7147.22	7147.22	586.06	586.06	8236.51	8236.51	6863.76	6863.76	O	1002.03	1002.03	bcbs	epo
ampicillin 500 mg inj	cpt	J0290	3073.87	3073.87	486.78	486.78	6558.29	6558.29	5465.24	5465.24	O	3073.87	3073.87	bcbs	hmo
ampicillin 500 mg inj	cpt	J0290	3073.87	3073.87	486.78	486.78	6558.29	6558.29	5465.24	5465.24	O	3073.87	3073.87	bcbs	hmo
ampicillin 500 mg inj	cpt	J0290	3073.87	3073.87	486.78	486.78	6558.29	6558.29	5465.24	5465.24	O	3073.87	3073.87	bcbs	pos
ampicillin 500 mg inj	cpt	J0290	3073.87	3073.87	486.78	486.78	6558.29	6558.29	5465.24	5465.24	O	3073.87	3073.87	bcbs	ppo
ampicillin 500 mg inj	cpt	J0290	3073.87	3073.87	486.78	486.78	6558.29	6558.29	5465.24	5465.24	O	3073.87	3073.87	bcbs	epo
amphotericin b liposome inj	cpt	J0289	3073.87	3073.87	3073.87	3073.87	15408.5	15408.5	12840.42	12840.42	O	3073.87	3073.87	bcbs	hmo
amphotericin b liposome inj	cpt	J0289	3073.87	3073.87	3073.87	3073.87	15408.5	15408.5	12840.42	12840.42	O	3073.87	3073.87	bcbs	hmo
amphotericin b liposome inj	cpt	J0289	3073.87	3073.87	3073.87	3073.87	15408.5	15408.5	12840.42	12840.42	O	3073.87	3073.87	bcbs	pos
amphotericin b liposome inj	cpt	J0289	3073.87	3073.87	3073.87	3073.87	15408.5	15408.5	12840.42	12840.42	O	3073.87	3073.87	bcbs	ppo
amphotericin b liposome inj	cpt	J0289	3073.87	3073.87	3073.87	3073.87	15408.5	15408.5	12840.42	12840.42	O	3073.87	3073.87	bcbs	epo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	10903.98	10903.98	bcbs	hmo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	10903.98	10903.98	bcbs	hmo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	10903.98	10903.98	bcbs	pos
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	10903.98	10903.98	bcbs	ppo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	10903.98	10903.98	bcbs	epo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	6354.01	6354.01	bcbs	hmo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	6354.01	6354.01	bcbs	hmo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	6354.01	6354.01	bcbs	pos
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	6354.01	6354.01	bcbs	ppo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	6354.01	6354.01	bcbs	epo
"Removal of lower spine bone and growth other than a tumor, extradural"	cpt	63267	10903.98	10903.98	5214.5	5214.5	33315.5	33315.5	27762.92	27762.92	O	10903.98	10903.98	bcbs	hmo
"Removal of lower spine bone and growth other than a tumor, extradural"	cpt	63267	10903.98	10903.98	5214.5	5214.5	33315.5	33315.5	27762.92	27762.92	O	10903.98	10903.98	bcbs	hmo
"Removal of lower spine bone and growth other than a tumor, extradural"	cpt	63267	10903.98	10903.98	5214.5	5214.5	33315.5	33315.5	27762.92	27762.92	O	10903.98	10903.98	bcbs	pos
"Removal of lower spine bone and growth other than a tumor, extradural"	cpt	63267	10903.98	10903.98	5214.5	5214.5	33315.5	33315.5	27762.92	27762.92	O	10903.98	10903.98	bcbs	ppo
"Removal of lower spine bone and growth other than a tumor, extradural"	cpt	63267	10903.98	10903.98	5214.5	5214.5	33315.5	33315.5	27762.92	27762.92	O	10903.98	10903.98	bcbs	epo
"Implantation of spinal neurostimulator electrodes, accessed through the skin"	cpt	63650	8962.99	8962.99	8962.99	8962.99	16176.48	16176.48	13480.4	13480.4	O	8962.99	8962.99	bcbs	hmo
"Implantation of spinal neurostimulator electrodes, accessed through the skin"	cpt	63650	8962.99	8962.99	8962.99	8962.99	16176.48	16176.48	13480.4	13480.4	O	8962.99	8962.99	bcbs	hmo
"Implantation of spinal neurostimulator electrodes, accessed through the skin"	cpt	63650	8962.99	8962.99	8962.99	8962.99	16176.48	16176.48	13480.4	13480.4	O	8962.99	8962.99	bcbs	pos
"Implantation of spinal neurostimulator electrodes, accessed through the skin"	cpt	63650	8962.99	8962.99	8962.99	8962.99	16176.48	16176.48	13480.4	13480.4	O	8962.99	8962.99	bcbs	ppo
"Implantation of spinal neurostimulator electrodes, accessed through the skin"	cpt	63650	8962.99	8962.99	8962.99	8962.99	16176.48	16176.48	13480.4	13480.4	O	8962.99	8962.99	bcbs	epo
Injection of anesthetic agent and/or steroid into trigeminal nerve of face	cpt	64400	1202.31	1202.31	1202.31	1202.31	1442.77	1442.77	1202.31	1202.31	O	1202.31	1202.31	bcbs	hmo
Injection of anesthetic agent and/or steroid into trigeminal nerve of face	cpt	64400	1202.31	1202.31	1202.31	1202.31	1442.77	1442.77	1202.31	1202.31	O	1202.31	1202.31	bcbs	hmo
Injection of anesthetic agent and/or steroid into trigeminal nerve of face	cpt	64400	1202.31	1202.31	1202.31	1202.31	1442.77	1442.77	1202.31	1202.31	O	1202.31	1202.31	bcbs	pos
Injection of anesthetic agent and/or steroid into trigeminal nerve of face	cpt	64400	1202.31	1202.31	1202.31	1202.31	1442.77	1442.77	1202.31	1202.31	O	1202.31	1202.31	bcbs	ppo
Injection of anesthetic agent and/or steroid into trigeminal nerve of face	cpt	64400	1202.31	1202.31	1202.31	1202.31	1442.77	1442.77	1202.31	1202.31	O	1202.31	1202.31	bcbs	epo
acyclovir injection	cpt	J0133	3073.87	3073.87	1124.12	1124.12	8409.73	8409.73	7008.11	7008.11	O	3073.87	3073.87	bcbs	hmo
acyclovir injection	cpt	J0133	3073.87	3073.87	1124.12	1124.12	8409.73	8409.73	7008.11	7008.11	O	3073.87	3073.87	bcbs	hmo
acyclovir injection	cpt	J0133	3073.87	3073.87	1124.12	1124.12	8409.73	8409.73	7008.11	7008.11	O	3073.87	3073.87	bcbs	pos
acyclovir injection	cpt	J0133	3073.87	3073.87	1124.12	1124.12	8409.73	8409.73	7008.11	7008.11	O	3073.87	3073.87	bcbs	ppo
acyclovir injection	cpt	J0133	3073.87	3073.87	1124.12	1124.12	8409.73	8409.73	7008.11	7008.11	O	3073.87	3073.87	bcbs	epo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	12067.91	12067.91	bcbs	hmo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	12067.91	12067.91	bcbs	hmo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	12067.91	12067.91	bcbs	pos
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	12067.91	12067.91	bcbs	ppo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	12067.91	12067.91	bcbs	epo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	6476.33	6476.33	bcbs	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	6476.33	6476.33	bcbs	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	6476.33	6476.33	bcbs	pos
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	6476.33	6476.33	bcbs	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	6476.33	6476.33	bcbs	epo
drug test def 15-21 classes	cpt	G0482	99	99	99	99	1503.49	1503.49	1252.91	1252.91	O	99	99	bcbs	hmo
drug test def 15-21 classes	cpt	G0482	99	99	99	99	1503.49	1503.49	1252.91	1252.91	O	99	99	bcbs	hmo
drug test def 15-21 classes	cpt	G0482	99	99	99	99	1503.49	1503.49	1252.91	1252.91	O	99	99	bcbs	pos
drug test def 15-21 classes	cpt	G0482	99	99	99	99	1503.49	1503.49	1252.91	1252.91	O	99	99	bcbs	ppo
drug test def 15-21 classes	cpt	G0482	99	99	99	99	1503.49	1503.49	1252.91	1252.91	O	99	99	bcbs	epo
drug test def 1-7 classes	cpt	G0480	1427.41	1427.41	961.2	961.2	5732.09	5732.09	4776.74	4776.74	O	961.2	961.2	bcbs	hmo
drug test def 1-7 classes	cpt	G0480	1427.41	1427.41	961.2	961.2	5732.09	5732.09	4776.74	4776.74	O	961.2	961.2	bcbs	hmo
drug test def 1-7 classes	cpt	G0480	1427.41	1427.41	961.2	961.2	5732.09	5732.09	4776.74	4776.74	O	961.2	961.2	bcbs	pos
drug test def 1-7 classes	cpt	G0480	1427.41	1427.41	961.2	961.2	5732.09	5732.09	4776.74	4776.74	O	961.2	961.2	bcbs	ppo
drug test def 1-7 classes	cpt	G0480	1427.41	1427.41	961.2	961.2	5732.09	5732.09	4776.74	4776.74	O	961.2	961.2	bcbs	epo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	343.78	343.78	bcbs	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	343.78	343.78	bcbs	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	343.78	343.78	bcbs	pos
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	343.78	343.78	bcbs	ppo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	343.78	343.78	bcbs	epo
lev 3 hosp type b ed visit	cpt	G0382	533.3	533.3	533.3	533.3	2662.08	2662.08	2218.4	2218.4	O	533.3	533.3	bcbs	hmo
lev 3 hosp type b ed visit	cpt	G0382	533.3	533.3	533.3	533.3	2662.08	2662.08	2218.4	2218.4	O	533.3	533.3	bcbs	hmo
lev 3 hosp type b ed visit	cpt	G0382	533.3	533.3	533.3	533.3	2662.08	2662.08	2218.4	2218.4	O	533.3	533.3	bcbs	pos
lev 3 hosp type b ed visit	cpt	G0382	533.3	533.3	533.3	533.3	2662.08	2662.08	2218.4	2218.4	O	533.3	533.3	bcbs	ppo
lev 3 hosp type b ed visit	cpt	G0382	533.3	533.3	533.3	533.3	2662.08	2662.08	2218.4	2218.4	O	533.3	533.3	bcbs	epo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1799.19	1799.19	bcbs	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1799.19	1799.19	bcbs	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1799.19	1799.19	bcbs	pos
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1799.19	1799.19	bcbs	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1799.19	1799.19	bcbs	epo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	2903.73	2903.73	bcbs	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	2903.73	2903.73	bcbs	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	2903.73	2903.73	bcbs	pos
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	2903.73	2903.73	bcbs	ppo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	2903.73	2903.73	bcbs	epo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	312.75	312.75	bcbs	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	312.75	312.75	bcbs	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	312.75	312.75	bcbs	pos
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	312.75	312.75	bcbs	ppo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	312.75	312.75	bcbs	epo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	1799.19	1799.19	bcbs	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	1799.19	1799.19	bcbs	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	1799.19	1799.19	bcbs	pos
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	1799.19	1799.19	bcbs	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	1799.19	1799.19	bcbs	epo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	1799.19	1799.19	bcbs	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	1799.19	1799.19	bcbs	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	1799.19	1799.19	bcbs	pos
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	1799.19	1799.19	bcbs	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	1799.19	1799.19	bcbs	epo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	1387.03	1387.03	bcbs	hmo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	1387.03	1387.03	bcbs	hmo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	1387.03	1387.03	bcbs	pos
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	1387.03	1387.03	bcbs	ppo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	1387.03	1387.03	bcbs	epo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	384.61	384.61	bcbs	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	384.61	384.61	bcbs	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	384.61	384.61	bcbs	pos
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	384.61	384.61	bcbs	ppo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	384.61	384.61	bcbs	epo
Destruction of lower or sacral spinal facet joint nerves using imaging guidance	cpt	64635	1803.46	1803.46	1391.28	1391.28	8020.78	8020.78	6683.98	6683.98	O	1803.46	1803.46	bcbs	hmo
Destruction of lower or sacral spinal facet joint nerves using imaging guidance	cpt	64635	1803.46	1803.46	1391.28	1391.28	8020.78	8020.78	6683.98	6683.98	O	1803.46	1803.46	bcbs	hmo
Destruction of lower or sacral spinal facet joint nerves using imaging guidance	cpt	64635	1803.46	1803.46	1391.28	1391.28	8020.78	8020.78	6683.98	6683.98	O	1803.46	1803.46	bcbs	pos
Destruction of lower or sacral spinal facet joint nerves using imaging guidance	cpt	64635	1803.46	1803.46	1391.28	1391.28	8020.78	8020.78	6683.98	6683.98	O	1803.46	1803.46	bcbs	ppo
Destruction of lower or sacral spinal facet joint nerves using imaging guidance	cpt	64635	1803.46	1803.46	1391.28	1391.28	8020.78	8020.78	6683.98	6683.98	O	1803.46	1803.46	bcbs	epo
Destruction of lower or sacral spinal facet joint nerves with imaging guidance	cpt	64636	1803.46	1803.46	1391.28	1391.28	8021.77	8021.77	6684.81	6684.81	O	1803.46	1803.46	bcbs	hmo
Destruction of lower or sacral spinal facet joint nerves with imaging guidance	cpt	64636	1803.46	1803.46	1391.28	1391.28	8021.77	8021.77	6684.81	6684.81	O	1803.46	1803.46	bcbs	hmo
Destruction of lower or sacral spinal facet joint nerves with imaging guidance	cpt	64636	1803.46	1803.46	1391.28	1391.28	8021.77	8021.77	6684.81	6684.81	O	1803.46	1803.46	bcbs	pos
Destruction of lower or sacral spinal facet joint nerves with imaging guidance	cpt	64636	1803.46	1803.46	1391.28	1391.28	8021.77	8021.77	6684.81	6684.81	O	1803.46	1803.46	bcbs	ppo
Destruction of lower or sacral spinal facet joint nerves with imaging guidance	cpt	64636	1803.46	1803.46	1391.28	1391.28	8021.77	8021.77	6684.81	6684.81	O	1803.46	1803.46	bcbs	epo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	1055.98	1055.98	bcbs	hmo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	1055.98	1055.98	bcbs	hmo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	1055.98	1055.98	bcbs	pos
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	1055.98	1055.98	bcbs	ppo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	1055.98	1055.98	bcbs	epo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	4460.03	4460.03	bcbs	hmo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	4460.03	4460.03	bcbs	hmo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	4460.03	4460.03	bcbs	pos
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	4460.03	4460.03	bcbs	ppo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	4460.03	4460.03	bcbs	epo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1382.14	1382.14	bcbs	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1382.14	1382.14	bcbs	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1382.14	1382.14	bcbs	pos
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1382.14	1382.14	bcbs	ppo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1382.14	1382.14	bcbs	epo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	4350.3	4350.3	bcbs	hmo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	4350.3	4350.3	bcbs	hmo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	4350.3	4350.3	bcbs	pos
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	4350.3	4350.3	bcbs	ppo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	4350.3	4350.3	bcbs	epo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	1372.47	1372.47	bcbs	hmo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	1372.47	1372.47	bcbs	hmo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	1372.47	1372.47	bcbs	pos
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	1372.47	1372.47	bcbs	ppo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	1372.47	1372.47	bcbs	epo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	95.83	95.83	bcbs	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	95.83	95.83	bcbs	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	95.83	95.83	bcbs	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	95.83	95.83	bcbs	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	95.83	95.83	bcbs	epo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	3029.49	3029.49	bcbs	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	3029.49	3029.49	bcbs	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	3029.49	3029.49	bcbs	pos
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	3029.49	3029.49	bcbs	ppo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	3029.49	3029.49	bcbs	epo
Removal of embedded foreign body in eyelid	cpt	67938	944.79	944.79	944.79	944.79	1133.75	1133.75	944.79	944.79	O	944.79	944.79	bcbs	hmo
Removal of embedded foreign body in eyelid	cpt	67938	944.79	944.79	944.79	944.79	1133.75	1133.75	944.79	944.79	O	944.79	944.79	bcbs	hmo
Removal of embedded foreign body in eyelid	cpt	67938	944.79	944.79	944.79	944.79	1133.75	1133.75	944.79	944.79	O	944.79	944.79	bcbs	pos
Removal of embedded foreign body in eyelid	cpt	67938	944.79	944.79	944.79	944.79	1133.75	1133.75	944.79	944.79	O	944.79	944.79	bcbs	ppo
Removal of embedded foreign body in eyelid	cpt	67938	944.79	944.79	944.79	944.79	1133.75	1133.75	944.79	944.79	O	944.79	944.79	bcbs	epo
Removal of impacted ear wax by washing	cpt	69209	409.91	409.91	409.91	409.91	1077.82	1077.82	898.18	898.18	O	409.91	409.91	bcbs	hmo
Removal of impacted ear wax by washing	cpt	69209	409.91	409.91	409.91	409.91	1077.82	1077.82	898.18	898.18	O	409.91	409.91	bcbs	hmo
Removal of impacted ear wax by washing	cpt	69209	409.91	409.91	409.91	409.91	1077.82	1077.82	898.18	898.18	O	409.91	409.91	bcbs	pos
Removal of impacted ear wax by washing	cpt	69209	409.91	409.91	409.91	409.91	1077.82	1077.82	898.18	898.18	O	409.91	409.91	bcbs	ppo
Removal of impacted ear wax by washing	cpt	69209	409.91	409.91	409.91	409.91	1077.82	1077.82	898.18	898.18	O	409.91	409.91	bcbs	epo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	70.78	70.78	bcbs	hmo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	70.78	70.78	bcbs	hmo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	70.78	70.78	bcbs	pos
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	70.78	70.78	bcbs	ppo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	70.78	70.78	bcbs	epo
"X-ray of paranasal sinus, complete, minimum of 3 views"	cpt	70220	151.6	151.6	21.76	21.76	368.88	368.88	307.4	307.4	O	151.6	151.6	bcbs	hmo
"X-ray of paranasal sinus, complete, minimum of 3 views"	cpt	70220	151.6	151.6	21.76	21.76	368.88	368.88	307.4	307.4	O	151.6	151.6	bcbs	hmo
"X-ray of paranasal sinus, complete, minimum of 3 views"	cpt	70220	151.6	151.6	21.76	21.76	368.88	368.88	307.4	307.4	O	151.6	151.6	bcbs	pos
"X-ray of paranasal sinus, complete, minimum of 3 views"	cpt	70220	151.6	151.6	21.76	21.76	368.88	368.88	307.4	307.4	O	151.6	151.6	bcbs	ppo
"X-ray of paranasal sinus, complete, minimum of 3 views"	cpt	70220	151.6	151.6	21.76	21.76	368.88	368.88	307.4	307.4	O	151.6	151.6	bcbs	epo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1017.53	1017.53	bcbs	hmo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1017.53	1017.53	bcbs	hmo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1017.53	1017.53	bcbs	pos
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1017.53	1017.53	bcbs	ppo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	1017.53	1017.53	bcbs	epo
X-ray of soft tissue of neck	cpt	70360	65.69	65.69	18.36	18.36	244.22	244.22	203.52	203.52	O	65.69	65.69	bcbs	hmo
X-ray of soft tissue of neck	cpt	70360	65.69	65.69	18.36	18.36	244.22	244.22	203.52	203.52	O	65.69	65.69	bcbs	hmo
X-ray of soft tissue of neck	cpt	70360	65.69	65.69	18.36	18.36	244.22	244.22	203.52	203.52	O	65.69	65.69	bcbs	pos
X-ray of soft tissue of neck	cpt	70360	65.69	65.69	18.36	18.36	244.22	244.22	203.52	203.52	O	65.69	65.69	bcbs	ppo
X-ray of soft tissue of neck	cpt	70360	65.69	65.69	18.36	18.36	244.22	244.22	203.52	203.52	O	65.69	65.69	bcbs	epo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	4436.99	4436.99	bcbs	hmo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	4436.99	4436.99	bcbs	hmo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	4436.99	4436.99	bcbs	pos
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	4436.99	4436.99	bcbs	ppo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	4436.99	4436.99	bcbs	epo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	11766.2	11766.2	bcbs	hmo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	11766.2	11766.2	bcbs	hmo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	11766.2	11766.2	bcbs	pos
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	11766.2	11766.2	bcbs	ppo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	11766.2	11766.2	bcbs	epo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	8848.19	8848.19	bcbs	hmo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	8848.19	8848.19	bcbs	hmo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	8848.19	8848.19	bcbs	pos
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	8848.19	8848.19	bcbs	ppo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	8848.19	8848.19	bcbs	epo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	482.16	482.16	bcbs	hmo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	482.16	482.16	bcbs	hmo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	482.16	482.16	bcbs	pos
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	482.16	482.16	bcbs	ppo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	482.16	482.16	bcbs	epo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	8239.98	8239.98	bcbs	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	8239.98	8239.98	bcbs	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	8239.98	8239.98	bcbs	pos
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	8239.98	8239.98	bcbs	ppo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	8239.98	8239.98	bcbs	epo
CT scan of cranial cavity with contrast	cpt	70481	405.43	405.43	405.43	405.43	1507.32	1507.32	1256.1	1256.1	O	405.43	405.43	bcbs	hmo
CT scan of cranial cavity with contrast	cpt	70481	405.43	405.43	405.43	405.43	1507.32	1507.32	1256.1	1256.1	O	405.43	405.43	bcbs	hmo
CT scan of cranial cavity with contrast	cpt	70481	405.43	405.43	405.43	405.43	1507.32	1507.32	1256.1	1256.1	O	405.43	405.43	bcbs	pos
CT scan of cranial cavity with contrast	cpt	70481	405.43	405.43	405.43	405.43	1507.32	1507.32	1256.1	1256.1	O	405.43	405.43	bcbs	ppo
CT scan of cranial cavity with contrast	cpt	70481	405.43	405.43	405.43	405.43	1507.32	1507.32	1256.1	1256.1	O	405.43	405.43	bcbs	epo
CT scan of cranial cavity before and after contrast	cpt	70482	393.66	393.66	393.66	393.66	2255.82	2255.82	1879.85	1879.85	O	393.66	393.66	bcbs	hmo
CT scan of cranial cavity before and after contrast	cpt	70482	393.66	393.66	393.66	393.66	2255.82	2255.82	1879.85	1879.85	O	393.66	393.66	bcbs	hmo
CT scan of cranial cavity before and after contrast	cpt	70482	393.66	393.66	393.66	393.66	2255.82	2255.82	1879.85	1879.85	O	393.66	393.66	bcbs	pos
CT scan of cranial cavity before and after contrast	cpt	70482	393.66	393.66	393.66	393.66	2255.82	2255.82	1879.85	1879.85	O	393.66	393.66	bcbs	ppo
CT scan of cranial cavity before and after contrast	cpt	70482	393.66	393.66	393.66	393.66	2255.82	2255.82	1879.85	1879.85	O	393.66	393.66	bcbs	epo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	4087.43	4087.43	bcbs	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	4087.43	4087.43	bcbs	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	4087.43	4087.43	bcbs	pos
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	4087.43	4087.43	bcbs	ppo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	4087.43	4087.43	bcbs	epo
CT scan of face with contrast	cpt	70487	408.55	408.55	92.8	92.8	1507.32	1507.32	1256.1	1256.1	O	340.48	340.48	bcbs	hmo
CT scan of face with contrast	cpt	70487	408.55	408.55	92.8	92.8	1507.32	1507.32	1256.1	1256.1	O	340.48	340.48	bcbs	hmo
CT scan of face with contrast	cpt	70487	408.55	408.55	92.8	92.8	1507.32	1507.32	1256.1	1256.1	O	340.48	340.48	bcbs	pos
CT scan of face with contrast	cpt	70487	408.55	408.55	92.8	92.8	1507.32	1507.32	1256.1	1256.1	O	340.48	340.48	bcbs	ppo
CT scan of face with contrast	cpt	70487	408.55	408.55	92.8	92.8	1507.32	1507.32	1256.1	1256.1	O	340.48	340.48	bcbs	epo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	186.17	186.17	bcbs	hmo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	186.17	186.17	bcbs	hmo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	186.17	186.17	bcbs	pos
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	186.17	186.17	bcbs	ppo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	186.17	186.17	bcbs	epo
"catheter, ablation"	cpt	C1886	6142.86	6142.86	4006.52	4006.52	26466.79	26466.79	22055.66	22055.66	O	6142.86	6142.86	bcbs	hmo
"catheter, ablation"	cpt	C1886	6142.86	6142.86	4006.52	4006.52	26466.79	26466.79	22055.66	22055.66	O	6142.86	6142.86	bcbs	hmo
"catheter, ablation"	cpt	C1886	6142.86	6142.86	4006.52	4006.52	26466.79	26466.79	22055.66	22055.66	O	6142.86	6142.86	bcbs	pos
"catheter, ablation"	cpt	C1886	6142.86	6142.86	4006.52	4006.52	26466.79	26466.79	22055.66	22055.66	O	6142.86	6142.86	bcbs	ppo
"catheter, ablation"	cpt	C1886	6142.86	6142.86	4006.52	4006.52	26466.79	26466.79	22055.66	22055.66	O	6142.86	6142.86	bcbs	epo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8539.57	8539.57	bcbs	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8539.57	8539.57	bcbs	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8539.57	8539.57	bcbs	pos
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8539.57	8539.57	bcbs	ppo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8539.57	8539.57	bcbs	epo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	381.69	381.69	bcbs	hmo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	381.69	381.69	bcbs	hmo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	381.69	381.69	bcbs	pos
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	381.69	381.69	bcbs	ppo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	381.69	381.69	bcbs	epo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	8922.15	8922.15	bcbs	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	8922.15	8922.15	bcbs	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	8922.15	8922.15	bcbs	pos
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	8922.15	8922.15	bcbs	ppo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	8922.15	8922.15	bcbs	epo
CT scan of neck before and after contrast	cpt	70492	697.54	697.54	161.43	161.43	2148.41	2148.41	1790.34	1790.34	O	697.54	697.54	bcbs	hmo
CT scan of neck before and after contrast	cpt	70492	697.54	697.54	161.43	161.43	2148.41	2148.41	1790.34	1790.34	O	697.54	697.54	bcbs	hmo
CT scan of neck before and after contrast	cpt	70492	697.54	697.54	161.43	161.43	2148.41	2148.41	1790.34	1790.34	O	697.54	697.54	bcbs	pos
CT scan of neck before and after contrast	cpt	70492	697.54	697.54	161.43	161.43	2148.41	2148.41	1790.34	1790.34	O	697.54	697.54	bcbs	ppo
CT scan of neck before and after contrast	cpt	70492	697.54	697.54	161.43	161.43	2148.41	2148.41	1790.34	1790.34	O	697.54	697.54	bcbs	epo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	4400.88	4400.88	bcbs	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	4400.88	4400.88	bcbs	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	4400.88	4400.88	bcbs	pos
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	4400.88	4400.88	bcbs	ppo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	4400.88	4400.88	bcbs	epo
CT scan of blood vessel of head with contrast	cpt	70496	465.78	465.78	159.8	159.8	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	hmo
CT scan of blood vessel of head with contrast	cpt	70496	465.78	465.78	159.8	159.8	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	hmo
CT scan of blood vessel of head with contrast	cpt	70496	465.78	465.78	159.8	159.8	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	pos
CT scan of blood vessel of head with contrast	cpt	70496	465.78	465.78	159.8	159.8	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	ppo
CT scan of blood vessel of head with contrast	cpt	70496	465.78	465.78	159.8	159.8	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	epo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	7519.16	7519.16	bcbs	hmo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	7519.16	7519.16	bcbs	hmo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	7519.16	7519.16	bcbs	pos
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	7519.16	7519.16	bcbs	ppo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	7519.16	7519.16	bcbs	epo
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	7889.33	7889.33	bcbs	hmo
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	7889.33	7889.33	bcbs	hmo
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	7889.33	7889.33	bcbs	pos
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	7889.33	7889.33	bcbs	ppo
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	7889.33	7889.33	bcbs	epo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	hmo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	hmo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	pos
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	ppo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	465.78	465.78	bcbs	epo
"MRI scan bones of the eye, face, and/or neck"	cpt	70540	1258.88	1258.88	1258.88	1258.88	1901.64	1901.64	1584.7	1584.7	O	1258.88	1258.88	bcbs	hmo
"MRI scan bones of the eye, face, and/or neck"	cpt	70540	1258.88	1258.88	1258.88	1258.88	1901.64	1901.64	1584.7	1584.7	O	1258.88	1258.88	bcbs	hmo
"MRI scan bones of the eye, face, and/or neck"	cpt	70540	1258.88	1258.88	1258.88	1258.88	1901.64	1901.64	1584.7	1584.7	O	1258.88	1258.88	bcbs	pos
"MRI scan bones of the eye, face, and/or neck"	cpt	70540	1258.88	1258.88	1258.88	1258.88	1901.64	1901.64	1584.7	1584.7	O	1258.88	1258.88	bcbs	ppo
"MRI scan bones of the eye, face, and/or neck"	cpt	70540	1258.88	1258.88	1258.88	1258.88	1901.64	1901.64	1584.7	1584.7	O	1258.88	1258.88	bcbs	epo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	8239.98	8239.98	bcbs	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	8239.98	8239.98	bcbs	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	8239.98	8239.98	bcbs	pos
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	8239.98	8239.98	bcbs	ppo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	8239.98	8239.98	bcbs	epo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	481.31	481.31	bcbs	hmo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	481.31	481.31	bcbs	hmo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	481.31	481.31	bcbs	pos
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	481.31	481.31	bcbs	ppo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	481.31	481.31	bcbs	epo
MRA scan of neck blood vessels	cpt	70547	559.22	559.22	559.22	559.22	3060.43	3060.43	2550.36	2550.36	O	559.22	559.22	bcbs	hmo
MRA scan of neck blood vessels	cpt	70547	559.22	559.22	559.22	559.22	3060.43	3060.43	2550.36	2550.36	O	559.22	559.22	bcbs	hmo
MRA scan of neck blood vessels	cpt	70547	559.22	559.22	559.22	559.22	3060.43	3060.43	2550.36	2550.36	O	559.22	559.22	bcbs	pos
MRA scan of neck blood vessels	cpt	70547	559.22	559.22	559.22	559.22	3060.43	3060.43	2550.36	2550.36	O	559.22	559.22	bcbs	ppo
MRA scan of neck blood vessels	cpt	70547	559.22	559.22	559.22	559.22	3060.43	3060.43	2550.36	2550.36	O	559.22	559.22	bcbs	epo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	811.86	811.86	bcbs	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	811.86	811.86	bcbs	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	811.86	811.86	bcbs	pos
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	811.86	811.86	bcbs	ppo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	811.86	811.86	bcbs	epo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	4681.97	4681.97	bcbs	hmo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	4681.97	4681.97	bcbs	hmo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	4681.97	4681.97	bcbs	pos
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	4681.97	4681.97	bcbs	ppo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	4681.97	4681.97	bcbs	epo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2405.95	2405.95	bcbs	hmo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2405.95	2405.95	bcbs	hmo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2405.95	2405.95	bcbs	pos
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2405.95	2405.95	bcbs	ppo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2405.95	2405.95	bcbs	epo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	2407.34	2407.34	bcbs	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	2407.34	2407.34	bcbs	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	2407.34	2407.34	bcbs	pos
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	2407.34	2407.34	bcbs	ppo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	2407.34	2407.34	bcbs	epo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	7600.98	7600.98	bcbs	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	7600.98	7600.98	bcbs	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	7600.98	7600.98	bcbs	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	7600.98	7600.98	bcbs	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	7600.98	7600.98	bcbs	epo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1251.77	1251.77	bcbs	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1251.77	1251.77	bcbs	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1251.77	1251.77	bcbs	pos
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1251.77	1251.77	bcbs	ppo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	1251.77	1251.77	bcbs	epo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	66.4	66.4	bcbs	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	66.4	66.4	bcbs	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	66.4	66.4	bcbs	pos
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	66.4	66.4	bcbs	ppo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	66.4	66.4	bcbs	epo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	4483.23	4483.23	bcbs	hmo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	4483.23	4483.23	bcbs	hmo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	4483.23	4483.23	bcbs	pos
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	4483.23	4483.23	bcbs	ppo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	4483.23	4483.23	bcbs	epo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	1195.84	1195.84	bcbs	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	1195.84	1195.84	bcbs	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	1195.84	1195.84	bcbs	pos
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	1195.84	1195.84	bcbs	ppo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	1195.84	1195.84	bcbs	epo
"i131 iodide cap, rx"	cpt	A9517	1852.9	1852.9	713.83	713.83	4871.82	4871.82	4059.85	4059.85	O	713.83	713.83	bcbs	hmo
"i131 iodide cap, rx"	cpt	A9517	1852.9	1852.9	713.83	713.83	4871.82	4871.82	4059.85	4059.85	O	713.83	713.83	bcbs	hmo
"i131 iodide cap, rx"	cpt	A9517	1852.9	1852.9	713.83	713.83	4871.82	4871.82	4059.85	4059.85	O	713.83	713.83	bcbs	pos
"i131 iodide cap, rx"	cpt	A9517	1852.9	1852.9	713.83	713.83	4871.82	4871.82	4059.85	4059.85	O	713.83	713.83	bcbs	ppo
"i131 iodide cap, rx"	cpt	A9517	1852.9	1852.9	713.83	713.83	4871.82	4871.82	4059.85	4059.85	O	713.83	713.83	bcbs	epo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	1025.33	1025.33	bcbs	hmo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	1025.33	1025.33	bcbs	hmo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	1025.33	1025.33	bcbs	pos
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	1025.33	1025.33	bcbs	ppo
iodine i-123 sod iodide mic	cpt	A9516	1025.33	1025.33	322.26	322.26	1796.06	1796.06	1496.72	1496.72	O	1025.33	1025.33	bcbs	epo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	88.13	88.13	bcbs	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	88.13	88.13	bcbs	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	88.13	88.13	bcbs	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	88.13	88.13	bcbs	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	88.13	88.13	bcbs	epo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	747.74	747.74	bcbs	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	747.74	747.74	bcbs	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	747.74	747.74	bcbs	pos
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	747.74	747.74	bcbs	ppo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	747.74	747.74	bcbs	epo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1335.61	1335.61	bcbs	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1335.61	1335.61	bcbs	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1335.61	1335.61	bcbs	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1335.61	1335.61	bcbs	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1335.61	1335.61	bcbs	epo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	616.41	616.41	bcbs	hmo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	616.41	616.41	bcbs	hmo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	616.41	616.41	bcbs	pos
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	616.41	616.41	bcbs	ppo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	616.41	616.41	bcbs	epo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	157.17	157.17	bcbs	hmo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	157.17	157.17	bcbs	hmo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	157.17	157.17	bcbs	pos
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	157.17	157.17	bcbs	ppo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	157.17	157.17	bcbs	epo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	725.19	725.19	bcbs	hmo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	725.19	725.19	bcbs	hmo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	725.19	725.19	bcbs	pos
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	725.19	725.19	bcbs	ppo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	725.19	725.19	bcbs	epo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	27.09	27.09	bcbs	hmo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	27.09	27.09	bcbs	hmo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	27.09	27.09	bcbs	pos
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	27.09	27.09	bcbs	ppo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	27.09	27.09	bcbs	epo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	8915.14	8915.14	bcbs	hmo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	8915.14	8915.14	bcbs	hmo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	8915.14	8915.14	bcbs	pos
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	8915.14	8915.14	bcbs	ppo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	8915.14	8915.14	bcbs	epo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	70.9	70.9	bcbs	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	70.9	70.9	bcbs	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	70.9	70.9	bcbs	pos
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	70.9	70.9	bcbs	ppo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	70.9	70.9	bcbs	epo
"X-ray of both sides of the ribs, 3 views"	cpt	71110	36.25	36.25	35.5	35.5	515.16	515.16	429.3	429.3	O	35.5	35.5	bcbs	hmo
"X-ray of both sides of the ribs, 3 views"	cpt	71110	36.25	36.25	35.5	35.5	515.16	515.16	429.3	429.3	O	35.5	35.5	bcbs	hmo
"X-ray of both sides of the ribs, 3 views"	cpt	71110	36.25	36.25	35.5	35.5	515.16	515.16	429.3	429.3	O	35.5	35.5	bcbs	pos
"X-ray of both sides of the ribs, 3 views"	cpt	71110	36.25	36.25	35.5	35.5	515.16	515.16	429.3	429.3	O	35.5	35.5	bcbs	ppo
"X-ray of both sides of the ribs, 3 views"	cpt	71110	36.25	36.25	35.5	35.5	515.16	515.16	429.3	429.3	O	35.5	35.5	bcbs	epo
"X-ray of breast bone, minimum of 2 views"	cpt	71120	119.99	119.99	17.76	17.76	249.31	249.31	207.76	207.76	O	119.99	119.99	bcbs	hmo
"X-ray of breast bone, minimum of 2 views"	cpt	71120	119.99	119.99	17.76	17.76	249.31	249.31	207.76	207.76	O	119.99	119.99	bcbs	hmo
"X-ray of breast bone, minimum of 2 views"	cpt	71120	119.99	119.99	17.76	17.76	249.31	249.31	207.76	207.76	O	119.99	119.99	bcbs	pos
"X-ray of breast bone, minimum of 2 views"	cpt	71120	119.99	119.99	17.76	17.76	249.31	249.31	207.76	207.76	O	119.99	119.99	bcbs	ppo
"X-ray of breast bone, minimum of 2 views"	cpt	71120	119.99	119.99	17.76	17.76	249.31	249.31	207.76	207.76	O	119.99	119.99	bcbs	epo
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2862	2862	bcbs	hmo
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2862	2862	bcbs	hmo
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2862	2862	bcbs	pos
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2862	2862	bcbs	ppo
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2862	2862	bcbs	epo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	2862	2862	bcbs	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	2862	2862	bcbs	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	2862	2862	bcbs	pos
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	2862	2862	bcbs	ppo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	2862	2862	bcbs	epo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	16230.79	16230.79	bcbs	hmo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	16230.79	16230.79	bcbs	hmo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	16230.79	16230.79	bcbs	pos
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	16230.79	16230.79	bcbs	ppo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	16230.79	16230.79	bcbs	epo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs	hmo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs	hmo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs	pos
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs	ppo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs	epo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	10.92	10.92	bcbs	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	10.92	10.92	bcbs	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	10.92	10.92	bcbs	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	10.92	10.92	bcbs	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	10.92	10.92	bcbs	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	11.48	11.48	bcbs	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	11.48	11.48	bcbs	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	11.48	11.48	bcbs	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	11.48	11.48	bcbs	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	11.48	11.48	bcbs	epo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	396.78	396.78	bcbs	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	396.78	396.78	bcbs	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	396.78	396.78	bcbs	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	396.78	396.78	bcbs	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	396.78	396.78	bcbs	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	34.46	34.46	bcbs	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	34.46	34.46	bcbs	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	34.46	34.46	bcbs	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	34.46	34.46	bcbs	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	34.46	34.46	bcbs	epo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	808.13	808.13	bcbs	hmo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	808.13	808.13	bcbs	hmo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	808.13	808.13	bcbs	pos
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	808.13	808.13	bcbs	ppo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	808.13	808.13	bcbs	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	26.73	26.73	bcbs	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	26.73	26.73	bcbs	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	26.73	26.73	bcbs	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	26.73	26.73	bcbs	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	26.73	26.73	bcbs	epo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	19.96	19.96	bcbs	hmo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	19.96	19.96	bcbs	hmo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	19.96	19.96	bcbs	pos
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	19.96	19.96	bcbs	ppo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	19.96	19.96	bcbs	epo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	621.12	621.12	bcbs	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	621.12	621.12	bcbs	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	621.12	621.12	bcbs	pos
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	621.12	621.12	bcbs	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	621.12	621.12	bcbs	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	4.32	4.32	bcbs	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	4.32	4.32	bcbs	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	4.32	4.32	bcbs	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	4.32	4.32	bcbs	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	4.32	4.32	bcbs	epo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	72.81	72.81	bcbs	hmo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	72.81	72.81	bcbs	hmo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	72.81	72.81	bcbs	pos
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	72.81	72.81	bcbs	ppo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	72.81	72.81	bcbs	epo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	bcbs	hmo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	bcbs	hmo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	bcbs	pos
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	bcbs	ppo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	21.26	21.26	bcbs	epo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	21.16	21.16	bcbs	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	21.16	21.16	bcbs	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	21.16	21.16	bcbs	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	21.16	21.16	bcbs	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	21.16	21.16	bcbs	epo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	138.45	138.45	bcbs	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	138.45	138.45	bcbs	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	138.45	138.45	bcbs	pos
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	138.45	138.45	bcbs	ppo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	138.45	138.45	bcbs	epo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	18.76	18.76	bcbs	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	18.76	18.76	bcbs	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	18.76	18.76	bcbs	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	18.76	18.76	bcbs	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	18.76	18.76	bcbs	epo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	17.97	17.97	bcbs	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	17.97	17.97	bcbs	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	17.97	17.97	bcbs	pos
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	17.97	17.97	bcbs	ppo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	17.97	17.97	bcbs	epo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	65.62	65.62	bcbs	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	65.62	65.62	bcbs	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	65.62	65.62	bcbs	pos
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	65.62	65.62	bcbs	ppo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	65.62	65.62	bcbs	epo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	134.26	134.26	bcbs	hmo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	134.26	134.26	bcbs	hmo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	134.26	134.26	bcbs	pos
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	134.26	134.26	bcbs	ppo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	134.26	134.26	bcbs	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	26.35	26.35	bcbs	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	26.35	26.35	bcbs	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	26.35	26.35	bcbs	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	26.35	26.35	bcbs	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	26.35	26.35	bcbs	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	25.05	25.05	bcbs	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	25.05	25.05	bcbs	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	25.05	25.05	bcbs	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	25.05	25.05	bcbs	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	25.05	25.05	bcbs	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	21.35	21.35	bcbs	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	21.35	21.35	bcbs	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	21.35	21.35	bcbs	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	21.35	21.35	bcbs	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	21.35	21.35	bcbs	epo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	77.24	77.24	bcbs	hmo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	77.24	77.24	bcbs	hmo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	77.24	77.24	bcbs	pos
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	77.24	77.24	bcbs	ppo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	77.24	77.24	bcbs	epo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	61.44	61.44	bcbs	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	61.44	61.44	bcbs	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	61.44	61.44	bcbs	pos
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	61.44	61.44	bcbs	ppo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	61.44	61.44	bcbs	epo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	529.29	529.29	bcbs	hmo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	529.29	529.29	bcbs	hmo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	529.29	529.29	bcbs	pos
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	529.29	529.29	bcbs	ppo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	529.29	529.29	bcbs	epo
"X-ray of spine, entire middle and lower spine, 1 view"	cpt	72081	81.3	81.3	23.65	23.65	230.23	230.23	191.86	191.86	O	81.3	81.3	bcbs	hmo
"X-ray of spine, entire middle and lower spine, 1 view"	cpt	72081	81.3	81.3	23.65	23.65	230.23	230.23	191.86	191.86	O	81.3	81.3	bcbs	hmo
"X-ray of spine, entire middle and lower spine, 1 view"	cpt	72081	81.3	81.3	23.65	23.65	230.23	230.23	191.86	191.86	O	81.3	81.3	bcbs	pos
"X-ray of spine, entire middle and lower spine, 1 view"	cpt	72081	81.3	81.3	23.65	23.65	230.23	230.23	191.86	191.86	O	81.3	81.3	bcbs	ppo
"X-ray of spine, entire middle and lower spine, 1 view"	cpt	72081	81.3	81.3	23.65	23.65	230.23	230.23	191.86	191.86	O	81.3	81.3	bcbs	epo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	616.41	616.41	bcbs	hmo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	616.41	616.41	bcbs	hmo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	616.41	616.41	bcbs	pos
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	616.41	616.41	bcbs	ppo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	616.41	616.41	bcbs	epo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2526.95	2526.95	bcbs	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2526.95	2526.95	bcbs	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2526.95	2526.95	bcbs	pos
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2526.95	2526.95	bcbs	ppo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	2526.95	2526.95	bcbs	epo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	116.63	116.63	bcbs	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	116.63	116.63	bcbs	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	116.63	116.63	bcbs	pos
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	116.63	116.63	bcbs	ppo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	116.63	116.63	bcbs	epo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1543.69	1543.69	bcbs	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1543.69	1543.69	bcbs	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1543.69	1543.69	bcbs	pos
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1543.69	1543.69	bcbs	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1543.69	1543.69	bcbs	epo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	178.54	178.54	bcbs	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	178.54	178.54	bcbs	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	178.54	178.54	bcbs	pos
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	178.54	178.54	bcbs	ppo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	178.54	178.54	bcbs	epo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1517.61	1517.61	bcbs	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1517.61	1517.61	bcbs	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1517.61	1517.61	bcbs	pos
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1517.61	1517.61	bcbs	ppo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1517.61	1517.61	bcbs	epo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1662	1662	bcbs	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1662	1662	bcbs	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1662	1662	bcbs	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1662	1662	bcbs	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1662	1662	bcbs	epo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1810.27	1810.27	bcbs	hmo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1810.27	1810.27	bcbs	hmo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1810.27	1810.27	bcbs	pos
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1810.27	1810.27	bcbs	ppo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1810.27	1810.27	bcbs	epo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	337.48	337.48	bcbs	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	337.48	337.48	bcbs	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	337.48	337.48	bcbs	pos
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	337.48	337.48	bcbs	ppo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	337.48	337.48	bcbs	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	1375.89	1375.89	bcbs medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	1375.89	1375.89	bcbs medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1934.02	1934.02	bcbs medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1934.02	1934.02	bcbs medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	2685.64	2685.64	bcbs medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	2685.64	2685.64	bcbs medicare advantage	ppo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs medicare advantage	pos
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	482.16	482.16	bcbs medicare advantage	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	54.9	54.9	bcbs medicare advantage	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	54.9	54.9	bcbs medicare advantage	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	bcbs medicare advantage	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	bcbs medicare advantage	ppo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	49.35	49.35	bcbs medicare advantage	pos
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	49.35	49.35	bcbs medicare advantage	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	32.65	32.65	bcbs medicare advantage	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	32.65	32.65	bcbs medicare advantage	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	7.61	7.61	bcbs medicare advantage	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	7.61	7.61	bcbs medicare advantage	ppo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	12.87	12.87	bcbs medicare advantage	pos
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	12.87	12.87	bcbs medicare advantage	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	22.82	22.82	bcbs medicare advantage	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	22.82	22.82	bcbs medicare advantage	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	23.26	23.26	bcbs medicare advantage	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	23.26	23.26	bcbs medicare advantage	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	21.47	21.47	bcbs medicare advantage	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	21.47	21.47	bcbs medicare advantage	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	31.53	31.53	bcbs medicare advantage	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	31.53	31.53	bcbs medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1934.02	1934.02	bcbs medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1934.02	1934.02	bcbs medicare advantage	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.09	10.09	bcbs medicare advantage	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	10.09	10.09	bcbs medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1934.02	1934.02	bcbs medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1934.02	1934.02	bcbs medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1108.98	1108.98	bcbs medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1108.98	1108.98	bcbs medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1934.02	1934.02	bcbs medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1934.02	1934.02	bcbs medicare advantage	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1934.02	1934.02	bcbs medicare advantage	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1934.02	1934.02	bcbs medicare advantage	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	23.62	23.62	bcbs medicare advantage	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	23.62	23.62	bcbs medicare advantage	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	98.86	98.86	bcbs medicare advantage	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	98.86	98.86	bcbs medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	51.42	51.42	bcbs medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	51.42	51.42	bcbs medicare advantage	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.12	13.12	bcbs medicare advantage	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.12	13.12	bcbs medicare advantage	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	94.59	94.59	bcbs medicare advantage	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	94.59	94.59	bcbs medicare advantage	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	45.56	45.56	bcbs medicare advantage	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	45.56	45.56	bcbs medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	44.06	44.06	bcbs medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	44.06	44.06	bcbs medicare advantage	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	12.76	12.76	bcbs medicare advantage	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	12.76	12.76	bcbs medicare advantage	ppo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1934.02	1934.02	bcbs medicare advantage	pos
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1934.02	1934.02	bcbs medicare advantage	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1108.98	1108.98	bcbs medicare advantage	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1108.98	1108.98	bcbs medicare advantage	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1934.02	1934.02	bcbs medicare advantage	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1934.02	1934.02	bcbs medicare advantage	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1934.02	1934.02	bcbs medicare advantage	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1934.02	1934.02	bcbs medicare advantage	ppo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1934.02	1934.02	bcbs medicare advantage	pos
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1934.02	1934.02	bcbs medicare advantage	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1108.98	1108.98	bcbs medicare advantage	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1108.98	1108.98	bcbs medicare advantage	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	1934.02	1934.02	bcbs medicare advantage	pos
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	1934.02	1934.02	bcbs medicare advantage	ppo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1934.02	1934.02	bcbs medicare advantage	pos
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1934.02	1934.02	bcbs medicare advantage	ppo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	1934.02	1934.02	bcbs medicare advantage	pos
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	1934.02	1934.02	bcbs medicare advantage	ppo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	2685.64	2685.64	bcbs medicare advantage	pos
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	2685.64	2685.64	bcbs medicare advantage	ppo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2685.64	2685.64	bcbs medicare advantage	pos
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	2685.64	2685.64	bcbs medicare advantage	ppo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	139.32	139.32	bcbs medicare advantage	pos
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	139.32	139.32	bcbs medicare advantage	ppo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2685.64	2685.64	bcbs medicare advantage	pos
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	2685.64	2685.64	bcbs medicare advantage	ppo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	2685.64	2685.64	bcbs medicare advantage	pos
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	2685.64	2685.64	bcbs medicare advantage	ppo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	2685.64	2685.64	bcbs medicare advantage	pos
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	2685.64	2685.64	bcbs medicare advantage	ppo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	139.32	139.32	bcbs medicare advantage	pos
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	139.32	139.32	bcbs medicare advantage	ppo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	2685.64	2685.64	bcbs medicare advantage	pos
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	2685.64	2685.64	bcbs medicare advantage	ppo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2685.64	2685.64	bcbs medicare advantage	pos
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	2685.64	2685.64	bcbs medicare advantage	ppo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2685.64	2685.64	bcbs medicare advantage	pos
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2685.64	2685.64	bcbs medicare advantage	ppo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	2685.64	2685.64	bcbs medicare advantage	pos
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	2685.64	2685.64	bcbs medicare advantage	ppo
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	6761.15	6761.15	bcbs medicare advantage	pos
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	6761.15	6761.15	bcbs medicare advantage	ppo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	912.58	912.58	bcbs medicare advantage	pos
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	912.58	912.58	bcbs medicare advantage	ppo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	20722.79	20722.79	bcbs medicare advantage	pos
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	20722.79	20722.79	bcbs medicare advantage	ppo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	4985.65	4985.65	bcbs medicare advantage	pos
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	4985.65	4985.65	bcbs medicare advantage	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	99.29	99.29	champus insurance	champus
piperacillin/tazobactam	cpt	J2543	21270.9	21270.9	812.44	812.44	12102.08	12102.08	10085.07	10085.07	E	3117.11	3117.11	champus insurance	champus
"injection, pegfilgrastim 6mg"	cpt	J2505	21516.54	21516.54	6856.46	6856.46	40442.53	40442.53	33702.11	33702.11	O	10414.51	10414.51	champus insurance	champus
Tying of multiple internal hemorrhoid groups	cpt	46946	17972.06	17972.06	2076.66	2076.66	15925.92	15925.92	13271.6	13271.6	O	2076.66	2076.66	champus insurance	champus
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	100.27	100.27	champus insurance	champus
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	161.43	161.43	champus insurance	champus
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	25.57	25.57	champus insurance	champus
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	161.43	161.43	champus insurance	champus
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4311.72	4311.72	champus insurance	champus
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	4709.98	4709.98	champus insurance	champus
Removal of tissue abnormalities of anus	cpt	46922	2076.66	2076.66	2043.43	2043.43	17814.5	17814.5	14845.42	14845.42	O	2076.66	2076.66	champus insurance	champus
"injection, oritavancin"	cpt	J2407	3105.49	3105.49	210.36	210.36	7352.36	7352.36	6126.97	6126.97	O	3105.49	3105.49	champus insurance	champus
"injection, oritavancin"	cpt	J2407	3598.87	3598.87	3598.87	3598.87	8925.98	8925.98	7438.32	7438.32	E	3598.87	3598.87	champus insurance	champus
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2683.82	2683.82	champus insurance	champus
"Needle biopsy of liver, accessed through the skin"	cpt	47000	1559.48	1559.48	1215.96	1215.96	10715.04	10715.04	8929.2	8929.2	O	1215.96	1215.96	champus insurance	champus
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	4282.09	4282.09	champus insurance	champus
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	7.95	7.95	champus insurance	champus
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	3915.43	3915.43	champus insurance	champus
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	6966.42	6966.42	champus insurance	champus
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	29.72	29.72	champus insurance	champus
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	680.86	680.86	champus insurance	champus
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.57	1965.57	champus insurance	champus
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	224.22	224.22	champus insurance	champus
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	champus insurance	champus
"other injury, poisoning and toxic effect diagnoses with mcc"	ms-drg	922	13207.03	13207.03	8531.27	8531.27	34786.19	34786.19	28988.49	28988.49	I	13207.03	13207.03	champus insurance	champus
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	197.85	197.85	champus insurance	champus
"octreotide inj, non-depot"	cpt	J2354	6865.24	6865.24	1357.6	1357.6	10984.32	10984.32	9153.6	9153.6	O	1444.99	1444.99	champus insurance	champus
o.r. procedures for obesity without cc/mcc	ms-drg	621	17948.64	17948.64	9347.86	9347.86	51584.39	51584.39	42986.99	42986.99	I	9371.18	9371.18	champus insurance	champus
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	champus insurance	champus
Biopsy of abdomen using an endoscope	cpt	49321	7453.01	7453.01	4282.09	4282.09	31398.76	31398.76	26165.63	26165.63	O	7453.01	7453.01	champus insurance	champus
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	161.43	161.43	champus insurance	champus
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	champus insurance	champus
o.r. procedures for obesity with cc	ms-drg	620	11977.51	11977.51	10950.84	10950.84	49613.87	49613.87	41344.89	41344.89	I	11977.51	11977.51	champus insurance	champus
inj naloxone hydrochloride	cpt	J2310	3917.15	3917.15	1917.44	1917.44	24768.65	24768.65	20640.54	20640.54	O	1917.44	1917.44	champus insurance	champus
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	12.46	12.46	champus insurance	champus
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	25.92	25.92	champus insurance	champus
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	champus insurance	champus
Aspiration of abdominal cavity or cyst using an endoscope	cpt	49322	4282.09	4282.09	4092	4092	30438.56	30438.56	25365.47	25365.47	O	4282.09	4282.09	champus insurance	champus
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	4282.09	4282.09	champus insurance	champus
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	4.4	4.4	champus insurance	champus
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	222.96	222.96	champus insurance	champus
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	32.11	32.11	champus insurance	champus
MRI scan of abdomen before and after contrast	cpt	74183	338.27	338.27	335.57	335.57	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	champus insurance	champus
Homocysteine (amino acid) level	cpt	83090	17.99	17.99	17.92	17.92	46.8	46.8	39	39	O	17.99	17.99	champus insurance	champus
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	812.68	812.68	champus insurance	champus
Hydroxyindolacetic acid (product of metabolism) level	cpt	83497	14.39	14.39	11.47	11.47	228.96	228.96	190.8	190.8	O	14.39	14.39	champus insurance	champus
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	champus insurance	champus
Insertion of abdominal cavity catheter using an endoscope	cpt	49324	4282.09	4282.09	3925.09	3925.09	21801.68	21801.68	18168.07	18168.07	O	4282.09	4282.09	champus insurance	champus
Thyroglobulin (thyroid related hormone) level	cpt	84432	16.13	16.13	14.29	14.29	100.49	100.49	83.74	83.74	O	16.13	16.13	champus insurance	champus
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	12.92	12.92	champus insurance	champus
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	champus insurance	champus
"Repair of incisional or abdominal hernia, recurrent of secondary, not trapped"	cpt	49565	4282.09	4282.09	4282.09	4282.09	24204.56	24204.56	20170.47	20170.47	O	4282.09	4282.09	champus insurance	champus
"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report"	cpt	93291	101.06	101.06	20.37	20.37	137.38	137.38	114.48	114.48	O	20.37	20.37	champus insurance	champus
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.57	1965.57	champus insurance	champus
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	338.27	338.27	champus insurance	champus
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	27.28	27.28	champus insurance	champus
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	4282.09	4282.09	champus insurance	champus
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	3522.68	3522.68	champus insurance	champus
"injection, mepolizumab, 1mg"	cpt	J2182	2982.57	2982.57	2982.57	2982.57	8542.16	8542.16	7118.47	7118.47	O	2982.57	2982.57	champus insurance	champus
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	334.5	334.5	champus insurance	champus
Repair of hernia at navel patient age 5 years or older	cpt	49585	2754.5	2754.5	2624.9	2624.9	19799.99	19799.99	16499.99	16499.99	O	2754.5	2754.5	champus insurance	champus
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	champus insurance	champus
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	4282.09	4282.09	champus insurance	champus
CT scan of abdomen and pelvis before and after contrast	cpt	74178	338.27	338.27	332.86	332.86	4935.36	4935.36	4112.8	4112.8	E	338.27	338.27	champus insurance	champus
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	206.45	206.45	champus insurance	champus
meperidine hydrochl /100 mg	cpt	J2175	4282.09	4282.09	1368.64	1368.64	13257.42	13257.42	11047.85	11047.85	E	4282.09	4282.09	champus insurance	champus
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	5935.19	5935.19	champus insurance	champus
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	7923.09	7923.09	champus insurance	champus
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	107.9	107.9	champus insurance	champus
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	517.64	517.64	197.85	197.85	1425.3	1425.3	1187.75	1187.75	E	197.85	197.85	champus insurance	champus
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	426.62	426.62	champus insurance	champus
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	99.29	99.29	champus insurance	champus
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	8791.16	8791.16	champus insurance	champus
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	champus insurance	champus
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	7453.01	7453.01	champus insurance	champus
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	465.08	465.08	champus insurance	champus
lidocaine injection	cpt	J2001	2164.03	2164.03	686.47	686.47	17322.78	17322.78	14435.65	14435.65	O	686.47	686.47	champus insurance	champus
"tendonitis, myositis and bursitis without mcc"	ms-drg	558	5634.19	5634.19	2674.8	2674.8	15380.44	15380.44	12817.03	12817.03	I	3373.57	3373.57	champus insurance	champus
Abdominal procedure	cpt	49999	696.23	696.23	696.23	696.23	19383.04	19383.04	16152.53	16152.53	O	696.23	696.23	champus insurance	champus
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	champus insurance	champus
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	2524.71	2524.71	champus insurance	champus
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10026.87	10026.87	champus insurance	champus
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	1215.96	1215.96	champus insurance	champus
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	champus insurance	champus
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	206.45	206.45	champus insurance	champus
"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12013	732.06	732.06	214.42	214.42	5787.49	5787.49	4822.91	4822.91	E	214.42	214.42	champus insurance	champus
"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals"	cpt	12041	506.01	506.01	506.01	506.01	1997.34	1997.34	1664.45	1664.45	E	506.01	506.01	champus insurance	champus
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.06	9.06	champus insurance	champus
Injection for X-ray imaging of aorta above heart valve	cpt	93567	2524.71	2524.71	2524.71	2524.71	22959.67	22959.67	19133.06	19133.06	O	2524.71	2524.71	champus insurance	champus
levofloxacin injection	cpt	J1956	4436.99	4436.99	1541.69	1541.69	17091.4	17091.4	14242.83	14242.83	O	2674.06	2674.06	champus insurance	champus
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	326.12	326.12	champus insurance	champus
Evaluation of heart function using tilt table	cpt	93660	430.19	430.19	286.66	286.66	1264.37	1264.37	1053.64	1053.64	O	430.19	430.19	champus insurance	champus
"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals"	cpt	12041	1215.96	1215.96	1196.5	1196.5	3949.92	3949.92	3291.6	3291.6	O	1215.96	1215.96	champus insurance	champus
"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals"	cpt	12042	2037.83	2037.83	1215.96	1215.96	3714.06	3714.06	3095.05	3095.05	O	1215.96	1215.96	champus insurance	champus
levofloxacin injection	cpt	J1956	2485.45	2485.45	941.32	941.32	14500.13	14500.13	12083.44	12083.44	E	941.32	941.32	champus insurance	champus
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	682.29	682.29	champus insurance	champus
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	2674.06	2674.06	champus insurance	champus
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	206.45	206.45	champus insurance	champus
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	180.31	180.31	champus insurance	champus
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.58	11.58	champus insurance	champus
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1409.82	1409.82	champus insurance	champus
Injection procedure for X-ray imaging of the bladder or during voiding	cpt	51600	412.9	412.9	62.56	62.56	2807.77	2807.77	2339.81	2339.81	O	206.45	206.45	champus insurance	champus
viral illness without mcc	ms-drg	866	5584.95	5584.95	2164.75	2164.75	24105.13	24105.13	20087.61	20087.61	I	4294.18	4294.18	champus insurance	champus
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	5563.26	5563.26	champus insurance	champus
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	3766.39	3766.39	champus insurance	champus
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	206.45	206.45	champus insurance	champus
CT scan abdomen with contrast	cpt	74160	161.43	161.43	161.43	161.43	2148.41	2148.41	1790.34	1790.34	E	161.43	161.43	champus insurance	champus
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	96.59	96.59	champus insurance	champus
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	8512.61	8512.61	champus insurance	champus
back and neck procedures except spinal fusion with cc	ms-drg	519	36370.92	36370.92	10756.98	10756.98	60402.74	60402.74	50335.62	50335.62	I	11025.42	11025.42	champus insurance	champus
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	champus insurance	champus
Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope	cpt	52000	2674.06	2674.06	1569.38	1569.38	18026.12	18026.12	15021.77	15021.77	O	2674.06	2674.06	champus insurance	champus
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.14	15.14	champus insurance	champus
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	99.29	99.29	champus insurance	champus
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	268.55	268.55	champus insurance	champus
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.25	16.25	champus insurance	champus
infliximab not biosimil 10mg	cpt	J1745	2621.84	2621.84	2621.84	2621.84	15293.02	15293.02	12744.18	12744.18	O	2621.84	2621.84	champus insurance	champus
hydrocortisone sodium succ i	cpt	J1720	4282.09	4282.09	2580.23	2580.23	7796.72	7796.72	6497.27	6497.27	E	4282.09	4282.09	champus insurance	champus
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	champus insurance	champus
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	3.94	3.94	champus insurance	champus
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	7453.01	7453.01	champus insurance	champus
back and neck procedures except spinal fusion with mcc or disc device or neurostimulator	ms-drg	518	14166.16	14166.16	14166.16	14166.16	99602.48	99602.48	83002.07	83002.07	I	14166.16	14166.16	champus insurance	champus
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	99.29	99.29	88.01	88.01	657.62	657.62	548.02	548.02	E	99.29	99.29	champus insurance	champus
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	431.57	431.57	97.7	97.7	657.62	657.62	548.02	548.02	O	99.29	99.29	champus insurance	champus
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	206.45	206.45	champus insurance	champus
Insertion of catheter into urinary duct (ureter) using an endoscope through the bladder area	cpt	52005	1569.38	1569.38	1500.24	1500.24	16097.6	16097.6	13414.67	13414.67	O	1569.38	1569.38	champus insurance	champus
"Measurement of substance using immunoassay technique, by radioimmunoassay"	cpt	83519	18.48	18.48	16.37	16.37	226.42	226.42	188.68	188.68	O	18.48	18.48	champus insurance	champus
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc	ms-drg	517	9446.71	9446.71	4008.64	4008.64	36975.23	36975.23	30812.69	30812.69	I	9446.71	9446.71	champus insurance	champus
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1965.57	1965.57	champus insurance	champus
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	champus insurance	champus
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	99.29	99.29	champus insurance	champus
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	11080.96	11080.96	champus insurance	champus
Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	cpt	52224	1569.38	1569.38	1544.27	1544.27	17268.6	17268.6	14390.5	14390.5	O	1569.38	1569.38	champus insurance	champus
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	99.29	99.29	champus insurance	champus
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	15.03	15.03	champus insurance	champus
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	2524.71	2524.71	champus insurance	champus
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	1952.13	1952.13	champus insurance	champus
Incision of the bladder canal (urethra) using an endoscope	cpt	52276	1569.38	1569.38	1544.27	1544.27	17091.4	17091.4	14242.83	14242.83	O	1569.38	1569.38	champus insurance	champus
Dilation of bladder canal (urethra) using an endoscope	cpt	52281	1569.38	1569.38	1569.38	1569.38	15026.72	15026.72	12522.27	12522.27	O	1569.38	1569.38	champus insurance	champus
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	99.29	99.29	champus insurance	champus
other musculoskeletal system and connective tissue o.r. procedures with cc	ms-drg	516	13074.37	13074.37	12081.3	12081.3	47397.76	47397.76	39498.13	39498.13	I	13074.37	13074.37	champus insurance	champus
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	17.01	17.01	champus insurance	champus
"Ventilation assistance and management, hospital inpatient or observation, initial day"	cpt	94002	2333.86	2333.86	1055.23	1055.23	9290.54	9290.54	7742.12	7742.12	E	2333.86	2333.86	champus insurance	champus
"Ventilation assistance and management, hospital inpatient or observation, initial day"	cpt	94002	1466.26	1466.26	1199.26	1199.26	13744.27	13744.27	11453.56	11453.56	O	1427.41	1427.41	champus insurance	champus
Small bone graft harvest	cpt	20900	10542.6	10542.6	10542.6	10542.6	101990.27	101990.27	84991.89	84991.89	O	10542.6	10542.6	champus insurance	champus
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	4.77	4.77	champus insurance	champus
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	224.22	224.22	champus insurance	champus
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	champus insurance	champus
local excision and removal of internal fixation devices of hip and femur with cc/mcc	ms-drg	498	11039.03	11039.03	11039.03	11039.03	75959.83	75959.83	63299.86	63299.86	I	11039.03	11039.03	champus insurance	champus
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	789.07	789.07	champus insurance	champus
"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope"	cpt	52310	1569.38	1569.38	1569.38	1569.38	6452.41	6452.41	5377.01	5377.01	E	1569.38	1569.38	champus insurance	champus
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	15.48	15.48	champus insurance	champus
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	224.22	224.22	champus insurance	champus
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	2674.06	2674.06	champus insurance	champus
haloperidol injection	cpt	J1630	711.92	711.92	360.62	360.62	5059.73	5059.73	4216.44	4216.44	E	360.62	360.62	champus insurance	champus
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	268.55	268.55	champus insurance	champus
Measurement of substance using immunoassay technique	cpt	83520	33.85	33.85	15.36	15.36	39.43	39.43	32.86	32.86	O	17.34	17.34	champus insurance	champus
glucagon hydrochloride/1 mg	cpt	J1610	1531.4	1531.4	468.43	468.43	3889.4	3889.4	3241.17	3241.17	E	468.43	468.43	champus insurance	champus
"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope"	cpt	52351	2674.06	2674.06	2674.06	2674.06	14430	14430	12025	12025	O	2674.06	2674.06	champus insurance	champus
"lower extremity and humerus procedures except hip, foot and femur without cc/mcc"	ms-drg	494	33138.65	33138.65	7298.14	7298.14	52502.23	52502.23	43751.86	43751.86	I	9797.37	9797.37	champus insurance	champus
garamycin gentamicin inj	cpt	J1580	10542.6	10542.6	2021.39	2021.39	29695.73	29695.73	24746.44	24746.44	O	10542.6	10542.6	champus insurance	champus
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	2683.82	2683.82	champus insurance	champus
inj ivig privigen 500 mg	cpt	J1459	3799.33	3799.33	2693.89	2693.89	11760.28	11760.28	9800.23	9800.23	O	2693.89	2693.89	champus insurance	champus
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	champus insurance	champus
Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope	cpt	52352	4436.99	4436.99	2519.87	2519.87	23377.46	23377.46	19481.22	19481.22	O	2674.06	2674.06	champus insurance	champus
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	357.24	357.24	champus insurance	champus
postoperative and post-traumatic infections without mcc	ms-drg	863	15967.49	15967.49	2487.74	2487.74	15221.04	15221.04	12684.2	12684.2	I	2487.74	2487.74	champus insurance	champus
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	11.48	11.48	champus insurance	champus
"Partial thickness skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)"	cpt	15120	11689.03	11689.03	2683.82	2683.82	19013.27	19013.27	15844.39	15844.39	O	2683.82	2683.82	champus insurance	champus
MRI scan of leg joint with contrast	cpt	73722	603.12	603.12	603.12	603.12	2213.52	2213.52	1844.6	1844.6	O	603.12	603.12	champus insurance	champus
"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device"	cpt	94664	2121.81	2121.81	216.25	216.25	2288.58	2288.58	1907.15	1907.15	E	612.63	612.63	champus insurance	champus
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	166.39	166.39	champus insurance	champus
"lower extremity and humerus procedures except hip, foot and femur with cc"	ms-drg	493	17098.05	17098.05	11409.73	11409.73	65822.2	65822.2	54851.83	54851.83	I	14057.92	14057.92	champus insurance	champus
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	612.63	612.63	champus insurance	champus
"Grafting of patient soft tissue, harvested by direct excision"	cpt	15769	7920.95	7920.95	7920.95	7920.95	65099.52	65099.52	54249.6	54249.6	O	7920.95	7920.95	champus insurance	champus
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	2956.22	2956.22	champus insurance	champus
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	champus insurance	champus
hip and femur procedures except major joint without cc/mcc	ms-drg	482	18778.5	18778.5	9099.73	9099.73	55806.76	55806.76	46505.63	46505.63	I	9099.73	9099.73	champus insurance	champus
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	champus insurance	champus
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	13361.26	13361.26	champus insurance	champus
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	3748.71	3748.71	champus insurance	champus
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	716.79	716.79	champus insurance	champus
Dressing change and/or removal of burn tissue (less than 5% total body surface)	cpt	16020	192.88	192.88	152.31	152.31	650.72	650.72	542.27	542.27	O	192.88	192.88	champus insurance	champus
CT scan of lower leg blood vessels with contrast	cpt	73706	161.43	161.43	161.43	161.43	1985.59	1985.59	1654.66	1654.66	E	161.43	161.43	champus insurance	champus
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	10624.49	10624.49	champus insurance	champus
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	987.77	987.77	champus insurance	champus
CT scan leg with contrast injection	cpt	73701	161.43	161.43	161.43	161.43	1658.69	1658.69	1382.24	1382.24	E	161.43	161.43	champus insurance	champus
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.51	6.51	champus insurance	champus
"Removal of foreskin, patient older than 28 days of age"	cpt	54161	1569.38	1569.38	1434.1	1434.1	15835.43	15835.43	13196.19	13196.19	O	1569.38	1569.38	champus insurance	champus
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	13950.81	13950.81	champus insurance	champus
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	805.22	805.22	champus insurance	champus
ertapenem injection	cpt	J1335	2076.66	2076.66	148.68	148.68	1092.52	1092.52	910.43	910.43	O	2076.66	2076.66	champus insurance	champus
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	champus insurance	champus
Removal of testicle	cpt	54520	2674.06	2674.06	2674.06	2674.06	19647.04	19647.04	16372.53	16372.53	O	2674.06	2674.06	champus insurance	champus
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	15747.67	15747.67	champus insurance	champus
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	99.29	99.29	champus insurance	champus
"Biopsy of breast accessed through the skin with stereotactic guidance, first lesion"	cpt	19081	1215.96	1215.96	1215.96	1215.96	11913.47	11913.47	9927.89	9927.89	O	1215.96	1215.96	champus insurance	champus
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	224.22	224.22	champus insurance	champus
ertapenem injection	cpt	J1335	891.9	891.9	639.12	639.12	8466.52	8466.52	7055.43	7055.43	E	674.98	674.98	champus insurance	champus
Repair of twisted testicle	cpt	54600	2754.5	2754.5	2754.5	2754.5	18960.14	18960.14	15800.12	15800.12	O	2754.5	2754.5	champus insurance	champus
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	545.11	545.11	champus insurance	champus
postoperative or post-traumatic infections with o.r. procedures with mcc	ms-drg	856	65295.34	65295.34	23364.17	23364.17	104472.54	104472.54	87060.45	87060.45	I	25622.31	25622.31	champus insurance	champus
Repositioning and fixation of misplaced testicle	cpt	54640	2754.5	2754.5	2754.5	2754.5	20760.92	20760.92	17300.77	17300.77	O	2754.5	2754.5	champus insurance	champus
Removal of sperm duct	cpt	55250	1569.38	1569.38	1569.38	1569.38	16856.66	16856.66	14047.22	14047.22	O	1569.38	1569.38	champus insurance	champus
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	325.54	325.54	champus insurance	champus
Incision or repair of sperm duct	cpt	55400	2674.06	2674.06	2674.06	2674.06	33218.92	33218.92	27682.43	27682.43	O	2674.06	2674.06	champus insurance	champus
disorders of the biliary tract with mcc	ms-drg	444	10366.72	10366.72	8535.61	8535.61	41391.48	41391.48	34492.9	34492.9	I	8700.71	8700.71	champus insurance	champus
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	4311.72	4311.72	champus insurance	champus
Removal of spermatic cord venous dilation or tying of spermatic veins	cpt	55530	2674.06	2674.06	2674.06	2674.06	21606.19	21606.19	18005.16	18005.16	O	2674.06	2674.06	champus insurance	champus
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.7	70.7	champus insurance	champus
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	541.93	541.93	champus insurance	champus
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis without cc/mcc"	ms-drg	443	8609.76	8609.76	3148.67	3148.67	12770.82	12770.82	10642.35	10642.35	I	3148.67	3148.67	champus insurance	champus
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	820.87	820.87	champus insurance	champus
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	643.21	643.21	champus insurance	champus
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with cc"	ms-drg	442	6432.48	6432.48	2765.26	2765.26	15198.22	15198.22	12665.18	12665.18	I	2765.26	2765.26	champus insurance	champus
Spermatic cord procedure using an endoscope	cpt	55559	7519.16	7519.16	4282.09	4282.09	32160.6	32160.6	26800.5	26800.5	O	4282.09	4282.09	champus insurance	champus
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with mcc"	ms-drg	441	14233.9	14233.9	9046.97	9046.97	48815.94	48815.94	40679.95	40679.95	I	14233.9	14233.9	champus insurance	champus
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	987.77	987.77	champus insurance	champus
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	4282.09	4282.09	champus insurance	champus
"Plastic repair of vagina and tissue separating vagina, rectum, and bladder"	cpt	57260	7453.01	7453.01	7453.01	7453.01	52503.65	52503.65	43753.04	43753.04	O	7453.01	7453.01	champus insurance	champus
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	913.96	913.96	champus insurance	champus
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	12.86	12.86	champus insurance	champus
acetazolamid sodium injectio	cpt	J1120	197.85	197.85	197.85	197.85	1470.4	1470.4	1225.33	1225.33	E	197.85	197.85	champus insurance	champus
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4282.09	4282.09	champus insurance	champus
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	710.99	710.99	champus insurance	champus
Creation of sling around bladder canal (urethra) to control leakage	cpt	57288	9490.45	9490.45	3784.07	3784.07	31149.61	31149.61	25958.01	25958.01	O	5618.54	5618.54	champus insurance	champus
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	10706.37	10706.37	champus insurance	champus
Surgical vaginal defect repair using an endoscope	cpt	57425	7453.01	7453.01	7453.01	7453.01	50987.53	50987.53	42489.61	42489.61	O	7453.01	7453.01	champus insurance	champus
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.54	4.54	champus insurance	champus
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	197.85	197.85	champus insurance	champus
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	1275.2	1275.2	champus insurance	champus
methylprednisolone 80 mg inj	cpt	J1040	553.72	553.72	102.7	102.7	604.8	604.8	504	504	O	553.72	553.72	champus insurance	champus
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	553.72	553.72	champus insurance	champus
disorders of pancreas except malignancy without cc/mcc	ms-drg	440	13723.07	13723.07	3523.84	3523.84	16448.54	16448.54	13707.12	13707.12	I	3523.84	3523.84	champus insurance	champus
Removal of intra-uterine device (IUD) for pregnancy prevention	cpt	58301	2260.96	2260.96	238.36	238.36	19397.1	19397.1	16164.25	16164.25	O	2260.96	2260.96	champus insurance	champus
Introduction of saline or X-ray contrast material for X-ray imaging of the uterus and tubes	cpt	58340	206.45	206.45	206.45	206.45	3408.2	3408.2	2840.17	2840.17	O	206.45	206.45	champus insurance	champus
Examination of uterus with destruction of uterine lining using an endoscope	cpt	58563	6142.86	6142.86	4033.08	4033.08	27275.76	27275.76	22729.8	22729.8	O	4033.08	4033.08	champus insurance	champus
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	4802.1	4802.1	champus insurance	champus
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4311.72	4311.72	champus insurance	champus
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	930.84	930.84	champus insurance	champus
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	2441.57	2441.57	champus insurance	champus
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	70.7	70.7	champus insurance	champus
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	29734.37	29734.37	champus insurance	champus
Zinc level	cpt	84630	11.44	11.44	10.07	10.07	82.68	82.68	68.9	68.9	O	11.44	11.44	champus insurance	champus
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	992.34	992.34	champus insurance	champus
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	3062.32	3062.32	champus insurance	champus
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	7453.01	7453.01	champus insurance	champus
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	197.85	197.85	champus insurance	champus
"injection, dalbavancin"	cpt	J0875	4878.62	4878.62	2187.19	2187.19	11412.58	11412.58	9510.48	9510.48	E	4878.62	4878.62	champus insurance	champus
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	16.84	16.84	champus insurance	champus
Removal of ovaries and/or tubes using an endoscope	cpt	58661	5642.61	5642.61	3975.41	3975.41	24783.68	24783.68	20653.07	20653.07	O	4282.09	4282.09	champus insurance	champus
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	2929.57	2929.57	champus insurance	champus
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	3.95	3.95	champus insurance	champus
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	2425.05	2425.05	champus insurance	champus
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	541.93	541.93	champus insurance	champus
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	4282.09	4282.09	champus insurance	champus
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	4282.09	4282.09	champus insurance	champus
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	607.46	607.46	champus insurance	champus
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	champus insurance	champus
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	1079.07	1079.07	champus insurance	champus
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	162.77	162.77	champus insurance	champus
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	20.9	20.9	champus insurance	champus
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	10804.08	10804.08	champus insurance	champus
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	906.43	906.43	champus insurance	champus
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	118.36	118.36	champus insurance	champus
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	70.7	70.7	champus insurance	champus
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	677.23	677.23	champus insurance	champus
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	197.85	197.85	champus insurance	champus
cefoxitin sodium injection	cpt	J0694	1952.13	1952.13	832.9	832.9	18152.78	18152.78	15127.32	15127.32	E	1952.13	1952.13	champus insurance	champus
Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope	cpt	59151	4282.09	4282.09	4282.09	4282.09	39845.57	39845.57	33204.64	33204.64	E	4282.09	4282.09	champus insurance	champus
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1215.96	1215.96	champus insurance	champus
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2719.16	2719.16	champus insurance	champus
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4206.12	4206.12	champus insurance	champus
cefazolin sodium injection	cpt	J0690	9081.99	9081.99	1725.97	1725.97	18886.44	18886.44	15738.7	15738.7	E	2425.05	2425.05	champus insurance	champus
"Removal of breast growth, open procedure"	cpt	19125	2683.82	2683.82	2683.82	2683.82	19864.31	19864.31	16553.59	16553.59	O	2683.82	2683.82	champus insurance	champus
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	938.77	938.77	champus insurance	champus
Spinal tap for diagnosis	cpt	62270	1258.34	1258.34	964.65	964.65	6589.96	6589.96	5491.63	5491.63	E	1000.66	1000.66	champus insurance	champus
Spinal tap with drainage of spinal fluid	cpt	62272	6841.37	6841.37	1003.2	1003.2	4703.68	4703.68	3919.73	3919.73	E	1003.2	1003.2	champus insurance	champus
"Placement of breast localization devices accessed through the skin with mammographic guidance, first lesion"	cpt	19281	2683.82	2683.82	194.62	194.62	23926.75	23926.75	19938.96	19938.96	O	2683.82	2683.82	champus insurance	champus
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	8460.55	8460.55	champus insurance	champus
penicillin g benzathine inj	cpt	J0561	440.81	440.81	363.81	363.81	1358.89	1358.89	1132.41	1132.41	E	363.81	363.81	champus insurance	champus
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1952.13	1952.13	champus insurance	champus
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	1258.2	1258.2	champus insurance	champus
X-ray of upper spinal canal with radiological supervision and interpretation	cpt	62302	941.39	941.39	691.17	691.17	7335.26	7335.26	6112.72	6112.72	O	941.39	941.39	champus insurance	champus
dicyclomine injection	cpt	J0500	718.51	718.51	233.2	233.2	3588.02	3588.02	2990.02	2990.02	E	233.2	233.2	champus insurance	champus
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	10323.64	10323.64	champus insurance	champus
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	99.29	99.29	champus insurance	champus
baclofen 10 mg injection	cpt	J0475	1289.69	1289.69	1289.69	1289.69	6057.1	6057.1	5047.58	5047.58	O	1289.69	1289.69	champus insurance	champus
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	2441.57	2441.57	champus insurance	champus
"Placement of breast localization devices accessed through the skin with ultrasound guidance, first lesion"	cpt	19285	4639.61	4639.61	2683.82	2683.82	30332.77	30332.77	25277.31	25277.31	O	2683.82	2683.82	champus insurance	champus
atropine sulfate injection	cpt	J0461	14120.9	14120.9	1106.07	1106.07	32990.4	32990.4	27492	27492	O	9547.8	9547.8	champus insurance	champus
Injection of substance into spinal canal of upper or middle back	cpt	62320	553.72	553.72	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	553.72	553.72	champus insurance	champus
atropine sulfate injection	cpt	J0461	8792.66	8792.66	1934.02	1934.02	27478.69	27478.69	22898.91	22898.91	E	8792.66	8792.66	champus insurance	champus
azithromycin	cpt	J0456	1409.82	1409.82	147.92	147.92	9187.79	9187.79	7656.49	7656.49	O	1409.82	1409.82	champus insurance	champus
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	4939.03	4939.03	champus insurance	champus
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	759.68	759.68	champus insurance	champus
Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician	cpt	62370	1289.69	1289.69	236.15	236.15	4731.84	4731.84	3943.2	3943.2	O	1289.69	1289.69	champus insurance	champus
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	5299.29	5299.29	champus insurance	champus
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	70.7	70.7	champus insurance	champus
hydralazine hcl injection	cpt	J0360	2136.63	2136.63	1934.02	1934.02	16012.49	16012.49	13343.74	13343.74	E	2136.63	2136.63	champus insurance	champus
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	15.11	15.11	champus insurance	champus
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	4282.09	4282.09	champus insurance	champus
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	938.77	938.77	champus insurance	champus
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	142.79	142.79	champus insurance	champus
laparoscopic cholecystectomy without c.d.e. with cc	ms-drg	418	12197.9	12197.9	5638.44	5638.44	46278.29	46278.29	38565.24	38565.24	I	5638.44	5638.44	champus insurance	champus
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4286.52	4286.52	champus insurance	champus
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	3307.98	3307.98	champus insurance	champus
"Re-exploration of spine repair with release of lower spinal cord or nerves, single interspace"	cpt	63042	10573.89	10573.89	5299.29	5299.29	30661.06	30661.06	25550.88	25550.88	O	5299.29	5299.29	champus insurance	champus
ampicillin sulbactam 1.5 gm	cpt	J0295	2069.31	2069.31	534.88	534.88	3702.38	3702.38	3085.32	3085.32	E	669.6	669.6	champus insurance	champus
ampicillin 500 mg inj	cpt	J0290	3073.87	3073.87	486.78	486.78	6558.29	6558.29	5465.24	5465.24	O	1524.42	1524.42	champus insurance	champus
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	champus insurance	champus
laparoscopic cholecystectomy without c.d.e. with mcc	ms-drg	417	13810.6	13810.6	10906.98	10906.98	46700.2	46700.2	38916.83	38916.83	I	10906.98	10906.98	champus insurance	champus
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	2683.82	2683.82	champus insurance	champus
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	7923.09	7923.09	champus insurance	champus
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	70.7	70.7	champus insurance	champus
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	5381.9	5381.9	champus insurance	champus
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.8	5.8	champus insurance	champus
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	8184.57	8184.57	champus insurance	champus
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	7.55	7.55	champus insurance	champus
adrenalin epinephrine inject	cpt	J0171	2087.31	2087.31	439.13	439.13	3485.48	3485.48	2904.57	2904.57	E	439.13	439.13	champus insurance	champus
Partial removal of spine bone with release of spinal cord and/or nerves	cpt	63048	5340.6	5340.6	5299.29	5299.29	30550.06	30550.06	25458.38	25458.38	O	5340.6	5340.6	champus insurance	champus
other digestive system diagnoses without cc/mcc	ms-drg	395	6014.04	6014.04	3253.33	3253.33	12390.65	12390.65	10325.54	10325.54	I	4324.06	4324.06	champus insurance	champus
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	8132.37	8132.37	champus insurance	champus
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	5299.29	5299.29	champus insurance	champus
Radiological supervision and interpretation X-ray of hip joint	cpt	73525	338.27	338.27	332.86	332.86	1232.57	1232.57	1027.14	1027.14	O	338.27	338.27	champus insurance	champus
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	4282.09	4282.09	champus insurance	champus
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch	cpt	64450	686.5	686.5	553.72	553.72	1626.79	1626.79	1355.66	1355.66	E	553.72	553.72	champus insurance	champus
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	champus insurance	champus
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4639.61	4639.61	champus insurance	champus
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	625.38	625.38	champus insurance	champus
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	3209.36	3209.36	champus insurance	champus
chemotherapy without acute leukemia as secondary diagnosis with mcc	ms-drg	846	17225.19	17225.19	7611.67	7611.67	47658.86	47658.86	39715.72	39715.72	I	17225.19	17225.19	champus insurance	champus
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	99.29	99.29	97.3	97.3	727.58	727.58	606.32	606.32	E	99.29	99.29	champus insurance	champus
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	4028.98	4028.98	champus insurance	champus
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	577.69	577.69	champus insurance	champus
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	1079.07	1079.07	champus insurance	champus
Injections of trigger points in 1 or 2 muscles	cpt	20552	593.86	593.86	593.86	593.86	2179.02	2179.02	1815.85	1815.85	E	593.86	593.86	champus insurance	champus
drug test def 1-7 classes	cpt	G0480	1427.41	1427.41	961.2	961.2	5732.09	5732.09	4776.74	4776.74	O	1427.41	1427.41	champus insurance	champus
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	2.38	2.38	champus insurance	champus
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	409.88	409.88	champus insurance	champus
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	99.29	99.29	champus insurance	champus
"Injections of upper or middle spine facet joint using imaging guidance, single level"	cpt	64490	1063.31	1063.31	719.38	719.38	4559.56	4559.56	3799.63	3799.63	O	719.38	719.38	champus insurance	champus
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	446.94	446.94	champus insurance	champus
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	894	894	champus insurance	champus
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	111.53	111.53	champus insurance	champus
"esophagitis, gastroenteritis and miscellaneous digestive disorders with mcc"	ms-drg	391	8351.98	8351.98	6959.33	6959.33	31444.44	31444.44	26203.7	26203.7	I	6959.33	6959.33	champus insurance	champus
hospital outpt clinic visit	cpt	G0463	2553.53	2553.53	1934.02	1934.02	23345.64	23345.64	19454.7	19454.7	E	1952.13	1952.13	champus insurance	champus
"prostate biopsy, any mthd"	cpt	G0416	3688.73	3688.73	696.23	696.23	5130.25	5130.25	4275.21	4275.21	O	696.23	696.23	champus insurance	champus
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3089.67	3089.67	champus insurance	champus
gastrointestinal obstruction without cc/mcc	ms-drg	390	4096.32	4096.32	2655.11	2655.11	15854.21	15854.21	13211.84	13211.84	I	2947.02	2947.02	champus insurance	champus
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	726.33	726.33	champus insurance	champus
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	4276.41	4276.41	champus insurance	champus
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	6097.78	6097.78	champus insurance	champus
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1079.07	1079.07	champus insurance	champus
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	603.12	603.12	champus insurance	champus
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	1079.07	1079.07	champus insurance	champus
Aspiration and/or injection of large joint or joint capsule	cpt	20610	678.84	678.84	467.14	467.14	2107.97	2107.97	1756.64	1756.64	E	678.84	678.84	champus insurance	champus
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6461	6461	champus insurance	champus
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	946.96	946.96	champus insurance	champus
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	618.63	618.63	champus insurance	champus
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1965.57	1965.57	champus insurance	champus
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	2.38	2.38	champus insurance	champus
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	231.9	231.9	champus insurance	champus
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	3.03	3.03	champus insurance	champus
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70.7	70.7	champus insurance	champus
"Self-care or home management training, each 15 minutes"	cpt	97535	680.1	680.1	137.83	137.83	2973.6	2973.6	2478	2478	O	680.1	680.1	champus insurance	champus
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2136.63	2136.63	2034.73	2034.73	15002.65	15002.65	12502.21	12502.21	E	2136.63	2136.63	champus insurance	champus
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	5140.13	5140.13	champus insurance	champus
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	1079.07	1079.07	champus insurance	champus
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	863.02	863.02	champus insurance	champus
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.78	8.78	champus insurance	champus
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	380.16	380.16	champus insurance	champus
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	199.87	199.87	champus insurance	champus
gastrointestinal hemorrhage with mcc	ms-drg	377	17273.54	17273.54	7149.07	7149.07	36153.05	36153.05	30127.54	30127.54	I	11346.04	11346.04	champus insurance	champus
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	4.01	4.01	champus insurance	champus
"Release of nerve of arm or leg, open procedure"	cpt	64708	1523.14	1523.14	1523.14	1523.14	20985.68	20985.68	17488.07	17488.07	O	1523.14	1523.14	champus insurance	champus
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	490.2	490.2	champus insurance	champus
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	8777.72	8777.72	champus insurance	champus
Removal of deep bone implant	cpt	20680	5259.68	5259.68	1627.49	1627.49	19506.22	19506.22	16255.18	16255.18	O	1627.49	1627.49	champus insurance	champus
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	1523.14	1523.14	champus insurance	champus
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	830.58	830.58	champus insurance	champus
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	9.5	9.5	champus insurance	champus
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	10624.85	10624.85	champus insurance	champus
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	champus insurance	champus
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	676.71	676.71	champus insurance	champus
"Evaluation of occupational therapy, typically 30 minutes"	cpt	97165	2088.08	2088.08	2088.08	2088.08	16433.63	16433.63	13694.69	13694.69	E	2088.08	2088.08	champus insurance	champus
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	1523.14	1523.14	champus insurance	champus
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	4.5	4.5	champus insurance	champus
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	676.71	676.71	champus insurance	champus
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	561.64	561.64	champus insurance	champus
major gastrointestinal disorders and peritoneal infections without cc/mcc	ms-drg	373	4953.28	4953.28	2914.2	2914.2	19001.1	19001.1	15834.25	15834.25	I	2914.2	2914.2	champus insurance	champus
"Removal of foreign body, external eye, cornea"	cpt	65220	197.85	197.85	197.85	197.85	1109.51	1109.51	924.59	924.59	E	197.85	197.85	champus insurance	champus
CT scan of arm	cpt	73200	99.29	99.29	99.29	99.29	1366.13	1366.13	1138.44	1138.44	E	99.29	99.29	champus insurance	champus
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery	cpt	20930	10573.89	10573.89	5215.79	5215.79	74066.99	74066.99	61722.49	61722.49	O	10542.6	10542.6	champus insurance	champus
lymphoma and non-acute leukemia with cc	ms-drg	841	24430.5	24430.5	10276.4	10276.4	22126.63	22126.63	18438.86	18438.86	I	12578.51	12578.51	champus insurance	champus
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	1099.17	1099.17	champus insurance	champus
"Removal or relocation of corneal conjunctiva, with graft"	cpt	65426	1714.35	1714.35	1714.35	1714.35	20257.37	20257.37	16881.14	16881.14	O	1714.35	1714.35	champus insurance	champus
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	champus insurance	champus
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	78.86	78.86	champus insurance	champus
"Removal of cataract with insertion of lens, complex"	cpt	66982	3382.58	3382.58	1639	1639	16101.53	16101.53	13417.94	13417.94	O	3382.58	3382.58	champus insurance	champus
other digestive system o.r. procedures with mcc	ms-drg	356	24337.34	24337.34	16073.72	16073.72	87729.18	87729.18	73107.65	73107.65	I	16073.72	16073.72	champus insurance	champus
Removal of embedded foreign body in eyelid	cpt	67938	437.47	437.47	437.47	437.47	1050.64	1050.64	875.53	875.53	E	437.47	437.47	champus insurance	champus
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	257.49	257.49	champus insurance	champus
Clotting factor VIII (VW factor) antigen	cpt	85246	23.03	23.03	20.4	20.4	166.63	166.63	138.86	138.86	O	23.03	23.03	champus insurance	champus
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	2010.24	2010.24	champus insurance	champus
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	70.7	70.7	champus insurance	champus
hernia procedures except inguinal and femoral without cc/mcc	ms-drg	355	9838.77	9838.77	8545.85	8545.85	63563.32	63563.32	52969.43	52969.43	I	9838.77	9838.77	champus insurance	champus
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	3.65	3.65	champus insurance	champus
Supplies and materials provided by the physician beyond those usually included in the office visit or service	cpt	99070	410.93	410.93	410.93	410.93	2964.3	2964.3	2470.25	2470.25	E	410.93	410.93	champus insurance	champus
Supplies and materials provided by the physician beyond those usually included in the office visit or service	cpt	99070	1127.01	1127.01	1127.01	1127.01	8570	8570	7141.67	7141.67	O	1127.01	1127.01	champus insurance	champus
Physician educational services provided in a group setting	cpt	99078	4282.09	4282.09	4282.09	4282.09	33766.63	33766.63	28138.86	28138.86	E	4282.09	4282.09	champus insurance	champus
Physician educational services provided in a group setting	cpt	99078	2674.06	2674.06	2674.06	2674.06	24203.03	24203.03	20169.19	20169.19	O	2674.06	2674.06	champus insurance	champus
Structural donor bone graft for spine surgery	cpt	20931	10583.91	10583.91	5215.79	5215.79	74613.46	74613.46	62177.88	62177.88	O	10583.91	10583.91	champus insurance	champus
Removal of foreign body from ear canal	cpt	69200	197.85	197.85	180.72	180.72	1026.5	1026.5	855.42	855.42	E	197.85	197.85	champus insurance	champus
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	8791.16	8791.16	champus insurance	champus
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2524.71	2524.71	champus insurance	champus
Harvest of bone from same spine incision for graft	cpt	20936	10573.89	10573.89	10359.91	10359.91	90858.1	90858.1	75715.08	75715.08	O	10542.6	10542.6	champus insurance	champus
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	115.63	115.63	champus insurance	champus
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	14120.9	14120.9	champus insurance	champus
perc drug-el cor stent sing	cpt	C9600	11328.88	11328.88	8777.72	8777.72	81384.32	81384.32	67820.27	67820.27	E	8791.16	8791.16	champus insurance	champus
"X-ray of bones of nose, minimum of 3 views"	cpt	70160	70.7	70.7	23.05	23.05	333.26	333.26	277.72	277.72	O	70.7	70.7	champus insurance	champus
lymphoma and non-acute leukemia with mcc	ms-drg	840	24876.86	24876.86	16212.54	16212.54	103181.56	103181.56	85984.63	85984.63	I	24876.86	24876.86	champus insurance	champus
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	8791.16	8791.16	1723.62	1723.62	51580.72	51580.72	42983.93	42983.93	E	8791.16	8791.16	champus insurance	champus
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	338.27	338.27	champus insurance	champus
CT scan head or brain before and after contrast	cpt	70470	161.43	161.43	107.65	107.65	2755.15	2755.15	2295.96	2295.96	E	161.43	161.43	champus insurance	champus
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	3211.39	3211.39	champus insurance	champus
anal and stomal procedures with mcc	ms-drg	347	18519.1	18519.1	18519.1	18519.1	87634.51	87634.51	73028.76	73028.76	I	18519.1	18519.1	champus insurance	champus
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2524.71	2524.71	champus insurance	champus
CT scan of cranial cavity	cpt	70480	99.29	99.29	94.12	94.12	1366.13	1366.13	1138.44	1138.44	E	99.29	99.29	champus insurance	champus
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	7453.01	7453.01	champus insurance	champus
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	3748.71	3748.71	champus insurance	champus
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	352.64	352.64	champus insurance	champus
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	70.7	70.7	champus insurance	champus
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	champus insurance	champus
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	2524.71	2524.71	champus insurance	champus
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	8791.16	8791.16	champus insurance	champus
CT scan of cranial cavity with contrast	cpt	70481	168.39	168.39	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	champus insurance	champus
CT scan of face with contrast	cpt	70487	161.43	161.43	93.52	93.52	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	champus insurance	champus
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	10.22	10.22	champus insurance	champus
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	3912	3912	champus insurance	champus
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	8791.16	8791.16	champus insurance	champus
"catheter, ablation"	cpt	C1886	6142.86	6142.86	4006.52	4006.52	26466.79	26466.79	22055.66	22055.66	O	4033.08	4033.08	champus insurance	champus
CT scan of neck with contrast	cpt	70491	161.43	161.43	112.47	112.47	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	champus insurance	champus
Closed treatment of broken nasal bone with stabilization	cpt	21320	2320.38	2320.38	2320.38	2320.38	16237.06	16237.06	13530.88	13530.88	O	2320.38	2320.38	champus insurance	champus
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	11449.31	11449.31	champus insurance	champus
"Emergency department visit, self limited or minor problem"	cpt	99281	137.73	137.73	56.33	56.33	209.88	209.88	174.9	174.9	E	61.67	61.67	champus insurance	champus
embolization protect syst	cpt	C1884	11328.88	11328.88	6589.84	6589.84	72908.51	72908.51	60757.09	60757.09	E	8791.16	8791.16	champus insurance	champus
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	408.55	408.55	champus insurance	champus
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	2674.06	2674.06	champus insurance	champus
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	champus insurance	champus
Open treatment of broken thumb at wrist	cpt	26665	2425.05	2425.05	2425.05	2425.05	35263.28	35263.28	29386.07	29386.07	O	2425.05	2425.05	champus insurance	champus
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	7176.4	7176.4	champus insurance	champus
"stent, coated/cov w/del sys"	cpt	C1874	13873.2	13873.2	8777.72	8777.72	83814.13	83814.13	69845.11	69845.11	E	8791.16	8791.16	champus insurance	champus
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	champus insurance	champus
appendectomy without complicated principal diagnosis without cc/mcc	ms-drg	343	9395.5	9395.5	5698.84	5698.84	36435.43	36435.43	30362.86	30362.86	I	6538.67	6538.67	champus insurance	champus
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	champus insurance	champus
Fibrinogen (factor 1) activity measurement	cpt	85384	51	51	8.65	8.65	102.52	102.52	85.43	85.43	O	9.76	9.76	champus insurance	champus
CT scan of neck before and after contrast	cpt	70492	697.54	697.54	161.43	161.43	2148.41	2148.41	1790.34	1790.34	O	161.43	161.43	champus insurance	champus
CT scan of blood vessel of head with contrast	cpt	70496	306.42	306.42	159.8	159.8	1985.59	1985.59	1654.66	1654.66	E	161.43	161.43	champus insurance	champus
"ocular imp, aqueous drain de"	cpt	C1783	3382.58	3382.58	3382.58	3382.58	28467.73	28467.73	23723.11	23723.11	O	3382.58	3382.58	champus insurance	champus
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	4282.09	4282.09	champus insurance	champus
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	5299.29	5299.29	champus insurance	champus
appendectomy without complicated principal diagnosis with cc	ms-drg	342	8397.82	8397.82	6592.95	6592.95	33691.25	33691.25	28076.04	28076.04	I	8397.82	8397.82	champus insurance	champus
CT scan of neck blood vessels with contrast	cpt	70498	408.55	408.55	168.41	168.41	1985.59	1985.59	1654.66	1654.66	E	408.55	408.55	champus insurance	champus
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	2524.71	2524.71	champus insurance	champus
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	8791.16	8791.16	champus insurance	champus
"graft, vascular"	cpt	C1768	7453.01	7453.01	3902.07	3902.07	25441.12	25441.12	21200.93	21200.93	O	7453.01	7453.01	champus insurance	champus
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	champus insurance	champus
"conn tiss, non-human"	cpt	C1763	10542.6	10542.6	9490.45	9490.45	54305.62	54305.62	45254.68	45254.68	O	10542.6	10542.6	champus insurance	champus
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	19.05	19.05	champus insurance	champus
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	541.93	541.93	champus insurance	champus
"conn tiss, human(inc fascia)"	cpt	C1762	5711.87	5711.87	5711.87	5711.87	73976.5	73976.5	61647.08	61647.08	O	5711.87	5711.87	champus insurance	champus
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	8777.72	8777.72	champus insurance	champus
MRI scan brain	cpt	70551	1815.29	1815.29	124.83	124.83	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	champus insurance	champus
"cath, intra echocardiography"	cpt	C1759	14120.9	14120.9	8704.03	8704.03	94032.49	94032.49	78360.41	78360.41	O	14120.9	14120.9	champus insurance	champus
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	609.71	609.71	champus insurance	champus
"cath, intra echocardiography"	cpt	C1759	14000.33	14000.33	8792.66	8792.66	93375.96	93375.96	77813.3	77813.3	E	8792.66	8792.66	champus insurance	champus
appendectomy without complicated principal diagnosis with mcc	ms-drg	341	14495.62	14495.62	9375.78	9375.78	41189.74	41189.74	34324.78	34324.78	I	9375.78	9375.78	champus insurance	champus
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	2674.06	2674.06	champus insurance	champus
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	10.15	10.15	champus insurance	champus
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	2333.86	2333.86	2333.86	2333.86	14420.36	14420.36	12016.97	12016.97	E	2333.86	2333.86	champus insurance	champus
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	champus insurance	champus
"Closed treatment of jaw temporomandibular joint (TMJ) dislocation, uncomplicated"	cpt	21480	592.32	592.32	388.88	388.88	2606.84	2606.84	2172.37	2172.37	E	388.88	388.88	champus insurance	champus
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	787.11	787.11	champus insurance	champus
appendectomy with complicated principal diagnosis with cc	ms-drg	339	10970.51	10970.51	8877.02	8877.02	60592.91	60592.91	50494.09	50494.09	I	8877.02	8877.02	champus insurance	champus
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	champus insurance	champus
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	11449.31	11449.31	champus insurance	champus
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	9763.35	9763.35	champus insurance	champus
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	1284.15	1284.15	champus insurance	champus
"Preventive medicine counseling, approximately 15 minutes"	cpt	99401	24.64	24.64	24.64	24.64	178.08	178.08	148.4	148.4	O	24.64	24.64	champus insurance	champus
Anesthesia procedure	cpt	1999	4282.09	4282.09	4282.09	4282.09	33766.63	33766.63	28138.86	28138.86	E	4282.09	4282.09	champus insurance	champus
Anesthesia procedure	cpt	1999	2674.06	2674.06	2674.06	2674.06	23709.52	23709.52	19757.93	19757.93	O	2674.06	2674.06	champus insurance	champus
"cath, translumin non-laser"	cpt	C1725	13873.2	13873.2	6589.84	6589.84	75620.26	75620.26	63016.88	63016.88	E	8791.16	8791.16	champus insurance	champus
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	champus insurance	champus
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	338.27	338.27	champus insurance	champus
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	70.7	70.7	champus insurance	champus
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.71	2.71	champus insurance	champus
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	9891.43	9891.43	champus insurance	champus
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	5299.29	5299.29	champus insurance	champus
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	champus insurance	champus
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	1569.38	1569.38	champus insurance	champus
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	70.7	70.7	champus insurance	champus
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	338.27	338.27	champus insurance	champus
Injection of substance into spinal canal of lower back or sacrum	cpt	62322	1477.69	1477.69	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	553.72	553.72	champus insurance	champus
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	15399.07	15399.07	champus insurance	champus
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	553.72	553.72	champus insurance	champus
"gad-base mr contrast nos,1ml"	cpt	A9579	1952.13	1952.13	1005.31	1005.31	14304.31	14304.31	11920.26	11920.26	E	1382.41	1382.41	champus insurance	champus
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	17.21	17.21	champus insurance	champus
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	champus insurance	champus
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	996.24	996.24	champus insurance	champus
Drainage of multiple abscess	cpt	10061	480.9	480.9	454.66	454.66	1173.38	1173.38	977.82	977.82	E	480.9	480.9	champus insurance	champus
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	326.12	326.12	champus insurance	champus
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	1791.13	1791.13	champus insurance	champus
"Fusion of spine bones with removal of disc at upper spinal column, anterior approach, complex"	cpt	22551	10542.6	10542.6	10359.91	10359.91	56256.43	56256.43	46880.36	46880.36	O	10542.6	10542.6	champus insurance	champus
tc99m maa	cpt	A9540	1952.13	1952.13	1943.08	1943.08	13059.28	13059.28	10882.73	10882.73	E	1952.13	1952.13	champus insurance	champus
"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach"	cpt	22552	10542.6	10542.6	10542.6	10542.6	71210.34	71210.34	59341.95	59341.95	O	10542.6	10542.6	champus insurance	champus
tc99m pentetate	cpt	A9539	421.27	421.27	260.45	260.45	1775.23	1775.23	1479.36	1479.36	O	418.12	418.12	champus insurance	champus
Red blood cell sickling measurement	cpt	85660	5.53	5.53	4.9	4.9	39.17	39.17	32.64	32.64	O	5.53	5.53	champus insurance	champus
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	805.22	805.22	champus insurance	champus
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	755.46	755.46	champus insurance	champus
"stomach, esophageal and duodenal procedures without cc/mcc"	ms-drg	328	13958.64	13958.64	5175.14	5175.14	49664.04	49664.04	41386.7	41386.7	I	10222.4	10222.4	champus insurance	champus
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	champus insurance	champus
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	6.86	6.86	champus insurance	champus
tc99m pyrophosphate	cpt	A9538	326.12	326.12	320.9	320.9	2718.01	2718.01	2265.01	2265.01	O	326.12	326.12	champus insurance	champus
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	467.77	467.77	champus insurance	champus
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	118.72	118.72	champus insurance	champus
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	70.7	70.7	champus insurance	champus
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	734.67	734.67	champus insurance	champus
CT scan pelvis	cpt	72192	99.29	99.29	76.69	76.69	1367.4	1367.4	1139.5	1139.5	E	99.29	99.29	champus insurance	champus
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	champus insurance	champus
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.03	6.03	champus insurance	champus
extensive o.r. procedures unrelated to principal diagnosis without cc/mcc	ms-drg	983	10428.98	10428.98	8044.15	8044.15	43105.16	43105.16	35920.97	35920.97	I	8044.15	8044.15	champus insurance	champus
"stomach, esophageal and duodenal procedures with mcc"	ms-drg	326	288925.38	288925.38	28518.81	28518.81	166466.87	166466.87	138722.39	138722.39	I	30301.35	30301.35	champus insurance	champus
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	champus insurance	champus
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.57	1965.57	champus insurance	champus
extensive o.r. procedures unrelated to principal diagnosis with cc	ms-drg	982	14004.61	14004.61	2771.51	2771.51	62525.57	62525.57	52104.64	52104.64	I	2771.51	2771.51	champus insurance	champus
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.7	70.7	champus insurance	champus
other circulatory system diagnoses with cc	ms-drg	315	6368.18	6368.18	6098.97	6098.97	18163.28	18163.28	15136.07	15136.07	I	6098.97	6098.97	champus insurance	champus
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	99.29	99.29	champus insurance	champus
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	521.99	521.99	champus insurance	champus
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.2	5.2	champus insurance	champus
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	253.92	253.92	champus insurance	champus
"Fusion of lower spine bones, posterior or posterolateral approach"	cpt	22612	10625.2	10625.2	71.67	71.67	98531.21	98531.21	82109.34	82109.34	O	10542.6	10542.6	champus insurance	champus
contact layer >16<= 48 sq in	cpt	A6207	102.7	102.7	28.09	28.09	1424.02	1424.02	1186.68	1186.68	O	102.7	102.7	champus insurance	champus
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	283.05	283.05	champus insurance	champus
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	champus insurance	champus
surgical supplies	cpt	A4649	9907.54	9907.54	2386.25	2386.25	23508.36	23508.36	19590.3	19590.3	O	5299.29	5299.29	champus insurance	champus
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	2683.82	2683.82	champus insurance	champus
MRI scan of lower spinal canal before and after contrast	cpt	72158	338.27	338.27	218.02	218.02	4123.82	4123.82	3436.52	3436.52	E	338.27	338.27	champus insurance	champus
tubing (oxygen) per foot	cpt	A4616	475.24	475.24	475.24	475.24	5870.3	5870.3	4891.92	4891.92	O	475.24	475.24	champus insurance	champus
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	12.14	12.14	champus insurance	champus
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	99.29	99.29	champus insurance	champus
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	2425.05	2425.05	champus insurance	champus
chest pain	ms-drg	313	5722.44	5722.44	3212.87	3212.87	19324.42	19324.42	16103.68	16103.68	I	3938.65	3938.65	champus insurance	champus
als 2	cpt	A0433	751.18	751.18	634.19	634.19	1819.21	1819.21	1516.01	1516.01	O	751.18	751.18	champus insurance	champus
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	386.48	386.48	champus insurance	champus
bls	cpt	A0428	911.16	911.16	251.75	251.75	819.6	819.6	683	683	O	911.16	911.16	champus insurance	champus
bls	cpt	A0428	911.16	911.16	251.75	251.75	819.6	819.6	683	683	O	629.22	629.22	champus insurance	champus
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	10542.6	10542.6	champus insurance	champus
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	champus insurance	champus
Quantitation of therapeutic drug	cpt	80299	18.72	18.72	5.39	5.39	36.89	36.89	30.74	30.74	O	18.72	18.72	champus insurance	champus
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	436.56	436.56	champus insurance	champus
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	champus insurance	champus
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	950.89	950.89	champus insurance	champus
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	629.22	629.22	champus insurance	champus
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	2923.72	2923.72	champus insurance	champus
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	428.94	428.94	champus insurance	champus
CT scan pelvis with contrast	cpt	72193	989.18	989.18	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	champus insurance	champus
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	62.54	62.54	champus insurance	champus
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.31	4.31	champus insurance	champus
CT scan chest with contrast	cpt	71260	917.69	917.69	147.45	147.45	1913.09	1913.09	1594.24	1594.24	E	917.69	917.69	champus insurance	champus
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	10542.6	10542.6	champus insurance	champus
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	champus insurance	champus
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	champus insurance	champus
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	3295.73	3295.73	champus insurance	champus
"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments"	cpt	22845	10542.6	10542.6	10359.91	10359.91	56691.74	56691.74	47243.12	47243.12	O	10542.6	10542.6	champus insurance	champus
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.8	7.8	champus insurance	champus
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	338.27	338.27	champus insurance	champus
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	99.29	99.29	champus insurance	champus
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	champus insurance	champus
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	232.5	232.5	champus insurance	champus
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	511.19	511.19	90.7	90.7	817.9	817.9	681.58	681.58	E	99.29	99.29	champus insurance	champus
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.5	6.5	champus insurance	champus
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	99.29	99.29	champus insurance	champus
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.6	13.6	champus insurance	champus
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.2	5.2	champus insurance	champus
Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine	cpt	63035	5299.29	5299.29	5299.29	5299.29	41623.6	41623.6	34686.33	34686.33	O	5299.29	5299.29	champus insurance	champus
MRI scan of upper spinal canal	cpt	72141	473.49	473.49	206.45	206.45	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	champus insurance	champus
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	99.29	99.29	champus insurance	champus
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	161.43	161.43	champus insurance	champus
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.87	16.87	champus insurance	champus
seizures with mcc	ms-drg	100	10932.38	10932.38	5168.61	5168.61	34160.78	34160.78	28467.32	28467.32	I	5168.61	5168.61	champus insurance	champus
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	234.68	234.68	14.94	14.94	274.75	274.75	228.96	228.96	E	234.68	234.68	champus insurance	champus
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	3377.11	3377.11	champus insurance	champus
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	83.77	83.77	champus insurance	champus
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	champus insurance	champus
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	18.47	18.47	champus insurance	champus
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	champus insurance	champus
other antepartum diagnoses without o.r. procedures without cc/mcc	ms-drg	833	4609.85	4609.85	1574.02	1574.02	9601.67	9601.67	8001.39	8001.39	I	2030	2030	champus insurance	champus
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	107.27	107.27	champus insurance	champus
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	99.29	99.29	champus insurance	champus
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.26	2.26	champus insurance	champus
peripheral vascular disorders without cc/mcc	ms-drg	301	5270.88	5270.88	3333.6	3333.6	20288.41	20288.41	16907.01	16907.01	I	3764.88	3764.88	champus insurance	champus
"Drainage of tailbone cyst, uncomplicated"	cpt	10080	738.25	738.25	738.25	738.25	1121.8	1121.8	934.83	934.83	E	738.25	738.25	champus insurance	champus
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	26.98	26.98	champus insurance	champus
peripheral vascular disorders with mcc	ms-drg	299	9368.28	9368.28	4924.74	4924.74	37040.12	37040.12	30866.77	30866.77	I	4924.74	4924.74	champus insurance	champus
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.65	88.65	champus insurance	champus
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	37.84	37.84	champus insurance	champus
"Removal of 1 or more breast growth, open procedure"	cpt	19120	3225.81	3225.81	2571.39	2571.39	17570.48	17570.48	14642.07	14642.07	O	2683.82	2683.82	champus insurance	champus
CT scan of upper spine with contrast	cpt	72126	338.27	338.27	338.27	338.27	1857.71	1857.71	1548.09	1548.09	O	338.27	338.27	champus insurance	champus
Shaving of shoulder bone using an endoscope	cpt	29826	12067.91	12067.91	2425.05	2425.05	31991.54	31991.54	26659.62	26659.62	O	2425.05	2425.05	champus insurance	champus
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.47	18.47	champus insurance	champus
"Measurement of complement (immune system proteins), antigen,"	cpt	86160	12.05	12.05	10.67	10.67	54.7	54.7	45.58	45.58	O	12.05	12.05	champus insurance	champus
Removal of one knee cartilage using an endoscope	cpt	29881	7460.54	7460.54	2274.34	2274.34	20616.25	20616.25	17180.21	17180.21	O	2425.05	2425.05	champus insurance	champus
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	70.7	70.7	champus insurance	champus
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	champus insurance	champus
heart failure and shock without cc/mcc	ms-drg	293	9035.93	9035.93	2941.69	2941.69	15739.96	15739.96	13116.63	13116.63	I	2941.69	2941.69	champus insurance	champus
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	champus insurance	champus
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	696.23	696.23	champus insurance	champus
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.2	8.2	champus insurance	champus
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	13.69	13.69	champus insurance	champus
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	8.72	8.72	champus insurance	champus
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	99.29	99.29	champus insurance	champus
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	99.29	99.29	champus insurance	champus
Insertion of device into intervertebral disc space of spine and fusion of vertebrae	cpt	22853	10542.6	10542.6	10542.6	10542.6	55458.7	55458.7	46215.58	46215.58	O	10542.6	10542.6	champus insurance	champus
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	676.71	676.71	champus insurance	champus
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	13	13	champus insurance	champus
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	99.29	99.29	champus insurance	champus
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	99.29	99.29	champus insurance	champus
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.44	13.44	champus insurance	champus
"Insertion of artificial upper spine disc, anterior approach"	cpt	22856	14208.92	14208.92	14208.92	14208.92	67805.96	67805.96	56504.97	56504.97	O	14208.92	14208.92	champus insurance	champus
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	champus insurance	champus
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.44	13.44	champus insurance	champus
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	1237.74	1237.74	champus insurance	champus
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	6706.49	6706.49	champus insurance	champus
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	99.29	99.29	champus insurance	champus
other antepartum diagnoses without o.r. procedures with cc	ms-drg	832	7684.4	7684.4	1960.72	1960.72	12643.03	12643.03	10535.86	10535.86	I	1960.72	1960.72	champus insurance	champus
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.6	10.6	champus insurance	champus
"X-ray of spine, entire middle and lower spine, 1 view"	cpt	72081	81.3	81.3	23.65	23.65	230.23	230.23	191.86	191.86	O	70.7	70.7	champus insurance	champus
Partial removal of collar bone	cpt	23120	5299.29	5299.29	5299.29	5299.29	31887.79	31887.79	26573.16	26573.16	O	5299.29	5299.29	champus insurance	champus
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	271.34	271.34	champus insurance	champus
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	238.4	238.4	champus insurance	champus
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.49	8.49	champus insurance	champus
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	18	18	champus insurance	champus
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	6.06	6.06	champus insurance	champus
Screening test for antibody to noninfectious agent	cpt	86255	12.1	12.1	8.25	8.25	94.8	94.8	79	79	O	12.1	12.1	champus insurance	champus
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	941.39	941.39	champus insurance	champus
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	6355.08	6355.08	champus insurance	champus
Open treatment of collar bone broken	cpt	23515	5299.29	5299.29	5299.29	5299.29	33572.42	33572.42	27977.02	27977.02	O	5299.29	5299.29	champus insurance	champus
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	19.78	19.78	champus insurance	champus
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	5315.78	5315.78	champus insurance	champus
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	18.66	18.66	champus insurance	champus
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.9	20.9	champus insurance	champus
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	20.9	20.9	champus insurance	champus
Open treatment of collar bone and shoulder joint dislocation	cpt	23550	5299.29	5299.29	5299.29	5299.29	47480.96	47480.96	39567.47	39567.47	O	5299.29	5299.29	champus insurance	champus
other antepartum diagnoses without o.r. procedures with mcc	ms-drg	831	8473.81	8473.81	3236.69	3236.69	13886.92	13886.92	11572.43	11572.43	I	4249.78	4249.78	champus insurance	champus
lymphoma and leukemia with major o.r. procedures without cc/mcc	ms-drg	822	18012.77	18012.77	8024.86	8024.86	29988.86	29988.86	24990.72	24990.72	I	8024.86	8024.86	champus insurance	champus
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	23.22	23.22	champus insurance	champus
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.6	13.6	champus insurance	champus
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	142.04	142.04	champus insurance	champus
Analysis for detection of tumor marker	cpt	86316	22.06	22.06	18.51	18.51	133.56	133.56	111.3	111.3	O	22.06	22.06	champus insurance	champus
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	3.29	3.29	champus insurance	champus
"Removal of foreign body from tissue, accessed beneath the skin, simple"	cpt	10120	635.65	635.65	381.98	381.98	1477.88	1477.88	1231.57	1231.57	E	381.98	381.98	champus insurance	champus
"Digoxin level, total"	cpt	80162	153.36	153.36	11.81	11.81	175.27	175.27	146.06	146.06	E	153.36	153.36	champus insurance	champus
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.43	22.43	champus insurance	champus
other antepartum diagnoses with o.r. procedures without cc/mcc	ms-drg	819	9322.89	9322.89	5314.57	5314.57	36119.1	36119.1	30099.25	30099.25	I	5314.57	5314.57	champus insurance	champus
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	135.92	135.92	champus insurance	champus
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.5	6.5	champus insurance	champus
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.47	29.47	champus insurance	champus
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	47.83	47.83	champus insurance	champus
Closed treatment of shoulder dislocation with manipulation	cpt	23650	699.2	699.2	502.67	502.67	3187.81	3187.81	2656.51	2656.51	E	502.67	502.67	champus insurance	champus
Closed treatment of shoulder dislocation with manipulation under anesthesia	cpt	23655	1200.71	1200.71	1181.5	1181.5	3146.57	3146.57	2622.14	2622.14	E	1200.71	1200.71	champus insurance	champus
"Aspiration of abscess, blood accumulation, blister, or cyst"	cpt	10160	480.9	480.9	480.9	480.9	1074.16	1074.16	895.13	895.13	E	480.9	480.9	champus insurance	champus
other vascular procedures without cc/mcc	ms-drg	254	13485.52	13485.52	10936.61	10936.61	37141.75	37141.75	30951.46	30951.46	I	10936.61	10936.61	champus insurance	champus
percutaneous cardiovascular procedures without coronary artery stent without mcc	ms-drg	251	12258.03	12258.03	7183.91	7183.91	79584.41	79584.41	66320.34	66320.34	I	12258.03	12258.03	champus insurance	champus
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	11.59	11.59	champus insurance	champus
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	5.43	5.43	champus insurance	champus
Shoulder procedure	cpt	23929	2425.05	2425.05	2425.05	2425.05	26671.7	26671.7	22226.42	22226.42	O	2425.05	2425.05	champus insurance	champus
Manipulation of elbow under anesthesia	cpt	24300	1904.67	1904.67	1200.71	1200.71	21085.42	21085.42	17571.18	17571.18	O	1200.71	1200.71	champus insurance	champus
Reinsertion of torn biceps or triceps tendon at elbow	cpt	24342	5299.29	5299.29	5299.29	5299.29	36634.48	36634.48	30528.73	30528.73	O	5299.29	5299.29	champus insurance	champus
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.17	6.17	champus insurance	champus
"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation"	cpt	11012	2054.26	2054.26	2054.26	2054.26	23211.38	23211.38	19342.82	19342.82	O	2054.26	2054.26	champus insurance	champus
red blood cell disorders without mcc	ms-drg	812	8135.51	8135.51	3725.55	3725.55	22117.79	22117.79	18431.49	18431.49	I	4194.25	4194.25	champus insurance	champus
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	14509.1	14509.1	champus insurance	champus
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.92	6.92	champus insurance	champus
Closed treatment of a break of the mid portion of upper arm bone with manipulation	cpt	24505	1200.71	1200.71	1200.71	1200.71	2667.18	2667.18	2222.65	2222.65	E	1200.71	1200.71	champus insurance	champus
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	19800.43	19800.43	champus insurance	champus
"Open treatment of broken upper arm bone, mid-portion"	cpt	24515	10542.6	10542.6	9716.73	9716.73	43848.08	43848.08	36540.07	36540.07	O	10542.6	10542.6	champus insurance	champus
Open treatment of the forearm bone on the small finger side of the forearm (Ulna bone) in the elbow region	cpt	24685	5299.29	5299.29	5214.5	5214.5	41198.6	41198.6	34332.17	34332.17	O	5299.29	5299.29	champus insurance	champus
Syphilis detection test	cpt	86592	4.77	4.77	2.99	2.99	132.29	132.29	110.24	110.24	E	4.77	4.77	champus insurance	champus
Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation	cpt	25605	1200.71	1200.71	1162.07	1162.07	3895.34	3895.34	3246.12	3246.12	E	1200.71	1200.71	champus insurance	champus
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	36449.33	36449.33	champus insurance	champus
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	3341.91	3341.91	champus insurance	champus
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	4.29	4.29	champus insurance	champus
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware	cpt	25607	16572.45	16572.45	4897.01	4897.01	36409.4	36409.4	30341.17	30341.17	O	5299.29	5299.29	champus insurance	champus
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	7750.37	7750.37	champus insurance	champus
Nuclear medicine study with CT imaging whole body	cpt	78816	2822.36	2822.36	1257.95	1257.95	8147.16	8147.16	6789.3	6789.3	O	1278.4	1278.4	champus insurance	champus
coronary bypass with ptca without mcc	ms-drg	232	40869.47	40869.47	34390.85	34390.85	214749.47	214749.47	178957.89	178957.89	I	40869.47	40869.47	champus insurance	champus
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	champus insurance	champus
Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments	cpt	25608	7889.33	7889.33	4927.02	4927.02	34718.63	34718.63	28932.19	28932.19	O	5299.29	5299.29	champus insurance	champus
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	17.1	17.1	champus insurance	champus
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	champus insurance	champus
Analysis for antibody to Cytomegalovirus (CMV)	cpt	86644	23.13	23.13	12.8	12.8	85.22	85.22	71.02	71.02	O	14.45	14.45	champus insurance	champus
Analysis for antibody (IgM) to Cytomegalovirus (CMV)	cpt	86645	21.06	21.06	14.99	14.99	77.59	77.59	64.66	64.66	O	16.92	16.92	champus insurance	champus
"Nuclear medicine study of kidney with assessment of blood flow and function, with or without drugs, multiple studies"	cpt	78709	418.12	418.12	260.45	260.45	1436.09	1436.09	1196.74	1196.74	O	418.12	418.12	champus insurance	champus
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	13.24	13.24	champus insurance	champus
"Drainage of finger abscess, uncomplicated"	cpt	26010	352.64	352.64	229.65	229.65	1309.74	1309.74	1091.45	1091.45	E	352.64	352.64	champus insurance	champus
"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study, gated equilibrium"	cpt	78472	326.12	326.12	320.9	320.9	2477.86	2477.86	2064.88	2064.88	O	326.12	326.12	champus insurance	champus
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	31797.23	31797.23	champus insurance	champus
IgE (immune system protein) level	cpt	82785	36.9	36.9	11.05	11.05	75.05	75.05	62.54	62.54	O	16.53	16.53	champus insurance	champus
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	19.43	19.43	champus insurance	champus
respiratory signs and symptoms	ms-drg	204	5762.49	5762.49	3725.66	3725.66	11897.69	11897.69	9914.74	9914.74	I	4036.69	4036.69	champus insurance	champus
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1127.01	1127.01	champus insurance	champus
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	2859.8	2859.8	champus insurance	champus
bronchitis and asthma without cc/mcc	ms-drg	203	5079.97	5079.97	2129.55	2129.55	10737.54	10737.54	8947.95	8947.95	I	3230.8	3230.8	champus insurance	champus
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	3354.09	3354.09	champus insurance	champus
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5189.12	5189.12	champus insurance	champus
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	3549.64	3549.64	champus insurance	champus
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	27.03	27.03	champus insurance	champus
pneumothorax without cc/mcc	ms-drg	201	5301.15	5301.15	2927.64	2927.64	20972.84	20972.84	17477.37	17477.37	I	2927.64	2927.64	champus insurance	champus
pneumothorax with cc	ms-drg	200	22906.66	22906.66	4418.11	4418.11	25021.14	25021.14	20850.95	20850.95	I	5017.66	5017.66	champus insurance	champus
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	10.78	10.78	champus insurance	champus
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	3186.06	3186.06	champus insurance	champus
Closed treatment of fracture of bone of hand with manipulation	cpt	26605	502.67	502.67	415.61	415.61	2849.98	2849.98	2374.98	2374.98	E	502.67	502.67	champus insurance	champus
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.73	6.73	champus insurance	champus
other o.r. procedures of the blood and blood forming organs with mcc	ms-drg	802	99018.13	99018.13	99018.13	99018.13	112642.81	112642.81	93869.01	93869.01	I	99018.13	99018.13	champus insurance	champus
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	4488.94	4488.94	champus insurance	champus
headaches without mcc	ms-drg	103	5109.57	5109.57	3174.19	3174.19	17526.64	17526.64	14605.53	14605.53	I	4381.26	4381.26	champus insurance	champus
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	champus insurance	champus
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	5253.36	5253.36	champus insurance	champus
Analysis for antibody to mumps virus	cpt	86735	27.36	27.36	11.61	11.61	53.93	53.93	44.94	44.94	O	13.1	13.1	champus insurance	champus
"Insertion of hardware to broken finger or thumb, accessed through the skin"	cpt	26756	2425.05	2425.05	2425.05	2425.05	23510.05	23510.05	19591.71	19591.71	E	2425.05	2425.05	champus insurance	champus
Closed treatment of dislocated finger joint with manipulation	cpt	26770	445.78	445.78	445.78	445.78	2172.47	2172.47	1810.39	1810.39	E	445.78	445.78	champus insurance	champus
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	6293.35	6293.35	champus insurance	champus
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	14.45	14.45	champus insurance	champus
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	326.12	326.12	champus insurance	champus
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	326.12	326.12	champus insurance	champus
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	12.93	12.93	champus insurance	champus
Injection of dye for X-ray imaging of hip joint	cpt	27093	639.83	639.83	332.86	332.86	5036.53	5036.53	4197.11	4197.11	O	639.83	639.83	champus insurance	champus
normal newborn	ms-drg	795	2082.25	2082.25	707.81	707.81	4256.4	4256.4	3547	3547	I	707.81	707.81	champus insurance	champus
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	champus insurance	champus
Injection procedure into sacroiliac joint for anesthetic or steroid	cpt	27096	1079.07	1079.07	1079.07	1079.07	4992.34	4992.34	4160.28	4160.28	O	1079.07	1079.07	champus insurance	champus
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	12.93	12.93	champus insurance	champus
Closed treatment of dislocation of knee cap	cpt	27560	584.06	584.06	293.55	293.55	2430.83	2430.83	2025.69	2025.69	E	584.06	584.06	champus insurance	champus
"Insertion of hardware to broken thigh bone, accessed through the skin"	cpt	27235	5384.14	5384.14	5384.14	5384.14	34760.02	34760.02	28966.68	28966.68	O	5384.14	5384.14	champus insurance	champus
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	6232.72	6232.72	champus insurance	champus
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	426.6	426.6	champus insurance	champus
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	3622.47	3622.47	champus insurance	champus
Removal of foreign body of thigh or knee	cpt	27372	2054.26	2054.26	2054.26	2054.26	21281.98	21281.98	17734.98	17734.98	O	2054.26	2054.26	champus insurance	champus
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.98	15.98	champus insurance	champus
Reconstruction of knee joint ligaments	cpt	27427	5299.29	5299.29	5299.29	5299.29	54557.4	54557.4	45464.5	45464.5	O	5299.29	5299.29	champus insurance	champus
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	14.33	14.33	champus insurance	champus
respiratory infections and inflammations without cc/mcc	ms-drg	179	9651.21	9651.21	3828.24	3828.24	10946.44	10946.44	9122.03	9122.03	I	3828.24	3828.24	champus insurance	champus
Exploration of ankle joint	cpt	27620	5299.29	5299.29	5299.29	5299.29	38340.77	38340.77	31950.64	31950.64	O	5299.29	5299.29	champus insurance	champus
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	3391.36	3391.36	champus insurance	champus
Lengthening of calf muscle	cpt	27687	3544.14	3544.14	2425.05	2425.05	29642.78	29642.78	24702.32	24702.32	O	2425.05	2425.05	champus insurance	champus
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	25.92	25.92	champus insurance	champus
"Repair of disrupted collateral ligament of ankle, primary"	cpt	27695	5299.29	5299.29	5299.29	5299.29	38121.77	38121.77	31768.14	31768.14	O	5299.29	5299.29	champus insurance	champus
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	122.75	122.75	champus insurance	champus
"Repair of disrupted collateral ligament of ankle, secondary"	cpt	27698	5299.29	5299.29	5299.29	5299.29	37155.17	37155.17	30962.64	30962.64	O	5299.29	5299.29	champus insurance	champus
other respiratory system o.r. procedures with cc	ms-drg	167	18925.13	18925.13	5702.35	5702.35	57441.06	57441.06	47867.55	47867.55	I	5702.35	5702.35	champus insurance	champus
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	11773.8	11773.8	champus insurance	champus
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	43.82	43.82	champus insurance	champus
Identification of red blood cell antibodies	cpt	86870	251.07	251.07	23.42	23.42	310.8	310.8	259	259	O	251.07	251.07	champus insurance	champus
cesarean section with sterilization without cc/mcc	ms-drg	785	5437.77	5437.77	3250.27	3250.27	14747.66	14747.66	12289.72	12289.72	I	4184.04	4184.04	champus insurance	champus
Treatment of broken shin bone	cpt	27759	10624.49	10624.49	10624.49	10624.49	39660.5	39660.5	33050.42	33050.42	O	10624.49	10624.49	champus insurance	champus
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	29.61	29.61	champus insurance	champus
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	209.39	209.39	champus insurance	champus
Correction of toe joint deformity	cpt	28285	5299.29	5299.29	2405.65	2405.65	34078.68	34078.68	28398.9	28398.9	O	5299.29	5299.29	champus insurance	champus
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	14423.44	14423.44	champus insurance	champus
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	96.59	96.59	champus insurance	champus
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	19.63	19.63	champus insurance	champus
major chest procedures with mcc	ms-drg	163	28721.37	28721.37	15759.84	15759.84	142219.09	142219.09	118515.91	118515.91	I	25423.48	25423.48	champus insurance	champus
dental and oral diseases with cc	ms-drg	158	9311.37	9311.37	3170.15	3170.15	23073.84	23073.84	19228.2	19228.2	I	4912.52	4912.52	champus insurance	champus
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	5248.85	5248.85	champus insurance	champus
otitis media and uri without mcc	ms-drg	153	5161.07	5161.07	1899.95	1899.95	22377.64	22377.64	18648.03	18648.03	I	3135.8	3135.8	champus insurance	champus
Open treatment of the inside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27766	5299.29	5299.29	5299.29	5299.29	28443.89	28443.89	23703.24	23703.24	O	5299.29	5299.29	champus insurance	champus
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	477.34	477.34	champus insurance	champus
Open treatment of the outer bone of the lower leg	cpt	27784	5299.29	5299.29	5299.29	5299.29	28098.41	28098.41	23415.34	23415.34	O	5299.29	5299.29	champus insurance	champus
cesarean section with sterilization with mcc	ms-drg	783	7624.57	7624.57	4760.84	4760.84	22017.84	22017.84	18348.2	18348.2	I	7624.57	7624.57	champus insurance	champus
Removal of skin and/or muscle first 20 sq cm or less	cpt	11043	440.3	440.3	433.26	433.26	2436.26	2436.26	2030.22	2030.22	O	440.3	440.3	champus insurance	champus
Open treatment of the outside prominence of bone of the leg (fibula) in the region of the ankle	cpt	27792	7125.29	7125.29	4890.06	4890.06	32793.31	32793.31	27327.76	27327.76	O	5299.29	5299.29	champus insurance	champus
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	2546.76	2546.76	champus insurance	champus
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.42	39.42	champus insurance	champus
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	9.34	9.34	champus insurance	champus
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	13118.87	13118.87	champus insurance	champus
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	296.91	296.91	champus insurance	champus
Incision of tissues of muscle compartment of foot and/or toe	cpt	28008	3179.01	3179.01	2425.05	2425.05	14330.89	14330.89	11942.41	11942.41	O	2425.05	2425.05	champus insurance	champus
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	2725.99	2725.99	champus insurance	champus
Bacterial blood culture	cpt	87040	233.73	233.73	9.18	9.18	280.48	280.48	233.73	233.73	E	233.73	233.73	champus insurance	champus
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	10.36	10.36	champus insurance	champus
Removal or scraping of bone cyst or growth of heel bone with donor bone graft	cpt	28103	5299.29	5299.29	5299.29	5299.29	22238.88	22238.88	18532.4	18532.4	O	5299.29	5299.29	champus insurance	champus
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	9.48	9.48	champus insurance	champus
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.54	51.54	champus insurance	champus
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	112.14	112.14	champus insurance	champus
"abortion with d&c, aspiration curettage or hysterotomy"	ms-drg	770	4565.54	4565.54	4253.56	4253.56	23003.7	23003.7	19169.75	19169.75	I	4253.56	4253.56	champus insurance	champus
Partial removal of foot or heel bone for bone infection in the midfoot area	cpt	28122	2425.05	2425.05	2425.05	2425.05	22013.7	22013.7	18344.75	18344.75	O	2425.05	2425.05	champus insurance	champus
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	249.39	249.39	champus insurance	champus
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	3175.22	3175.22	champus insurance	champus
Repair of foot tendon on the sole of the foot without a graft	cpt	28200	2425.05	2425.05	2425.05	2425.05	22256.16	22256.16	18546.8	18546.8	O	2425.05	2425.05	champus insurance	champus
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	22.32	22.32	champus insurance	champus
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	991.98	991.98	champus insurance	champus
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1952.13	1952.13	champus insurance	champus
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.48	9.48	champus insurance	champus
Correction of bunion with removal of the base of the great toe	cpt	28292	3561.38	3561.38	2425.05	2425.05	37116.88	37116.88	30930.73	30930.73	O	2425.05	2425.05	champus insurance	champus
"Correction of bunion, with alignment correction of midfoot bone (metatarsal) towards toe areas"	cpt	28296	5299.29	5299.29	2425.05	2425.05	21810.48	21810.48	18175.4	18175.4	O	5299.29	5299.29	champus insurance	champus
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6856.49	6856.49	champus insurance	champus
Amputation of toe and midfoot bone	cpt	28810	2425.05	2425.05	2386.25	2386.25	18552.49	18552.49	15460.41	15460.41	O	2425.05	2425.05	champus insurance	champus
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	311.64	311.64	138.5	138.5	1779.53	1779.53	1482.94	1482.94	E	254.75	254.75	champus insurance	champus
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	6.54	6.54	champus insurance	champus
"Application of non-moveable, hinged finger splint"	cpt	29130	197.85	197.85	197.85	197.85	1704.72	1704.72	1420.6	1420.6	E	197.85	197.85	champus insurance	champus
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	8.66	8.66	champus insurance	champus
Application of short leg splint (calf to foot)	cpt	29515	402.03	402.03	239.29	239.29	1787.76	1787.76	1489.8	1489.8	E	316.33	316.33	champus insurance	champus
Incision of should joint capsule using an endoscope	cpt	29806	5299.29	5299.29	5299.29	5299.29	40696.28	40696.28	33913.57	33913.57	O	5299.29	5299.29	champus insurance	champus
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.32	27.32	champus insurance	champus
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	9.51	9.51	champus insurance	champus
Bacterial culture for anaerobic isolates	cpt	87076	8.11	8.11	7.19	7.19	103.92	103.92	86.6	86.6	O	8.11	8.11	champus insurance	champus
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	champus insurance	champus
Repair of shoulder socket cartilage using an endoscope	cpt	29807	5299.29	5299.29	5299.29	5299.29	41843.26	41843.26	34869.38	34869.38	O	5299.29	5299.29	champus insurance	champus
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	14.76	14.76	champus insurance	champus
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	2425.05	2425.05	champus insurance	champus
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.11	8.11	champus insurance	champus
inflammation of the male reproductive system without mcc	ms-drg	728	6665.67	6665.67	2407.15	2407.15	11957.9	11957.9	9964.92	9964.92	I	2407.15	2407.15	champus insurance	champus
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	2425.05	2425.05	champus insurance	champus
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	5299.29	5299.29	champus insurance	champus
Release or removal of shoulder scar tissue using an endoscope	cpt	29825	5550.48	5550.48	2405.65	2405.65	31991.54	31991.54	26659.62	26659.62	O	2425.05	2425.05	champus insurance	champus
Cardiac valve and other major cardiothoracic procedures	ms-drg	216	57813.21	57813.21	57090.86	57090.86	223866.24	223866.24	186555.2	186555.2	I	57090.86	57090.86	champus insurance	champus
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	5299.29	5299.29	champus insurance	champus
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	21.3	21.3	champus insurance	champus
Release of shoulder biceps tendon using an endoscope	cpt	29828	6466.87	6466.87	5299.29	5299.29	38752.94	38752.94	32294.12	32294.12	O	5299.29	5299.29	champus insurance	champus
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	6.66	6.66	champus insurance	champus
Removal of loose or foreign body of knee joint using an endoscope	cpt	29874	2425.05	2425.05	2425.05	2425.05	20644.62	20644.62	17203.85	17203.85	O	2425.05	2425.05	champus insurance	champus
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	12.63	12.63	champus insurance	champus
Partial removal of knee joint lining using an endoscope	cpt	29875	5454.29	5454.29	3862.17	3862.17	24288.23	24288.23	20240.19	20240.19	O	3862.17	3862.17	champus insurance	champus
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	champus insurance	champus
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	2425.05	2425.05	champus insurance	champus
Repair of knee joint with drilling and or scraping of the joint	cpt	29879	2425.05	2425.05	2425.05	2425.05	19707.74	19707.74	16423.12	16423.12	O	2425.05	2425.05	champus insurance	champus
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	champus insurance	champus
Repair of inside OR outside knee joint cartilage (meniscus) using an endoscope (arthroscopy)	cpt	29882	10542.6	10542.6	2386.25	2386.25	33847.09	33847.09	28205.91	28205.91	O	10542.6	10542.6	champus insurance	champus
Repair of anterior cruciate ligament of knee with assistance of an endoscope	cpt	29888	5299.29	5299.29	4948.03	4948.03	52105.64	52105.64	43421.37	43421.37	O	5299.29	5299.29	champus insurance	champus
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	316.47	316.47	champus insurance	champus
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.1	8.1	champus insurance	champus
Removal of dead or infected ankle joint tissue using an endoscope	cpt	29898	5299.29	5299.29	5299.29	5299.29	42780.92	42780.92	35650.77	35650.77	O	5299.29	5299.29	champus insurance	champus
"Removal of polyps in nose, extensive or complex"	cpt	30115	7551.65	7551.65	4819.51	4819.51	49945.48	49945.48	41621.23	41621.23	O	4819.51	4819.51	champus insurance	champus
Nasal procedure	cpt	30999	4819.51	4819.51	4819.51	4819.51	47279.42	47279.42	39399.52	39399.52	O	4819.51	4819.51	champus insurance	champus
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	41.45	41.45	champus insurance	champus
Partial removal of nasal sinus using an endoscope	cpt	31254	6790.97	6790.97	4819.51	4819.51	43785.56	43785.56	36487.97	36487.97	O	4819.51	4819.51	champus insurance	champus
Culture for acid-fast bacilli	cpt	87116	10.84	10.84	9.61	9.61	122.11	122.11	101.76	101.76	O	10.84	10.84	champus insurance	champus
"Removal of nasal sinus tissue using an endoscope, maxillary sinus"	cpt	31267	6790.97	6790.97	4819.51	4819.51	34277.41	34277.41	28564.51	28564.51	O	4819.51	4819.51	champus insurance	champus
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	2333.86	2333.86	champus insurance	champus
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.2	5.2	champus insurance	champus
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1409.82	1409.82	champus insurance	champus
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1103.22	1103.22	champus insurance	champus
"Removal of fluid from between lung and chest cavity, open procedure"	cpt	32551	1444.99	1444.99	1444.99	1444.99	3324.37	3324.37	2770.31	2770.31	E	1444.99	1444.99	champus insurance	champus
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	22360.86	22360.86	champus insurance	champus
"Insertion of catheter into abdominal pelvic or leg artery, each first order branch"	cpt	36245	2455.02	2455.02	125.31	125.31	25382.86	25382.86	21152.38	21152.38	O	2455.02	2455.02	champus insurance	champus
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1215.96	1215.96	champus insurance	champus
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	474.41	474.41	champus insurance	champus
amniotic membrane	cpt	V2790	1714.35	1714.35	1714.35	1714.35	20400.06	20400.06	17000.05	17000.05	O	1714.35	1714.35	champus insurance	champus
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	8.94	8.94	champus insurance	champus
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	179.27	179.27	champus insurance	champus
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	1791.13	1791.13	champus insurance	champus
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	7443.75	7443.75	champus insurance	champus
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	4.77	4.77	champus insurance	champus
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	224.29	224.29	champus insurance	champus
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	99.29	99.29	champus insurance	champus
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	1791.13	1791.13	champus insurance	champus
major male pelvic procedures with cc/mcc	ms-drg	707	13215.8	13215.8	10639.1	10639.1	62125.99	62125.99	51771.66	51771.66	I	12596.93	12596.93	champus insurance	champus
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.69	8.69	champus insurance	champus
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	4282.09	4282.09	champus insurance	champus
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1103.22	1103.22	champus insurance	champus
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	3619.14	3619.14	champus insurance	champus
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	3661.72	3661.72	champus insurance	champus
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	2683.82	2683.82	champus insurance	champus
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.29	4.29	champus insurance	champus
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	70.7	70.7	champus insurance	champus
Special stain for inclusion bodies or parasites	cpt	87207	6.01	6.01	6.01	6.01	19.98	19.98	16.65	16.65	O	6.01	6.01	champus insurance	champus
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	8777.72	8777.72	1362.44	1362.44	45290.62	45290.62	37742.18	37742.18	O	8777.72	8777.72	champus insurance	champus
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	14120.9	14120.9	8777.72	8777.72	75967.02	75967.02	63305.85	63305.85	E	8791.16	8791.16	champus insurance	champus
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	285.09	285.09	champus insurance	champus
"hocm 250-299mg/ml iodine,1ml"	cpt	Q9961	206.45	206.45	206.45	206.45	3408.2	3408.2	2840.17	2840.17	O	206.45	206.45	champus insurance	champus
"hocm <=149 mg/ml iodine, 1ml"	cpt	Q9958	309.68	309.68	206.45	206.45	2947.64	2947.64	2456.37	2456.37	O	206.45	206.45	champus insurance	champus
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.76	4.76	champus insurance	champus
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	34	34	champus insurance	champus
urinary stones without mcc	ms-drg	694	5014.21	5014.21	2963.72	2963.72	12824.16	12824.16	10686.8	10686.8	I	3248.11	3248.11	champus insurance	champus
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	812.68	812.68	champus insurance	champus
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	12.03	12.03	champus insurance	champus
grafix stravix prime pl sqcm	cpt	Q4133	1523.14	1523.14	1437.55	1437.55	6559.3	6559.3	5466.08	5466.08	O	1523.14	1523.14	champus insurance	champus
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	18.13	18.13	champus insurance	champus
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	champus insurance	champus
"albumin (human), 5%, 250 ml"	cpt	P9045	10542.6	10542.6	2181.31	2181.31	30719.15	30719.15	25599.29	25599.29	O	10542.6	10542.6	champus insurance	champus
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	10882.61	10882.61	champus insurance	champus
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	408.55	408.55	champus insurance	champus
plasma 1 donor frz w/in 8 hr	cpt	P9017	2415.74	2415.74	1444.99	1444.99	27667.37	27667.37	23056.14	23056.14	O	1444.99	1444.99	champus insurance	champus
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	979.86	979.86	champus insurance	champus
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	champus insurance	champus
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	champus insurance	champus
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	112.14	112.14	champus insurance	champus
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	champus insurance	champus
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.37	10.37	champus insurance	champus
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	98.51	98.51	champus insurance	champus
so acro/clav can web pre ots	cpt	L3670	16498.51	16498.51	5299.29	5299.29	37379.68	37379.68	31149.73	31149.73	O	5299.29	5299.29	champus insurance	champus
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1444.99	1444.99	champus insurance	champus
so 8 ab rstr can/web pre ots	cpt	L3660	9596.97	9596.97	4859.91	4859.91	40126.92	40126.92	33439.1	33439.1	O	5299.29	5299.29	champus insurance	champus
"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11422	1215.96	1215.96	1196.5	1196.5	16080.52	16080.52	13400.43	13400.43	O	1215.96	1215.96	champus insurance	champus
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	3565.19	3565.19	champus insurance	champus
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	24.18	24.18	champus insurance	champus
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	99.29	99.29	champus insurance	champus
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	102.7	102.7	champus insurance	champus
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	6312.25	6312.25	champus insurance	champus
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	12.03	12.03	champus insurance	champus
Injection of chemical agent into multiple incompetent veins of one leg	cpt	36471	12086.89	12086.89	240.32	240.32	499.13	499.13	415.94	415.94	O	2455.02	2455.02	champus insurance	champus
ko adj jnt pos r sup pre ots	cpt	L1833	5299.29	5299.29	4915.71	4915.71	41050.93	41050.93	34209.11	34209.11	O	5299.29	5299.29	champus insurance	champus
cerv flex n/adj foam pre ots	cpt	L0120	10542.6	10542.6	10359.91	10359.91	55458.7	55458.7	46215.58	46215.58	O	10542.6	10542.6	champus insurance	champus
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	1752.77	1752.77	champus insurance	champus
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	2455.02	2455.02	champus insurance	champus
vincristine sulfate 1 mg inj	cpt	J9370	11286.59	11286.59	9665.8	9665.8	53792.88	53792.88	44827.4	44827.4	O	11286.59	11286.59	champus insurance	champus
vinblastine sulfate inj	cpt	J9360	10076.53	10076.53	758.2	758.2	5234.28	5234.28	4361.9	4361.9	O	758.2	758.2	champus insurance	champus
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	champus insurance	champus
inj trastuzumab excl biosimi	cpt	J9355	11920.99	11920.99	4839.22	4839.22	26839.2	26839.2	22366	22366	O	10425.7	10425.7	champus insurance	champus
"injection, pertuzumab, 1 mg"	cpt	J9306	23772.44	23772.44	10140.03	10140.03	46463.62	46463.62	38719.68	38719.68	O	10425.7	10425.7	champus insurance	champus
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	champus insurance	champus
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.13	20.13	champus insurance	champus
Analysis using chemiluminescent technique (light and chemical )reaction	cpt	82397	14.18	14.18	6.55	6.55	58.19	58.19	48.49	48.49	O	14.18	14.18	champus insurance	champus
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	8001.63	8001.63	champus insurance	champus
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	127.01	127.01	champus insurance	champus
obinutuzumab inj	cpt	J9301	11286.59	11286.59	5283.13	5283.13	28931.02	28931.02	24109.18	24109.18	O	11286.59	11286.59	champus insurance	champus
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	2981.53	2981.53	champus insurance	champus
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.23	35.23	champus insurance	champus
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	508.17	508.17	champus insurance	champus
splenectomy without cc/mcc	ms-drg	801	7704.58	7704.58	7704.58	7704.58	46856.75	46856.75	39047.29	39047.29	I	7704.58	7704.58	champus insurance	champus
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	938.77	938.77	champus insurance	champus
methotrexate sodium inj	cpt	J9260	1952.13	1952.13	529.47	529.47	5076.19	5076.19	4230.16	4230.16	E	1952.13	1952.13	champus insurance	champus
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.65	14.65	champus insurance	champus
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.42	37.42	champus insurance	champus
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	751.73	751.73	champus insurance	champus
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	8573.35	8573.35	champus insurance	champus
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	341.79	341.79	champus insurance	champus
Carcinoembryonic antigen (CEA) protein level	cpt	82378	34.13	34.13	16.86	16.86	137.4	137.4	114.5	114.5	O	19.04	19.04	champus insurance	champus
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	1891.86	1891.86	champus insurance	champus
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	1409.82	1409.82	champus insurance	champus
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	8184.57	8184.57	champus insurance	champus
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	1391.91	1391.91	champus insurance	champus
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	146.68	146.68	champus insurance	champus
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	638.4	638.4	champus insurance	champus
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	20.95	20.95	champus insurance	champus
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1409.82	1409.82	champus insurance	champus
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	99.29	99.29	champus insurance	champus
dacarbazine 100 mg inj	cpt	J9130	810.71	810.71	758.2	758.2	5234.28	5234.28	4361.9	4361.9	O	758.2	758.2	champus insurance	champus
"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11423	2631.83	2631.83	1215.96	1215.96	17605.97	17605.97	14671.64	14671.64	O	1215.96	1215.96	champus insurance	champus
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.13	20.13	champus insurance	champus
"Ultrasound of pelvis, limited, not pregnancy related"	cpt	76857	272.6	272.6	58.94	58.94	190.8	190.8	159	159	O	272.6	272.6	champus insurance	champus
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	11286.59	11286.59	champus insurance	champus
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	7923.09	7923.09	champus insurance	champus
cetuximab injection	cpt	J9055	5439.13	5439.13	2730.38	2730.38	16940.5	16940.5	14117.08	14117.08	O	4311.72	4311.72	champus insurance	champus
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	2981.53	2981.53	champus insurance	champus
brentuximab vedotin inj	cpt	J9042	28140.84	28140.84	25901.14	25901.14	105462.79	105462.79	87885.66	87885.66	O	25901.14	25901.14	champus insurance	champus
bleomycin sulfate injection	cpt	J9040	851.54	851.54	791.36	791.36	5362.75	5362.75	4468.96	4468.96	O	791.36	791.36	champus insurance	champus
renal failure without cc/mcc	ms-drg	684	10924.55	10924.55	3036.64	3036.64	15925.09	15925.09	13270.91	13270.91	I	3036.64	3036.64	champus insurance	champus
"Ultrasound of pelvis, complete, not pregnancy related"	cpt	76856	99.29	99.29	63.46	63.46	703.42	703.42	586.18	586.18	E	99.29	99.29	champus insurance	champus
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	8590.23	8590.23	champus insurance	champus
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	2455.02	2455.02	champus insurance	champus
doxorubicin hcl injection	cpt	J9000	10076.53	10076.53	758.2	758.2	29950.2	29950.2	24958.5	24958.5	O	758.2	758.2	champus insurance	champus
"Detection test by nucleic acid for HIV-1 virus, quantification"	cpt	87536	489.72	489.72	75.7	75.7	559.68	559.68	466.4	466.4	O	94.94	94.94	champus insurance	champus
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	99.29	99.29	champus insurance	champus
"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37226	14007.94	14007.94	8097.07	8097.07	92080.52	92080.52	76733.77	76733.77	O	8777.72	8777.72	champus insurance	champus
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	268.55	268.55	champus insurance	champus
5% dextrose in lac ringers	cpt	J7121	6073.23	6073.23	478.56	478.56	3035.82	3035.82	2529.85	2529.85	E	482.86	482.86	champus insurance	champus
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	553.72	553.72	champus insurance	champus
"Removal of skin and tissue beneath the skin of underarms for excessive sweating, simple"	cpt	11450	2054.26	2054.26	2054.26	2054.26	20861.16	20861.16	17384.3	17384.3	O	2054.26	2054.26	champus insurance	champus
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.23	35.23	champus insurance	champus
Ultrasound and monitoring of heart of fetus	cpt	76818	456.54	456.54	99.29	99.29	928.56	928.56	773.8	773.8	O	99.29	99.29	champus insurance	champus
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	99.29	99.29	champus insurance	champus
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	612.63	612.63	champus insurance	champus
d5w infusion	cpt	J7070	3105.49	3105.49	210.36	210.36	7339.42	7339.42	6116.18	6116.18	O	3105.49	3105.49	champus insurance	champus
d5w infusion	cpt	J7070	3598.87	3598.87	589.26	589.26	12422.94	12422.94	10352.45	10352.45	E	3598.87	3598.87	champus insurance	champus
normal saline solution infus	cpt	J7050	1660.16	1660.16	196.53	196.53	3827.75	3827.75	3189.79	3189.79	O	196.53	196.53	champus insurance	champus
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	4316.65	4316.65	champus insurance	champus
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	39.15	39.15	champus insurance	champus
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	630.41	630.41	champus insurance	champus
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	4282.09	4282.09	champus insurance	champus
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	696.23	696.23	champus insurance	champus
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1200.71	1200.71	champus insurance	champus
Procalcitonin (hormone) level	cpt	84145	87.98	87.98	24.21	24.21	105.58	105.58	87.98	87.98	E	87.98	87.98	champus insurance	champus
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	35.23	35.23	champus insurance	champus
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	4639.61	4639.61	champus insurance	champus
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	2779.76	2779.76	champus insurance	champus
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	39.15	39.15	champus insurance	champus
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	578.87	578.87	champus insurance	champus
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	2683.82	2683.82	champus insurance	champus
Open biopsy or excision of lymph nodes in groin	cpt	38531	2683.82	2683.82	2640.88	2640.88	19339.18	19339.18	16115.98	16115.98	O	2683.82	2683.82	champus insurance	champus
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	99.29	99.29	champus insurance	champus
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	99.29	99.29	champus insurance	champus
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	7923.09	7923.09	champus insurance	champus
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	326.12	326.12	champus insurance	champus
inj potassium chloride	cpt	J3480	1971.24	1971.24	725.65	725.65	15041.03	15041.03	12534.19	12534.19	E	1952.13	1952.13	champus insurance	champus
Separation of single nail plate from nail bed	cpt	11730	251.42	251.42	197.85	197.85	1029.65	1029.65	858.04	858.04	E	197.85	197.85	champus insurance	champus
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	1524.42	1524.42	champus insurance	champus
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.13	20.13	champus insurance	champus
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	37.19	37.19	champus insurance	champus
Carboxyhemoglobin (protein) level	cpt	82375	98.58	98.58	10.96	10.96	118.3	118.3	98.58	98.58	E	98.58	98.58	champus insurance	champus
Relocation of mouth tissue to gum surface	cpt	41899	180.4	180.4	0.99	0.99	15461.33	15461.33	12884.44	12884.44	O	180.4	180.4	champus insurance	champus
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	1515.9	1515.9	champus insurance	champus
other kidney and urinary tract procedures with cc	ms-drg	674	19025.41	19025.41	12967.56	12967.56	50807.44	50807.44	42339.53	42339.53	I	12967.56	12967.56	champus insurance	champus
vitamin k phytonadione inj	cpt	J3430	4902.1	4902.1	1444.99	1444.99	24968.99	24968.99	20807.49	20807.49	O	1444.99	1444.99	champus insurance	champus
other kidney and urinary tract procedures with mcc	ms-drg	673	28002.28	28002.28	19960.91	19960.91	92745.01	92745.01	77287.51	77287.51	I	28002.28	28002.28	champus insurance	champus
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	99.29	99.29	champus insurance	champus
"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43247	1508.74	1508.74	1078.57	1078.57	5734.02	5734.02	4778.35	4778.35	E	1508.74	1508.74	champus insurance	champus
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	102.7	102.7	champus insurance	champus
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	28.14	28.14	champus insurance	champus
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	39.34	39.34	champus insurance	champus
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	508.17	508.17	champus insurance	champus
hydroxyzine hcl injection	cpt	J3410	466.82	466.82	233.2	233.2	1913.71	1913.71	1594.76	1594.76	E	233.2	233.2	champus insurance	champus
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	1044.35	1044.35	champus insurance	champus
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	3862.17	3862.17	champus insurance	champus
diazepam injection	cpt	J3360	3915.09	3915.09	53.57	53.57	9478.99	9478.99	7899.16	7899.16	O	53.57	53.57	champus insurance	champus
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	champus insurance	champus
triamcinolone acet inj nos	cpt	J3301	4701.08	4701.08	231.9	231.9	774.72	774.72	645.6	645.6	O	231.9	231.9	champus insurance	champus
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	255.2	255.2	61.35	61.35	408.31	408.31	340.26	340.26	E	99.29	99.29	champus insurance	champus
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	14120.9	14120.9	champus insurance	champus
tirofiban hcl	cpt	J3246	13879.76	13879.76	8791.16	8791.16	92266.52	92266.52	76888.77	76888.77	E	8791.16	8791.16	champus insurance	champus
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	19.46	19.46	champus insurance	champus
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	7453.01	7453.01	champus insurance	champus
chlorpromazine hcl injection	cpt	J3230	644.4	644.4	197.85	197.85	2857.18	2857.18	2380.98	2380.98	E	197.85	197.85	champus insurance	champus
Repair of hernia of muscle at esophagus and stomach using an endoscope	cpt	43281	7453.01	7453.01	7332.11	7332.11	41985.52	41985.52	34987.93	34987.93	O	7453.01	7453.01	champus insurance	champus
kidney and ureter procedures for non-neoplasm without cc/mcc	ms-drg	661	24215.64	24215.64	5983.11	5983.11	43738.31	43738.31	36448.59	36448.59	I	6870.84	6870.84	champus insurance	champus
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.69	3.69	champus insurance	champus
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	2674.06	2674.06	champus insurance	champus
Removal of appendix using an endoscope	cpt	44970	21270.9	21270.9	4222.64	4222.64	35680.25	35680.25	29733.54	29733.54	E	4282.09	4282.09	champus insurance	champus
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	1088.96	1088.96	champus insurance	champus
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	43.82	43.82	champus insurance	champus
Removal of appendix using an endoscope	cpt	44970	4282.09	4282.09	4133.64	4133.64	38493.3	38493.3	32077.75	32077.75	O	4282.09	4282.09	champus insurance	champus
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	196.53	196.53	champus insurance	champus
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	676.71	676.71	champus insurance	champus
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	394.38	394.38	champus insurance	champus
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1952.13	1952.13	champus insurance	champus
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	99.29	99.29	champus insurance	champus
na ferric gluconate complex	cpt	J2916	2415.74	2415.74	1952.13	1952.13	18008.15	18008.15	15006.79	15006.79	E	1952.13	1952.13	champus insurance	champus
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.18	5.18	champus insurance	champus
Removal of nail	cpt	11750	594.69	594.69	480.9	480.9	1124.98	1124.98	937.48	937.48	E	480.9	480.9	champus insurance	champus
Rabies immune globulin for injection beneath the skin and/or into muscle	cpt	90375	4276.88	4276.88	368.14	368.14	9260.98	9260.98	7717.48	7717.48	E	4276.88	4276.88	champus insurance	champus
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	champus insurance	champus
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1334.43	1334.43	champus insurance	champus
ropivacaine hcl injection	cpt	J2795	7567.25	7567.25	4940.62	4940.62	35964.18	35964.18	29970.15	29970.15	O	5299.29	5299.29	champus insurance	champus
rho d immune globulin inj	cpt	J2790	581.2	581.2	361.29	361.29	3862.79	3862.79	3218.99	3218.99	E	361.29	361.29	champus insurance	champus
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	70.7	70.7	champus insurance	champus
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1127.01	1127.01	champus insurance	champus
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	18.87	18.87	champus insurance	champus
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5135.56	5135.56	champus insurance	champus
"alcohol, drug abuse or dependence without rehabilitation therapy with mcc"	ms-drg	896	14293.05	14293.05	6299.39	6299.39	44680.85	44680.85	37234.04	37234.04	I	6514.56	6514.56	champus insurance	champus
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	3.69	3.69	champus insurance	champus
"Drainage of rectal abscess, superficial, surrounding the anus"	cpt	46050	874.56	874.56	798.85	798.85	1153.27	1153.27	961.06	961.06	E	874.56	874.56	champus insurance	champus
"alcohol, drug abuse or dependence, left ama"	ms-drg	894	1890.8	1890.8	1818.6	1818.6	16920.46	16920.46	14100.38	14100.38	I	1890.8	1890.8	champus insurance	champus
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.57	1965.57	champus insurance	champus
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	6.15	6.15	champus insurance	champus
kidney and ureter procedures for neoplasm with cc	ms-drg	657	19461.2	19461.2	11797.09	11797.09	55709.35	55709.35	46424.46	46424.46	I	13552.29	13552.29	champus insurance	champus
ranitidine hydrochloride inj	cpt	J2780	562.1	562.1	451.28	451.28	2485.64	2485.64	2071.37	2071.37	E	451.28	451.28	champus insurance	champus
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	7.98	7.98	champus insurance	champus
"Semen evaluation volume, sperm count, motility and analysis"	cpt	89320	127.99	127.99	12.36	12.36	146.28	146.28	121.9	121.9	O	12.36	12.36	champus insurance	champus
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	38.66	38.66	champus insurance	champus
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	222.96	222.96	champus insurance	champus
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	2425.05	2425.05	champus insurance	champus
Removal of external hemorrhoids by rubber banding	cpt	46221	17972.06	17972.06	676.71	676.71	5123.33	5123.33	4269.44	4269.44	O	676.71	676.71	champus insurance	champus
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	1113.96	1113.96	champus insurance	champus
Administration of vaccine	cpt	90472	4295.94	4295.94	368.14	368.14	10250.63	10250.63	8542.19	8542.19	E	4083.29	4083.29	champus insurance	champus
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	575.69	575.69	champus insurance	champus
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	champus insurance	champus
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	1842.42	1842.42	champus insurance	champus
inj protamine sulfate/10 mg	cpt	J2720	1523.14	1523.14	1523.14	1523.14	27765.84	27765.84	23138.2	23138.2	O	1523.14	1523.14	champus insurance	champus
Vaccine for rabies injection into skin	cpt	90676	4295.94	4295.94	229.65	229.65	1669.33	1669.33	1391.11	1391.11	E	425.38	425.38	champus insurance	champus
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	2010.24	2010.24	617.1	617.1	19339.78	19339.78	16116.48	16116.48	E	2010.24	2010.24	champus insurance	champus
Removal of single external and internal hemorrhoid group	cpt	46255	2076.66	2076.66	1557.5	1557.5	16490.1	16490.1	13741.75	13741.75	O	1557.5	1557.5	champus insurance	champus
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	11116.59	11116.59	champus insurance	champus
Repair of finger or toe nail bed	cpt	11760	2054.26	2054.26	1110.7	1110.7	19051.34	19051.34	15876.12	15876.12	O	2054.26	2054.26	champus insurance	champus
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	4282.09	4282.09	champus insurance	champus
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	222.96	222.96	champus insurance	champus
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.78	10.78	champus insurance	champus
neostigmine methylslfte inj	cpt	J2710	21270.9	21270.9	4044.95	4044.95	34866.31	34866.31	29055.26	29055.26	E	4282.09	4282.09	champus insurance	champus
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	1052.97	1052.97	champus insurance	champus
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.9	17.9	champus insurance	champus
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	304.08	304.08	143.86	143.86	1881.6	1881.6	1568	1568	O	230.49	230.49	champus insurance	champus
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2455.02	2455.02	champus insurance	champus
Evaluation of speech sound production with evaluation of language comprehension and expression	cpt	92523	2123.04	2123.04	1479.91	1479.91	16598.95	16598.95	13832.46	13832.46	E	1967.07	1967.07	champus insurance	champus
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	28.22	28.22	champus insurance	champus
Evaluation of speech sound production with evaluation of language comprehension and expression	cpt	92523	294	294	71.93	71.93	1205.17	1205.17	1004.31	1004.31	O	266.76	266.76	champus insurance	champus
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	3863.46	3863.46	champus insurance	champus
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	197.85	197.85	champus insurance	champus
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2136.63	2136.63	champus insurance	champus
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1569.38	1569.38	champus insurance	champus
Serotonin (hormone) level	cpt	84260	31.11	31.11	30.98	30.98	253.13	253.13	210.94	210.94	O	31.11	31.11	champus insurance	champus
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7102.03	7102.03	champus insurance	champus
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	250.66	250.66	champus insurance	champus
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	28.05	28.05	champus insurance	champus
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	4743.96	4743.96	champus insurance	champus
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14000.33	14000.33	8792.66	8792.66	92266.52	92266.52	76888.77	76888.77	E	8792.66	8792.66	champus insurance	champus
diabetes without cc/mcc	ms-drg	639	6905	6905	2716.05	2716.05	25004.18	25004.18	20836.82	20836.82	I	2760.03	2760.03	champus insurance	champus
Radiological supervision and interpretation X-ray of uterine tubes and ovaries	cpt	74740	206.45	206.45	206.45	206.45	1211.23	1211.23	1009.36	1009.36	O	206.45	206.45	champus insurance	champus
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	14120.9	14120.9	champus insurance	champus
"Radiological supervision and interpretation X-ray of urinary bladder and urethra, emptying"	cpt	74455	206.45	206.45	62.56	62.56	1086.29	1086.29	905.24	905.24	O	206.45	206.45	champus insurance	champus
"Ultrasound evaluation of heart blood vessel or graft, each additional vessel"	cpt	92979	14120.9	14120.9	172.42	172.42	114856.13	114856.13	95713.44	95713.44	O	14120.9	14120.9	champus insurance	champus
Attempt to restart heart and lungs	cpt	92950	2333.86	2333.86	671.16	671.16	3861.56	3861.56	3217.97	3217.97	E	2333.86	2333.86	champus insurance	champus
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.75	9.75	champus insurance	champus
Imaging of urinary tract using infusion technique with kidney section filming	cpt	74415	161.43	161.43	160.14	160.14	1024.8	1024.8	854	854	O	161.43	161.43	champus insurance	champus
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	475.24	475.24	champus insurance	champus
Chemical analysis using spectrophotometry (light)	cpt	84311	8.13	8.13	7.2	7.2	24.3	24.3	20.25	20.25	O	8.13	8.13	champus insurance	champus
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	311.64	311.64	champus insurance	champus
Removal of multiple internal and external hemorrhoid groups	cpt	46260	2076.66	2076.66	1955.05	1955.05	18954.95	18954.95	15795.79	15795.79	O	2076.66	2076.66	champus insurance	champus
"Repair of abnormal anal drainage tract, under the skin"	cpt	46270	2076.66	2076.66	2076.66	2076.66	17699.64	17699.64	14749.7	14749.7	O	2076.66	2076.66	champus insurance	champus
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	2333.86	2333.86	champus insurance	champus
piperacillin/tazobactam	cpt	J2543	4282.09	4282.09	389.58	389.58	13027.27	13027.27	10856.06	10856.06	O	4282.09	4282.09	champus insurance	champus
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	33.44	33.44	cigna	ppo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	33.44	33.44	cigna	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	33.44	33.44	cigna	pos
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	33.44	33.44	cigna	epo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1815.3	1815.3	cigna	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1815.3	1815.3	cigna	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1815.3	1815.3	cigna	pos
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1815.3	1815.3	cigna	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	7986.58	7986.58	cigna	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	7986.58	7986.58	cigna	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	7986.58	7986.58	cigna	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	7986.58	7986.58	cigna	epo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	692.28	692.28	cigna	ppo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	692.28	692.28	cigna	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	692.28	692.28	cigna	pos
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	692.28	692.28	cigna	epo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	21270.9	21270.9	cigna	ppo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	21270.9	21270.9	cigna	hmo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	21270.9	21270.9	cigna	pos
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	21270.9	21270.9	cigna	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	104.77	104.77	cigna	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	104.77	104.77	cigna	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	104.77	104.77	cigna	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	104.77	104.77	cigna	epo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	34704.54	34704.54	cigna	ppo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	34704.54	34704.54	cigna	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	34704.54	34704.54	cigna	pos
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	34704.54	34704.54	cigna	epo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	19270.59	19270.59	cigna	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	19270.59	19270.59	cigna	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	19270.59	19270.59	cigna	pos
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	19270.59	19270.59	cigna	epo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4844.02	4844.02	cigna	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4844.02	4844.02	cigna	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4844.02	4844.02	cigna	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4844.02	4844.02	cigna	epo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1623.33	1623.33	cigna	ppo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1623.33	1623.33	cigna	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1623.33	1623.33	cigna	pos
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1623.33	1623.33	cigna	epo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4844.02	4844.02	cigna	ppo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4844.02	4844.02	cigna	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4844.02	4844.02	cigna	pos
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4844.02	4844.02	cigna	epo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.78	26.78	cigna	ppo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.78	26.78	cigna	hmo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.78	26.78	cigna	pos
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	26.78	26.78	cigna	epo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15331.93	15331.93	cigna	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15331.93	15331.93	cigna	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15331.93	15331.93	cigna	pos
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15331.93	15331.93	cigna	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	81.95	81.95	cigna	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	81.95	81.95	cigna	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	81.95	81.95	cigna	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	81.95	81.95	cigna	epo
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	21270.9	21270.9	cigna	ppo
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	21270.9	21270.9	cigna	hmo
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	21270.9	21270.9	cigna	pos
"inj, propofol, 10 mg"	cpt	J2704	21270.9	21270.9	1218.97	1218.97	23712.79	23712.79	19760.66	19760.66	E	21270.9	21270.9	cigna	epo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	4844.02	4844.02	cigna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	4844.02	4844.02	cigna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	4844.02	4844.02	cigna	pos
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	4844.02	4844.02	cigna	epo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	63.9	63.9	cigna	ppo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	63.9	63.9	cigna	hmo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	63.9	63.9	cigna	pos
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	63.9	63.9	cigna	epo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	44.96	44.96	cigna	ppo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	44.96	44.96	cigna	hmo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	44.96	44.96	cigna	pos
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	44.96	44.96	cigna	epo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	4844.02	4844.02	cigna	ppo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	4844.02	4844.02	cigna	hmo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	4844.02	4844.02	cigna	pos
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	4844.02	4844.02	cigna	epo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	315.06	315.06	cigna	ppo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	315.06	315.06	cigna	hmo
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	315.06	315.06	cigna	pos
X-ray of upper digestive tract with single contrast and multiple serial films	cpt	74250	315.06	315.06	75.49	75.49	539.33	539.33	449.44	449.44	O	315.06	315.06	cigna	epo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5139.62	5139.62	cigna	ppo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5139.62	5139.62	cigna	hmo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5139.62	5139.62	cigna	pos
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	5139.62	5139.62	cigna	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.3	48.3	cigna	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.3	48.3	cigna	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.3	48.3	cigna	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.3	48.3	cigna	epo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	26.01	26.01	cigna	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	26.01	26.01	cigna	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	26.01	26.01	cigna	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	26.01	26.01	cigna	epo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	19270.59	19270.59	cigna	ppo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	19270.59	19270.59	cigna	hmo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	19270.59	19270.59	cigna	pos
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	19270.59	19270.59	cigna	epo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3539.01	3539.01	cigna	ppo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3539.01	3539.01	cigna	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3539.01	3539.01	cigna	pos
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	3539.01	3539.01	cigna	epo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	1130.86	1130.86	cigna	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	1130.86	1130.86	cigna	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	1130.86	1130.86	cigna	pos
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	1130.86	1130.86	cigna	epo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52182.52	52182.52	cigna	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52182.52	52182.52	cigna	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52182.52	52182.52	cigna	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52182.52	52182.52	cigna	epo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	608.56	608.56	cigna	ppo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	608.56	608.56	cigna	hmo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	608.56	608.56	cigna	pos
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	608.56	608.56	cigna	epo
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	8278.58	8278.58	cigna	ppo
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	8278.58	8278.58	cigna	hmo
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	8278.58	8278.58	cigna	pos
normal saline solution infus	cpt	J7050	8278.58	8278.58	598.59	598.59	11044.52	11044.52	9203.77	9203.77	E	8278.58	8278.58	cigna	epo
neostigmine methylslfte inj	cpt	J2710	21270.9	21270.9	4044.95	4044.95	34866.31	34866.31	29055.26	29055.26	E	21270.9	21270.9	cigna	ppo
neostigmine methylslfte inj	cpt	J2710	21270.9	21270.9	4044.95	4044.95	34866.31	34866.31	29055.26	29055.26	E	21270.9	21270.9	cigna	hmo
neostigmine methylslfte inj	cpt	J2710	21270.9	21270.9	4044.95	4044.95	34866.31	34866.31	29055.26	29055.26	E	21270.9	21270.9	cigna	pos
neostigmine methylslfte inj	cpt	J2710	21270.9	21270.9	4044.95	4044.95	34866.31	34866.31	29055.26	29055.26	E	21270.9	21270.9	cigna	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	16.35	16.35	cigna	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	16.35	16.35	cigna	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	16.35	16.35	cigna	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	16.35	16.35	cigna	epo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	3539.01	3539.01	cigna	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	3539.01	3539.01	cigna	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	3539.01	3539.01	cigna	pos
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	3539.01	3539.01	cigna	epo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	141.92	141.92	cigna	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	141.92	141.92	cigna	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	141.92	141.92	cigna	pos
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	141.92	141.92	cigna	epo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	19270.59	19270.59	cigna	ppo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	19270.59	19270.59	cigna	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	19270.59	19270.59	cigna	pos
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	19270.59	19270.59	cigna	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3225.5	3225.5	cigna	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3225.5	3225.5	cigna	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3225.5	3225.5	cigna	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3225.5	3225.5	cigna	epo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	41.02	41.02	cigna	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	41.02	41.02	cigna	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	41.02	41.02	cigna	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	41.02	41.02	cigna	epo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	ppo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	hmo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	pos
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	epo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	4844.02	4844.02	cigna	ppo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	4844.02	4844.02	cigna	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	4844.02	4844.02	cigna	pos
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	4844.02	4844.02	cigna	epo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	63.83	63.83	cigna	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	63.83	63.83	cigna	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	63.83	63.83	cigna	pos
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	63.83	63.83	cigna	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	448.08	448.08	cigna	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	448.08	448.08	cigna	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	448.08	448.08	cigna	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	448.08	448.08	cigna	epo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5460.04	5460.04	cigna	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5460.04	5460.04	cigna	hmo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5460.04	5460.04	cigna	pos
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5460.04	5460.04	cigna	epo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	80.4	80.4	cigna	ppo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	80.4	80.4	cigna	hmo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	80.4	80.4	cigna	pos
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	80.4	80.4	cigna	epo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	216.97	216.97	cigna	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	216.97	216.97	cigna	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	216.97	216.97	cigna	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	216.97	216.97	cigna	epo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	675.67	675.67	cigna	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	675.67	675.67	cigna	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	675.67	675.67	cigna	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	675.67	675.67	cigna	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	159.01	159.01	cigna	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	159.01	159.01	cigna	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	159.01	159.01	cigna	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	159.01	159.01	cigna	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	8278.58	8278.58	cigna	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	8278.58	8278.58	cigna	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	8278.58	8278.58	cigna	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	8278.58	8278.58	cigna	epo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	19270.59	19270.59	cigna	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	19270.59	19270.59	cigna	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	19270.59	19270.59	cigna	pos
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	19270.59	19270.59	cigna	epo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	122.6	122.6	cigna	ppo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	122.6	122.6	cigna	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	122.6	122.6	cigna	pos
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	122.6	122.6	cigna	epo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	4972.53	4972.53	cigna	ppo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	4972.53	4972.53	cigna	hmo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	4972.53	4972.53	cigna	pos
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	4972.53	4972.53	cigna	epo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	2651.78	2651.78	cigna	ppo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	2651.78	2651.78	cigna	hmo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	2651.78	2651.78	cigna	pos
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	2651.78	2651.78	cigna	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	21270.9	21270.9	cigna	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	21270.9	21270.9	cigna	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	21270.9	21270.9	cigna	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	21270.9	21270.9	cigna	epo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	182.72	182.72	cigna	ppo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	182.72	182.72	cigna	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	182.72	182.72	cigna	pos
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	182.72	182.72	cigna	epo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	19270.59	19270.59	cigna	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	19270.59	19270.59	cigna	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	19270.59	19270.59	cigna	pos
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	19270.59	19270.59	cigna	epo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	43.84	43.84	cigna	ppo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	43.84	43.84	cigna	hmo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	43.84	43.84	cigna	pos
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	43.84	43.84	cigna	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	72.08	72.08	cigna	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	72.08	72.08	cigna	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	72.08	72.08	cigna	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	72.08	72.08	cigna	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	562.74	562.74	cigna	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	562.74	562.74	cigna	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	562.74	562.74	cigna	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	562.74	562.74	cigna	epo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	5002.28	5002.28	cigna	ppo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	5002.28	5002.28	cigna	hmo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	5002.28	5002.28	cigna	pos
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	5002.28	5002.28	cigna	epo
"stomach, esophageal and duodenal procedures with mcc"	ms-drg	326	288925.38	288925.38	28518.81	28518.81	166466.87	166466.87	138722.39	138722.39	I	288925.38	288925.38	cigna	ppo
"stomach, esophageal and duodenal procedures with mcc"	ms-drg	326	288925.38	288925.38	28518.81	28518.81	166466.87	166466.87	138722.39	138722.39	I	288925.38	288925.38	cigna	hmo
"stomach, esophageal and duodenal procedures with mcc"	ms-drg	326	288925.38	288925.38	28518.81	28518.81	166466.87	166466.87	138722.39	138722.39	I	288925.38	288925.38	cigna	pos
"stomach, esophageal and duodenal procedures with mcc"	ms-drg	326	288925.38	288925.38	28518.81	28518.81	166466.87	166466.87	138722.39	138722.39	I	288925.38	288925.38	cigna	epo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2210.37	2210.37	cigna	ppo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2210.37	2210.37	cigna	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2210.37	2210.37	cigna	pos
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2210.37	2210.37	cigna	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	29.94	29.94	cigna	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	29.94	29.94	cigna	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	29.94	29.94	cigna	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	29.94	29.94	cigna	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	83.22	83.22	cigna	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	83.22	83.22	cigna	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	83.22	83.22	cigna	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	83.22	83.22	cigna	epo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	ppo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	hmo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	pos
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	384.91	384.91	cigna	epo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1286.12	1286.12	cigna	ppo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1286.12	1286.12	cigna	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1286.12	1286.12	cigna	pos
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1286.12	1286.12	cigna	epo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	142.67	142.67	cigna	ppo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	142.67	142.67	cigna	hmo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	142.67	142.67	cigna	pos
"X-ray of pelvis, 1 or 2 views"	cpt	72170	142.67	142.67	20.47	20.47	244.22	244.22	203.52	203.52	O	142.67	142.67	cigna	epo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	4154.86	4154.86	cigna	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	4154.86	4154.86	cigna	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	4154.86	4154.86	cigna	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	4154.86	4154.86	cigna	epo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	143.62	143.62	cigna	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	143.62	143.62	cigna	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	143.62	143.62	cigna	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	143.62	143.62	cigna	epo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	26149.85	26149.85	cigna	ppo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	26149.85	26149.85	cigna	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	26149.85	26149.85	cigna	pos
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	26149.85	26149.85	cigna	epo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	19270.59	19270.59	cigna	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	19270.59	19270.59	cigna	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	19270.59	19270.59	cigna	pos
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	19270.59	19270.59	cigna	epo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	5534.65	5534.65	cigna	ppo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	5534.65	5534.65	cigna	hmo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	5534.65	5534.65	cigna	pos
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	5534.65	5534.65	cigna	epo
cefazolin sodium injection	cpt	J0690	9081.99	9081.99	1725.97	1725.97	18886.44	18886.44	15738.7	15738.7	E	1725.97	1725.97	cigna	ppo
cefazolin sodium injection	cpt	J0690	9081.99	9081.99	1725.97	1725.97	18886.44	18886.44	15738.7	15738.7	E	1725.97	1725.97	cigna	hmo
cefazolin sodium injection	cpt	J0690	9081.99	9081.99	1725.97	1725.97	18886.44	18886.44	15738.7	15738.7	E	1725.97	1725.97	cigna	pos
cefazolin sodium injection	cpt	J0690	9081.99	9081.99	1725.97	1725.97	18886.44	18886.44	15738.7	15738.7	E	1725.97	1725.97	cigna	epo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4844.02	4844.02	cigna	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4844.02	4844.02	cigna	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4844.02	4844.02	cigna	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4844.02	4844.02	cigna	epo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1591.1	1591.1	cigna	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1591.1	1591.1	cigna	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1591.1	1591.1	cigna	pos
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1591.1	1591.1	cigna	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	2651.78	2651.78	cigna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	2651.78	2651.78	cigna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	2651.78	2651.78	cigna	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	2651.78	2651.78	cigna	epo
Ultrasound study of arteries of both legs at rest and exercise	cpt	93924	283.11	283.11	121.58	121.58	484.63	484.63	403.86	403.86	O	283.11	283.11	cigna	ppo
Ultrasound study of arteries of both legs at rest and exercise	cpt	93924	283.11	283.11	121.58	121.58	484.63	484.63	403.86	403.86	O	283.11	283.11	cigna	hmo
Ultrasound study of arteries of both legs at rest and exercise	cpt	93924	283.11	283.11	121.58	121.58	484.63	484.63	403.86	403.86	O	283.11	283.11	cigna	pos
Ultrasound study of arteries of both legs at rest and exercise	cpt	93924	283.11	283.11	121.58	121.58	484.63	484.63	403.86	403.86	O	283.11	283.11	cigna	epo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	3539.01	3539.01	cigna	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	3539.01	3539.01	cigna	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	3539.01	3539.01	cigna	pos
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	3539.01	3539.01	cigna	epo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1039.54	1039.54	cigna	ppo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1039.54	1039.54	cigna	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1039.54	1039.54	cigna	pos
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1039.54	1039.54	cigna	epo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	11447.12	11447.12	cigna	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	11447.12	11447.12	cigna	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	11447.12	11447.12	cigna	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	11447.12	11447.12	cigna	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	430.6	430.6	cigna	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	430.6	430.6	cigna	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	430.6	430.6	cigna	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	430.6	430.6	cigna	epo
Dilation of stomach outlet using an endoscope	cpt	43245	3539.01	3539.01	3539.01	3539.01	6316.46	6316.46	5263.72	5263.72	O	3539.01	3539.01	cigna	ppo
Dilation of stomach outlet using an endoscope	cpt	43245	3539.01	3539.01	3539.01	3539.01	6316.46	6316.46	5263.72	5263.72	O	3539.01	3539.01	cigna	hmo
Dilation of stomach outlet using an endoscope	cpt	43245	3539.01	3539.01	3539.01	3539.01	6316.46	6316.46	5263.72	5263.72	O	3539.01	3539.01	cigna	pos
Dilation of stomach outlet using an endoscope	cpt	43245	3539.01	3539.01	3539.01	3539.01	6316.46	6316.46	5263.72	5263.72	O	3539.01	3539.01	cigna	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	348.5	348.5	cigna	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	348.5	348.5	cigna	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	348.5	348.5	cigna	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	348.5	348.5	cigna	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	7694.58	7694.58	cigna	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	7694.58	7694.58	cigna	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	7694.58	7694.58	cigna	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	7694.58	7694.58	cigna	epo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	50054.52	50054.52	cigna	ppo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	50054.52	50054.52	cigna	hmo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	50054.52	50054.52	cigna	pos
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	50054.52	50054.52	cigna	epo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	21270.9	21270.9	cigna	ppo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	21270.9	21270.9	cigna	hmo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	21270.9	21270.9	cigna	pos
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	21270.9	21270.9	cigna	epo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1867.64	1867.64	cigna	ppo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1867.64	1867.64	cigna	hmo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1867.64	1867.64	cigna	pos
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	1867.64	1867.64	cigna	epo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	348.55	348.55	cigna	ppo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	348.55	348.55	cigna	hmo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	348.55	348.55	cigna	pos
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	348.55	348.55	cigna	epo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1337.49	1337.49	cigna	ppo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1337.49	1337.49	cigna	hmo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1337.49	1337.49	cigna	pos
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1337.49	1337.49	cigna	epo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	2876.37	2876.37	cigna	ppo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	2876.37	2876.37	cigna	hmo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	2876.37	2876.37	cigna	pos
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	2876.37	2876.37	cigna	epo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	230.05	230.05	cigna	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	230.05	230.05	cigna	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	230.05	230.05	cigna	pos
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	230.05	230.05	cigna	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1186.67	1186.67	cigna	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1186.67	1186.67	cigna	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1186.67	1186.67	cigna	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1186.67	1186.67	cigna	epo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	3539.01	3539.01	cigna	ppo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	3539.01	3539.01	cigna	hmo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	3539.01	3539.01	cigna	pos
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	3539.01	3539.01	cigna	epo
prematurity without major problems	ms-drg	792	29733.1	29733.1	7711.45	7711.45	12370.37	12370.37	10308.64	10308.64	I	29733.1	29733.1	cigna	ppo
prematurity without major problems	ms-drg	792	29733.1	29733.1	7711.45	7711.45	12370.37	12370.37	10308.64	10308.64	I	29733.1	29733.1	cigna	hmo
prematurity without major problems	ms-drg	792	29733.1	29733.1	7711.45	7711.45	12370.37	12370.37	10308.64	10308.64	I	29733.1	29733.1	cigna	pos
prematurity without major problems	ms-drg	792	29733.1	29733.1	7711.45	7711.45	12370.37	12370.37	10308.64	10308.64	I	29733.1	29733.1	cigna	epo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.49	52.49	cigna	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.49	52.49	cigna	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.49	52.49	cigna	pos
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.49	52.49	cigna	epo
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	21270.9	21270.9	cigna	ppo
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	21270.9	21270.9	cigna	hmo
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	21270.9	21270.9	cigna	pos
succinycholine chloride inj	cpt	J0330	21270.9	21270.9	1218.97	1218.97	29115.38	29115.38	24262.82	24262.82	E	21270.9	21270.9	cigna	epo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4844.02	4844.02	cigna	ppo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4844.02	4844.02	cigna	hmo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4844.02	4844.02	cigna	pos
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	4844.02	4844.02	cigna	epo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1117.56	1117.56	cigna	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1117.56	1117.56	cigna	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1117.56	1117.56	cigna	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1117.56	1117.56	cigna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.44	35.44	cigna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.44	35.44	cigna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.44	35.44	cigna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.44	35.44	cigna	epo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	622.98	622.98	cigna	ppo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	622.98	622.98	cigna	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	622.98	622.98	cigna	pos
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	622.98	622.98	cigna	epo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	55.41	55.41	cigna	ppo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	55.41	55.41	cigna	hmo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	55.41	55.41	cigna	pos
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	55.41	55.41	cigna	epo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	11266.74	11266.74	cigna	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	11266.74	11266.74	cigna	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	11266.74	11266.74	cigna	pos
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	11266.74	11266.74	cigna	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2136.3	2136.3	cigna	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2136.3	2136.3	cigna	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2136.3	2136.3	cigna	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2136.3	2136.3	cigna	epo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	epo
piperacillin/tazobactam	cpt	J2543	21270.9	21270.9	812.44	812.44	12102.08	12102.08	10085.07	10085.07	E	21270.9	21270.9	cigna	ppo
piperacillin/tazobactam	cpt	J2543	21270.9	21270.9	812.44	812.44	12102.08	12102.08	10085.07	10085.07	E	21270.9	21270.9	cigna	hmo
piperacillin/tazobactam	cpt	J2543	21270.9	21270.9	812.44	812.44	12102.08	12102.08	10085.07	10085.07	E	21270.9	21270.9	cigna	pos
piperacillin/tazobactam	cpt	J2543	21270.9	21270.9	812.44	812.44	12102.08	12102.08	10085.07	10085.07	E	21270.9	21270.9	cigna	epo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	21270.9	21270.9	cigna	ppo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	21270.9	21270.9	cigna	hmo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	21270.9	21270.9	cigna	pos
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	21270.9	21270.9	cigna	epo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	1379.36	1379.36	cigna	ppo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	1379.36	1379.36	cigna	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	1379.36	1379.36	cigna	pos
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	1379.36	1379.36	cigna	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	38.29	38.29	cigna	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	38.29	38.29	cigna	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	38.29	38.29	cigna	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	38.29	38.29	cigna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	55.95	55.95	cigna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	55.95	55.95	cigna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	55.95	55.95	cigna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	55.95	55.95	cigna	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2136.3	2136.3	cigna	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2136.3	2136.3	cigna	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2136.3	2136.3	cigna	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2136.3	2136.3	cigna	epo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	64.66	64.66	cigna	ppo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	64.66	64.66	cigna	hmo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	64.66	64.66	cigna	pos
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	64.66	64.66	cigna	epo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	54.86	54.86	cigna	ppo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	54.86	54.86	cigna	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	54.86	54.86	cigna	pos
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	54.86	54.86	cigna	epo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	3539.01	3539.01	cigna	ppo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	3539.01	3539.01	cigna	hmo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	3539.01	3539.01	cigna	pos
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	3539.01	3539.01	cigna	epo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	17825.76	17825.76	cigna	ppo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	17825.76	17825.76	cigna	hmo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	17825.76	17825.76	cigna	pos
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	17825.76	17825.76	cigna	epo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	18810.66	18810.66	cigna	ppo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	18810.66	18810.66	cigna	hmo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	18810.66	18810.66	cigna	pos
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	18810.66	18810.66	cigna	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	3225.5	3225.5	cigna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	3225.5	3225.5	cigna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	3225.5	3225.5	cigna	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	3225.5	3225.5	cigna	epo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	19270.59	19270.59	cigna	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	19270.59	19270.59	cigna	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	19270.59	19270.59	cigna	pos
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	19270.59	19270.59	cigna	epo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	611.54	611.54	cigna	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	611.54	611.54	cigna	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	611.54	611.54	cigna	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	611.54	611.54	cigna	epo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	115.02	115.02	cigna	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	115.02	115.02	cigna	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	115.02	115.02	cigna	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	115.02	115.02	cigna	epo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	42.57	42.57	cigna	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	42.57	42.57	cigna	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	42.57	42.57	cigna	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	42.57	42.57	cigna	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	155.22	155.22	cigna	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	155.22	155.22	cigna	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	155.22	155.22	cigna	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	155.22	155.22	cigna	epo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	18.13	18.13	cigna	ppo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	18.13	18.13	cigna	hmo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	18.13	18.13	cigna	pos
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	18.13	18.13	cigna	epo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	133.75	133.75	24.84	24.84	228.96	228.96	190.8	190.8	E	133.75	133.75	cigna	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	133.75	133.75	24.84	24.84	228.96	228.96	190.8	190.8	E	133.75	133.75	cigna	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	133.75	133.75	24.84	24.84	228.96	228.96	190.8	190.8	E	133.75	133.75	cigna	pos
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	133.75	133.75	24.84	24.84	228.96	228.96	190.8	190.8	E	133.75	133.75	cigna	epo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	21270.9	21270.9	cigna	ppo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	21270.9	21270.9	cigna	hmo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	21270.9	21270.9	cigna	pos
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	21270.9	21270.9	cigna	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	75.79	75.79	cigna	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	75.79	75.79	cigna	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	75.79	75.79	cigna	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	75.79	75.79	cigna	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	447.32	447.32	cigna	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	447.32	447.32	cigna	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	447.32	447.32	cigna	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	447.32	447.32	cigna	epo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.65	278.65	cigna	ppo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.65	278.65	cigna	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.65	278.65	cigna	pos
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.65	278.65	cigna	epo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4844.02	4844.02	cigna	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4844.02	4844.02	cigna	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4844.02	4844.02	cigna	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4844.02	4844.02	cigna	epo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	852.29	852.29	cigna	ppo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	852.29	852.29	cigna	hmo
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	852.29	852.29	cigna	pos
"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report"	cpt	93350	852.29	852.29	389.69	389.69	1458.98	1458.98	1215.82	1215.82	O	852.29	852.29	cigna	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	79.51	79.51	cigna	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	79.51	79.51	cigna	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	79.51	79.51	cigna	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	79.51	79.51	cigna	epo
kidney and ureter procedures for non-neoplasm without cc/mcc	ms-drg	661	24215.64	24215.64	5983.11	5983.11	43738.31	43738.31	36448.59	36448.59	I	24215.64	24215.64	cigna	ppo
kidney and ureter procedures for non-neoplasm without cc/mcc	ms-drg	661	24215.64	24215.64	5983.11	5983.11	43738.31	43738.31	36448.59	36448.59	I	24215.64	24215.64	cigna	hmo
kidney and ureter procedures for non-neoplasm without cc/mcc	ms-drg	661	24215.64	24215.64	5983.11	5983.11	43738.31	43738.31	36448.59	36448.59	I	24215.64	24215.64	cigna	pos
kidney and ureter procedures for non-neoplasm without cc/mcc	ms-drg	661	24215.64	24215.64	5983.11	5983.11	43738.31	43738.31	36448.59	36448.59	I	24215.64	24215.64	cigna	epo
Removal of appendix using an endoscope	cpt	44970	21270.9	21270.9	4222.64	4222.64	35680.25	35680.25	29733.54	29733.54	E	21270.9	21270.9	cigna	ppo
Removal of appendix using an endoscope	cpt	44970	21270.9	21270.9	4222.64	4222.64	35680.25	35680.25	29733.54	29733.54	E	21270.9	21270.9	cigna	hmo
Removal of appendix using an endoscope	cpt	44970	21270.9	21270.9	4222.64	4222.64	35680.25	35680.25	29733.54	29733.54	E	21270.9	21270.9	cigna	pos
Removal of appendix using an endoscope	cpt	44970	21270.9	21270.9	4222.64	4222.64	35680.25	35680.25	29733.54	29733.54	E	21270.9	21270.9	cigna	epo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	20.81	20.81	cigna	ppo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	20.81	20.81	cigna	hmo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	20.81	20.81	cigna	pos
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	20.81	20.81	cigna	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	69.1	69.1	cigna	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	69.1	69.1	cigna	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	69.1	69.1	cigna	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	69.1	69.1	cigna	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	187.86	187.86	cigna	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	187.86	187.86	cigna	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	187.86	187.86	cigna	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	187.86	187.86	cigna	epo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	8278.58	8278.58	cigna	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	8278.58	8278.58	cigna	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	8278.58	8278.58	cigna	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	8278.58	8278.58	cigna	epo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	49.79	49.79	cigna	ppo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	49.79	49.79	cigna	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	49.79	49.79	cigna	pos
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	49.79	49.79	cigna	epo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	8278.58	8278.58	cigna	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	8278.58	8278.58	cigna	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	8278.58	8278.58	cigna	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	8278.58	8278.58	cigna	epo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	52.76	52.76	cigna	ppo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	52.76	52.76	cigna	hmo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	52.76	52.76	cigna	pos
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	52.76	52.76	cigna	epo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	66.95	66.95	cigna	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	66.95	66.95	cigna	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	66.95	66.95	cigna	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	66.95	66.95	cigna	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.48	11.48	cigna	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.48	11.48	cigna	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.48	11.48	cigna	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.48	11.48	cigna	epo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	53.5	53.5	cigna	ppo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	53.5	53.5	cigna	hmo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	53.5	53.5	cigna	pos
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	53.5	53.5	cigna	epo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	8071.15	8071.15	cigna	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	8071.15	8071.15	cigna	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	8071.15	8071.15	cigna	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	8071.15	8071.15	cigna	epo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	45.85	45.85	cigna	ppo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	45.85	45.85	cigna	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	45.85	45.85	cigna	pos
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	45.85	45.85	cigna	epo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	8767.32	8767.32	cigna	ppo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	8767.32	8767.32	cigna	hmo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	8767.32	8767.32	cigna	pos
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	8767.32	8767.32	cigna	epo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	159.02	159.02	cigna	ppo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	159.02	159.02	cigna	hmo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	159.02	159.02	cigna	pos
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	159.02	159.02	cigna	epo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.8	208.8	cigna	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.8	208.8	cigna	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.8	208.8	cigna	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.8	208.8	cigna	epo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	24.52	24.52	cigna	ppo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	24.52	24.52	cigna	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	24.52	24.52	cigna	pos
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	24.52	24.52	cigna	epo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1590.91	1590.91	cigna	ppo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1590.91	1590.91	cigna	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1590.91	1590.91	cigna	pos
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1590.91	1590.91	cigna	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	8.69	8.69	cigna	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	8.69	8.69	cigna	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	8.69	8.69	cigna	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	8.69	8.69	cigna	epo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	187.99	187.99	cigna	ppo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	187.99	187.99	cigna	hmo
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	187.99	187.99	cigna	pos
"Pathology examination of tissue using a microscope, moderately high complexity"	cpt	88307	187.99	187.99	60.63	60.63	321.82	321.82	268.18	268.18	O	187.99	187.99	cigna	epo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	epo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	25.26	25.26	cigna	ppo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	25.26	25.26	cigna	hmo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	25.26	25.26	cigna	pos
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	25.26	25.26	cigna	epo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	115.92	115.92	cigna	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	115.92	115.92	cigna	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	115.92	115.92	cigna	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	115.92	115.92	cigna	epo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	48.76	48.76	cigna	ppo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	48.76	48.76	cigna	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	48.76	48.76	cigna	pos
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	48.76	48.76	cigna	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	78.7	78.7	cigna	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	78.7	78.7	cigna	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	78.7	78.7	cigna	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	78.7	78.7	cigna	epo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.51	46.51	cigna	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.51	46.51	cigna	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.51	46.51	cigna	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.51	46.51	cigna	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	95.74	95.74	cigna	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1725.97	1725.97	cigna	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1725.97	1725.97	cigna	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1725.97	1725.97	cigna	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1725.97	1725.97	cigna	epo
Lactate dehydrogenase (enzyme) level	cpt	83615	71.33	71.33	5.37	5.37	122.11	122.11	101.76	101.76	E	71.33	71.33	cigna	ppo
Lactate dehydrogenase (enzyme) level	cpt	83615	71.33	71.33	5.37	5.37	122.11	122.11	101.76	101.76	E	71.33	71.33	cigna	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	71.33	71.33	5.37	5.37	122.11	122.11	101.76	101.76	E	71.33	71.33	cigna	pos
Lactate dehydrogenase (enzyme) level	cpt	83615	71.33	71.33	5.37	5.37	122.11	122.11	101.76	101.76	E	71.33	71.33	cigna	epo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4844.02	4844.02	cigna	epo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.5	53.5	cigna	ppo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.5	53.5	cigna	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.5	53.5	cigna	pos
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.5	53.5	cigna	epo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4844.02	4844.02	cigna	ppo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4844.02	4844.02	cigna	hmo
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4844.02	4844.02	cigna	pos
oxaliplatin	cpt	J9263	5479.02	5479.02	938.77	938.77	8823.35	8823.35	7352.79	7352.79	O	4844.02	4844.02	cigna	epo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	37239.8	37239.8	cigna	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	37239.8	37239.8	cigna	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	37239.8	37239.8	cigna	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	37239.8	37239.8	cigna	epo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	240.04	240.04	cigna	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	240.04	240.04	cigna	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	240.04	240.04	cigna	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	240.04	240.04	cigna	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	295.84	295.84	cigna	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	295.84	295.84	cigna	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	295.84	295.84	cigna	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	295.84	295.84	cigna	epo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	3539.01	3539.01	cigna	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	3539.01	3539.01	cigna	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	3539.01	3539.01	cigna	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	3539.01	3539.01	cigna	epo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	19270.59	19270.59	cigna	ppo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	19270.59	19270.59	cigna	hmo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	19270.59	19270.59	cigna	pos
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	19270.59	19270.59	cigna	epo
Liver function blood test panel	cpt	80076	135.53	135.53	7.27	7.27	232.01	232.01	193.34	193.34	E	135.53	135.53	cigna	ppo
Liver function blood test panel	cpt	80076	135.53	135.53	7.27	7.27	232.01	232.01	193.34	193.34	E	135.53	135.53	cigna	hmo
Liver function blood test panel	cpt	80076	135.53	135.53	7.27	7.27	232.01	232.01	193.34	193.34	E	135.53	135.53	cigna	pos
Liver function blood test panel	cpt	80076	135.53	135.53	7.27	7.27	232.01	232.01	193.34	193.34	E	135.53	135.53	cigna	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1623.33	1623.33	cigna	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1623.33	1623.33	cigna	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1623.33	1623.33	cigna	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1623.33	1623.33	cigna	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	207.31	207.31	cigna	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	207.31	207.31	cigna	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	207.31	207.31	cigna	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	207.31	207.31	cigna	epo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	1130.86	1130.86	cigna	ppo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	1130.86	1130.86	cigna	hmo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	1130.86	1130.86	cigna	pos
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	1130.86	1130.86	cigna	epo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	69.83	69.83	cigna	ppo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	69.83	69.83	cigna	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	69.83	69.83	cigna	pos
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	69.83	69.83	cigna	epo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	192.96	192.96	cigna	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	192.96	192.96	cigna	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	192.96	192.96	cigna	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	192.96	192.96	cigna	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	77.2	77.2	cigna	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	77.2	77.2	cigna	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	77.2	77.2	cigna	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	77.2	77.2	cigna	epo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	19270.59	19270.59	cigna	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	19270.59	19270.59	cigna	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	19270.59	19270.59	cigna	pos
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	19270.59	19270.59	cigna	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	111.09	111.09	cigna	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	111.09	111.09	cigna	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	111.09	111.09	cigna	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	111.09	111.09	cigna	epo
Kidney function blood test panel	cpt	80069	180.41	180.41	7.72	7.72	308.83	308.83	257.36	257.36	E	180.41	180.41	cigna	ppo
Kidney function blood test panel	cpt	80069	180.41	180.41	7.72	7.72	308.83	308.83	257.36	257.36	E	180.41	180.41	cigna	hmo
Kidney function blood test panel	cpt	80069	180.41	180.41	7.72	7.72	308.83	308.83	257.36	257.36	E	180.41	180.41	cigna	pos
Kidney function blood test panel	cpt	80069	180.41	180.41	7.72	7.72	308.83	308.83	257.36	257.36	E	180.41	180.41	cigna	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1964.01	1964.01	cigna	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1964.01	1964.01	cigna	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1964.01	1964.01	cigna	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1964.01	1964.01	cigna	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	70.89	70.89	cigna	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	70.89	70.89	cigna	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	70.89	70.89	cigna	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	70.89	70.89	cigna	epo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	264.53	264.53	cigna	ppo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	264.53	264.53	cigna	hmo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	264.53	264.53	cigna	pos
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	264.53	264.53	cigna	epo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	10844.92	10844.92	cigna	ppo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	10844.92	10844.92	cigna	hmo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	10844.92	10844.92	cigna	pos
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	10844.92	10844.92	cigna	epo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	ppo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	pos
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	epo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4844.02	4844.02	cigna	ppo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4844.02	4844.02	cigna	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4844.02	4844.02	cigna	pos
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4844.02	4844.02	cigna	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	333.26	333.26	cigna	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	333.26	333.26	cigna	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	333.26	333.26	cigna	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	333.26	333.26	cigna	epo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	4154.86	4154.86	cigna	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	4154.86	4154.86	cigna	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	4154.86	4154.86	cigna	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	4154.86	4154.86	cigna	epo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	5002.28	5002.28	cigna	ppo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	5002.28	5002.28	cigna	hmo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	5002.28	5002.28	cigna	pos
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	5002.28	5002.28	cigna	epo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	52.44	52.44	cigna	ppo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	52.44	52.44	cigna	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	52.44	52.44	cigna	pos
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	52.44	52.44	cigna	epo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	ppo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	pos
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	608.56	608.56	cigna	epo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	19270.59	19270.59	cigna	ppo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	19270.59	19270.59	cigna	hmo
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	19270.59	19270.59	cigna	pos
"catheter, occlusion"	cpt	C2628	19270.59	19270.59	215.94	215.94	36433.46	36433.46	30361.22	30361.22	O	19270.59	19270.59	cigna	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	57.51	57.51	cigna	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	57.51	57.51	cigna	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	57.51	57.51	cigna	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	57.51	57.51	cigna	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	207.31	207.31	cigna	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	181.15	181.15	cigna	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	181.15	181.15	cigna	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	181.15	181.15	cigna	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	181.15	181.15	cigna	epo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1644.68	1644.68	cigna	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1644.68	1644.68	cigna	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1644.68	1644.68	cigna	pos
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1644.68	1644.68	cigna	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	26.82	26.82	cigna	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	26.82	26.82	cigna	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	26.82	26.82	cigna	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	26.82	26.82	cigna	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	44.13	44.13	cigna	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	44.13	44.13	cigna	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	44.13	44.13	cigna	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	44.13	44.13	cigna	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.13	44.13	cigna	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.13	44.13	cigna	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.13	44.13	cigna	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.13	44.13	cigna	epo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	46.39	46.39	cigna	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	46.39	46.39	cigna	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	46.39	46.39	cigna	pos
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	46.39	46.39	cigna	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.77	67.77	cigna	epo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	19286.76	19286.76	cigna	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	19286.76	19286.76	cigna	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	19286.76	19286.76	cigna	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	19286.76	19286.76	cigna	epo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	2005.98	2005.98	cigna	ppo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	2005.98	2005.98	cigna	hmo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	2005.98	2005.98	cigna	pos
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	2005.98	2005.98	cigna	epo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	418.93	418.93	cigna	ppo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	418.93	418.93	cigna	hmo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	418.93	418.93	cigna	pos
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	418.93	418.93	cigna	epo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	400.09	400.09	cigna	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	400.09	400.09	cigna	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	400.09	400.09	cigna	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	400.09	400.09	cigna	epo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	19270.59	19270.59	cigna	ppo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	19270.59	19270.59	cigna	hmo
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	19270.59	19270.59	cigna	pos
Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope	cpt	58571	19270.59	19270.59	215.94	215.94	35736.19	35736.19	29780.16	29780.16	O	19270.59	19270.59	cigna	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.22	57.22	cigna	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.22	57.22	cigna	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.22	57.22	cigna	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.22	57.22	cigna	epo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	1130.86	1130.86	cigna	ppo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	1130.86	1130.86	cigna	hmo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	1130.86	1130.86	cigna	pos
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	1130.86	1130.86	cigna	epo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	4154.86	4154.86	cigna	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	4154.86	4154.86	cigna	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	4154.86	4154.86	cigna	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	4154.86	4154.86	cigna	epo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	188.58	188.58	cigna	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	188.58	188.58	cigna	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	188.58	188.58	cigna	pos
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	188.58	188.58	cigna	epo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	912.6	912.6	cigna	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	912.6	912.6	cigna	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	912.6	912.6	cigna	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	912.6	912.6	cigna	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	33.14	33.14	cigna	epo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	19270.59	19270.59	cigna	ppo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	19270.59	19270.59	cigna	hmo
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	19270.59	19270.59	cigna	pos
metoclopramide hcl injection	cpt	J2765	19270.59	19270.59	1190.8	1190.8	19104.05	19104.05	15920.04	15920.04	O	19270.59	19270.59	cigna	epo
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	19059.25	19059.25	cigna	ppo
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	19059.25	19059.25	cigna	hmo
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	19059.25	19059.25	cigna	pos
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	19059.25	19059.25	cigna	epo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	917.66	917.66	cigna	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	917.66	917.66	cigna	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	917.66	917.66	cigna	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	917.66	917.66	cigna	epo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	21270.9	21270.9	cigna	ppo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	21270.9	21270.9	cigna	hmo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	21270.9	21270.9	cigna	pos
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	21270.9	21270.9	cigna	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4844.02	4844.02	cigna	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4844.02	4844.02	cigna	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4844.02	4844.02	cigna	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4844.02	4844.02	cigna	epo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	783.67	783.67	cigna	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	783.67	783.67	cigna	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	783.67	783.67	cigna	pos
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	783.67	783.67	cigna	epo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	25.26	25.26	cigna	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	25.26	25.26	cigna	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	25.26	25.26	cigna	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	25.26	25.26	cigna	epo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	4844.02	4844.02	cigna	epo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	150.1	150.1	cigna	ppo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	150.1	150.1	cigna	hmo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	150.1	150.1	cigna	pos
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	150.1	150.1	cigna	epo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2876.37	2876.37	cigna	ppo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2876.37	2876.37	cigna	hmo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2876.37	2876.37	cigna	pos
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2876.37	2876.37	cigna	epo
MRI scan brain	cpt	70551	1815.29	1815.29	124.83	124.83	3107.5	3107.5	2589.58	2589.58	E	1815.29	1815.29	cigna	ppo
MRI scan brain	cpt	70551	1815.29	1815.29	124.83	124.83	3107.5	3107.5	2589.58	2589.58	E	1815.29	1815.29	cigna	hmo
MRI scan brain	cpt	70551	1815.29	1815.29	124.83	124.83	3107.5	3107.5	2589.58	2589.58	E	1815.29	1815.29	cigna	pos
MRI scan brain	cpt	70551	1815.29	1815.29	124.83	124.83	3107.5	3107.5	2589.58	2589.58	E	1815.29	1815.29	cigna	epo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3225.5	3225.5	cigna	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3225.5	3225.5	cigna	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3225.5	3225.5	cigna	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3225.5	3225.5	cigna	epo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	19270.59	19270.59	cigna	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	19270.59	19270.59	cigna	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	19270.59	19270.59	cigna	pos
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	19270.59	19270.59	cigna	epo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	92.95	92.95	cigna	ppo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	92.95	92.95	cigna	hmo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	92.95	92.95	cigna	pos
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	92.95	92.95	cigna	epo
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	27632.25	27632.25	cigna	ppo
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	27632.25	27632.25	cigna	hmo
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	27632.25	27632.25	cigna	pos
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	27632.25	27632.25	cigna	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	3225.5	3225.5	cigna	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	3225.5	3225.5	cigna	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	3225.5	3225.5	cigna	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	3225.5	3225.5	cigna	epo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	21270.9	21270.9	cigna	ppo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	21270.9	21270.9	cigna	hmo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	21270.9	21270.9	cigna	pos
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	21270.9	21270.9	cigna	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.33	45.33	cigna	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.33	45.33	cigna	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.33	45.33	cigna	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.33	45.33	cigna	epo
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	29514.43	29514.43	cigna	ppo
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	29514.43	29514.43	cigna	hmo
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	29514.43	29514.43	cigna	pos
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	29514.43	29514.43	cigna	epo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	7986.58	7986.58	cigna	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	7986.58	7986.58	cigna	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	7986.58	7986.58	cigna	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	7986.58	7986.58	cigna	epo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	696.54	696.54	cigna	ppo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	696.54	696.54	cigna	hmo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	696.54	696.54	cigna	pos
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	696.54	696.54	cigna	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.35	10.35	cigna medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.35	10.35	cigna medicare advantage	hmo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.27	13.27	cigna medicare advantage	pos
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.27	13.27	cigna medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	39.09	39.09	cigna medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	39.09	39.09	cigna medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.61	7.61	cigna medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.61	7.61	cigna medicare advantage	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	4.92	4.92	cigna medicare advantage	pos
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	4.92	4.92	cigna medicare advantage	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.2	2.2	cigna medicare advantage	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.2	2.2	cigna medicare advantage	hmo
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc	ms-drg	517	9446.71	9446.71	4008.64	4008.64	36975.23	36975.23	30812.69	30812.69	I	4008.64	4008.64	healthchoice	hmo
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc	ms-drg	517	9446.71	9446.71	4008.64	4008.64	36975.23	36975.23	30812.69	30812.69	I	4008.64	4008.64	healthchoice	epo
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc	ms-drg	517	9446.71	9446.71	4008.64	4008.64	36975.23	36975.23	30812.69	30812.69	I	4008.64	4008.64	healthchoice	pos
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc	ms-drg	517	9446.71	9446.71	4008.64	4008.64	36975.23	36975.23	30812.69	30812.69	I	4008.64	4008.64	healthchoice	hmo
other musculoskeletal system and connective tissue o.r. procedures without cc/mcc	ms-drg	517	9446.71	9446.71	4008.64	4008.64	36975.23	36975.23	30812.69	30812.69	I	4008.64	4008.64	healthchoice	ppo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1648.63	1648.63	healthchoice	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1648.63	1648.63	healthchoice	epo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1648.63	1648.63	healthchoice	pos
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1648.63	1648.63	healthchoice	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	1648.63	1648.63	healthchoice	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5252.68	5252.68	healthchoice	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5252.68	5252.68	healthchoice	epo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5252.68	5252.68	healthchoice	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5252.68	5252.68	healthchoice	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	5252.68	5252.68	healthchoice	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4390.96	4390.96	healthchoice	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4390.96	4390.96	healthchoice	epo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4390.96	4390.96	healthchoice	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4390.96	4390.96	healthchoice	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4390.96	4390.96	healthchoice	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	28.76	28.76	healthchoice	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	28.76	28.76	healthchoice	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	28.76	28.76	healthchoice	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	28.76	28.76	healthchoice	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	28.76	28.76	healthchoice	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	432.25	432.25	healthchoice	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	432.25	432.25	healthchoice	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	432.25	432.25	healthchoice	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	432.25	432.25	healthchoice	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	432.25	432.25	healthchoice	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	32.23	32.23	healthchoice	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	32.23	32.23	healthchoice	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	32.23	32.23	healthchoice	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	32.23	32.23	healthchoice	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	32.23	32.23	healthchoice	ppo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	22.42	22.42	healthchoice	hmo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	22.42	22.42	healthchoice	epo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	22.42	22.42	healthchoice	pos
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	22.42	22.42	healthchoice	hmo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	22.42	22.42	healthchoice	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	5591.9	5591.9	healthchoice	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	5591.9	5591.9	healthchoice	epo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	5591.9	5591.9	healthchoice	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	5591.9	5591.9	healthchoice	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	5591.9	5591.9	healthchoice	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	859.66	859.66	healthchoice	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	859.66	859.66	healthchoice	epo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	859.66	859.66	healthchoice	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	859.66	859.66	healthchoice	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	859.66	859.66	healthchoice	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	40.85	40.85	healthchoice	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	40.85	40.85	healthchoice	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	40.85	40.85	healthchoice	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	40.85	40.85	healthchoice	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	40.85	40.85	healthchoice	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	49.3	49.3	healthchoice	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	49.3	49.3	healthchoice	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	49.3	49.3	healthchoice	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	49.3	49.3	healthchoice	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	49.3	49.3	healthchoice	ppo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	38.6	38.6	healthchoice	hmo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	38.6	38.6	healthchoice	epo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	38.6	38.6	healthchoice	pos
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	38.6	38.6	healthchoice	hmo
Vitamin B-6 level	cpt	84207	126.88	126.88	21.64	21.64	145.01	145.01	120.84	120.84	O	38.6	38.6	healthchoice	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	33.76	33.76	healthchoice	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	33.76	33.76	healthchoice	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	33.76	33.76	healthchoice	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	33.76	33.76	healthchoice	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	33.76	33.76	healthchoice	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	26.28	26.28	healthchoice	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	26.28	26.28	healthchoice	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	26.28	26.28	healthchoice	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	26.28	26.28	healthchoice	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	26.28	26.28	healthchoice	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	20.86	20.86	healthchoice	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	20.86	20.86	healthchoice	epo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	20.86	20.86	healthchoice	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	20.86	20.86	healthchoice	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	20.86	20.86	healthchoice	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	52.35	52.35	healthchoice	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	52.35	52.35	healthchoice	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	52.35	52.35	healthchoice	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	52.35	52.35	healthchoice	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	52.35	52.35	healthchoice	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	18.85	18.85	healthchoice	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	18.85	18.85	healthchoice	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	18.85	18.85	healthchoice	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	18.85	18.85	healthchoice	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	18.85	18.85	healthchoice	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	13.41	13.41	healthchoice	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	13.41	13.41	healthchoice	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	13.41	13.41	healthchoice	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	13.41	13.41	healthchoice	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	13.41	13.41	healthchoice	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	11.3	11.3	healthchoice	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	11.3	11.3	healthchoice	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	11.3	11.3	healthchoice	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	11.3	11.3	healthchoice	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	11.3	11.3	healthchoice	ppo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	56.49	56.49	healthchoice	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	56.49	56.49	healthchoice	epo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	56.49	56.49	healthchoice	pos
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	56.49	56.49	healthchoice	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	56.49	56.49	healthchoice	ppo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	2320.4	2320.4	healthchoice	hmo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	2320.4	2320.4	healthchoice	epo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	2320.4	2320.4	healthchoice	pos
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	2320.4	2320.4	healthchoice	hmo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	2320.4	2320.4	healthchoice	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.72	5.72	healthchoice	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.72	5.72	healthchoice	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.72	5.72	healthchoice	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.72	5.72	healthchoice	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.72	5.72	healthchoice	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	3.73	3.73	healthchoice	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	3.73	3.73	healthchoice	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	3.73	3.73	healthchoice	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	3.73	3.73	healthchoice	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	3.73	3.73	healthchoice	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	859.66	859.66	healthchoice	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	859.66	859.66	healthchoice	epo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	859.66	859.66	healthchoice	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	859.66	859.66	healthchoice	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	859.66	859.66	healthchoice	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	6.35	6.35	healthchoice	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	6.35	6.35	healthchoice	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	6.35	6.35	healthchoice	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	6.35	6.35	healthchoice	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	6.35	6.35	healthchoice	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	588.45	588.45	healthchoice	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	588.45	588.45	healthchoice	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	588.45	588.45	healthchoice	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	588.45	588.45	healthchoice	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	588.45	588.45	healthchoice	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	6.96	6.96	healthchoice	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	6.96	6.96	healthchoice	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	6.96	6.96	healthchoice	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	6.96	6.96	healthchoice	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	6.96	6.96	healthchoice	ppo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	33.71	33.71	humana	pos
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	33.71	33.71	humana	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	234.56	234.56	humana	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	234.56	234.56	humana	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	humana	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	humana	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	humana	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	humana	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	humana	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	humana	ppo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	humana	pos
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	humana	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	humana	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	humana	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	490.83	490.83	humana	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	490.83	490.83	humana	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	88.96	88.96	humana	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	88.96	88.96	humana	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	humana	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	humana	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	1760.46	1760.46	humana	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	1760.46	1760.46	humana	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	259.33	259.33	humana	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	259.33	259.33	humana	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	45.55	45.55	humana	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	45.55	45.55	humana	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	humana	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	humana	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	humana	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	humana	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	73.11	73.11	humana	pos
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	73.11	73.11	humana	ppo
Drugs requiring detailed coding	revCode	636	1760.46	1760.46	1760.46	1760.46	3320.41	3320.41	2767.01	2767.01	E	1760.46	1760.46	humana	pos
Drugs requiring detailed coding	revCode	636	1760.46	1760.46	1760.46	1760.46	3320.41	3320.41	2767.01	2767.01	E	1760.46	1760.46	humana	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1760.46	1760.46	humana	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1760.46	1760.46	humana	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	humana	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	humana	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	humana	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	humana	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	261.58	261.58	humana	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	261.58	261.58	humana	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	humana	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	humana	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	humana	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	humana	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	humana	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	humana	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1760.46	1760.46	humana	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	1760.46	1760.46	humana	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	56.16	56.16	humana	pos
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	56.16	56.16	humana	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	humana	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	humana	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1760.46	1760.46	humana	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	1760.46	1760.46	humana	ppo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	1444.99	1444.99	humana medicare advantage	hmo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	1444.99	1444.99	humana medicare advantage	pos
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	1444.99	1444.99	humana medicare advantage	ppo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	1444.99	1444.99	humana medicare advantage	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	3.28	3.28	humana medicare advantage	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	3.28	3.28	humana medicare advantage	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	3.28	3.28	humana medicare advantage	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	3.28	3.28	humana medicare advantage	hmo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.2	7.2	humana medicare advantage	hmo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.2	7.2	humana medicare advantage	pos
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.2	7.2	humana medicare advantage	ppo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	7.2	7.2	humana medicare advantage	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	humana medicare advantage	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	humana medicare advantage	pos
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	humana medicare advantage	ppo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	11.53	11.53	humana medicare advantage	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	18.58	18.58	humana medicare advantage	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	18.58	18.58	humana medicare advantage	pos
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	18.58	18.58	humana medicare advantage	ppo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	18.58	18.58	humana medicare advantage	hmo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	12.58	12.58	humana medicare advantage	hmo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	12.58	12.58	humana medicare advantage	pos
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	12.58	12.58	humana medicare advantage	ppo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	12.58	12.58	humana medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	9.71	9.71	humana medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	9.71	9.71	humana medicare advantage	pos
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	9.71	9.71	humana medicare advantage	ppo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	9.71	9.71	humana medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	humana medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	humana medicare advantage	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	humana medicare advantage	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	humana medicare advantage	hmo
Hydroxyindolacetic acid (product of metabolism) level	cpt	83497	14.39	14.39	11.47	11.47	228.96	228.96	190.8	190.8	O	12.9	12.9	humana medicare advantage	hmo
Hydroxyindolacetic acid (product of metabolism) level	cpt	83497	14.39	14.39	11.47	11.47	228.96	228.96	190.8	190.8	O	12.9	12.9	humana medicare advantage	pos
Hydroxyindolacetic acid (product of metabolism) level	cpt	83497	14.39	14.39	11.47	11.47	228.96	228.96	190.8	190.8	O	12.9	12.9	humana medicare advantage	ppo
Hydroxyindolacetic acid (product of metabolism) level	cpt	83497	14.39	14.39	11.47	11.47	228.96	228.96	190.8	190.8	O	12.9	12.9	humana medicare advantage	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	humana medicare advantage	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	humana medicare advantage	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	humana medicare advantage	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	humana medicare advantage	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.53	11.53	humana medicare advantage	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.53	11.53	humana medicare advantage	pos
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.53	11.53	humana medicare advantage	ppo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	11.53	11.53	humana medicare advantage	hmo
Measurement of substance using immunoassay technique	cpt	83520	33.85	33.85	15.36	15.36	39.43	39.43	32.86	32.86	O	17.27	17.27	humana medicare advantage	hmo
Measurement of substance using immunoassay technique	cpt	83520	33.85	33.85	15.36	15.36	39.43	39.43	32.86	32.86	O	17.27	17.27	humana medicare advantage	pos
Measurement of substance using immunoassay technique	cpt	83520	33.85	33.85	15.36	15.36	39.43	39.43	32.86	32.86	O	17.27	17.27	humana medicare advantage	ppo
Measurement of substance using immunoassay technique	cpt	83520	33.85	33.85	15.36	15.36	39.43	39.43	32.86	32.86	O	17.27	17.27	humana medicare advantage	hmo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	9.46	9.46	humana medicare advantage	hmo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	9.46	9.46	humana medicare advantage	pos
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	9.46	9.46	humana medicare advantage	ppo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	9.46	9.46	humana medicare advantage	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	humana medicare advantage	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	humana medicare advantage	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	humana medicare advantage	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	humana medicare advantage	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	humana medicare advantage	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	humana medicare advantage	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	humana medicare advantage	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	humana medicare advantage	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	6.04	6.04	humana medicare advantage	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	6.04	6.04	humana medicare advantage	pos
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	6.04	6.04	humana medicare advantage	ppo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	6.04	6.04	humana medicare advantage	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	humana medicare advantage	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	humana medicare advantage	pos
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	humana medicare advantage	ppo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	5.18	5.18	humana medicare advantage	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	19.7	19.7	humana medicare advantage	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	19.7	19.7	humana medicare advantage	pos
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	19.7	19.7	humana medicare advantage	ppo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	19.7	19.7	humana medicare advantage	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	5.12	5.12	humana medicare advantage	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	5.12	5.12	humana medicare advantage	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	5.12	5.12	humana medicare advantage	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	5.12	5.12	humana medicare advantage	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	humana medicare advantage	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	humana medicare advantage	pos
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	humana medicare advantage	ppo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	6.89	6.89	humana medicare advantage	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	humana medicare advantage	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	humana medicare advantage	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	humana medicare advantage	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	humana medicare advantage	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	11.55	11.55	humana medicare advantage	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	11.55	11.55	humana medicare advantage	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	11.55	11.55	humana medicare advantage	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	11.55	11.55	humana medicare advantage	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	humana medicare advantage	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	humana medicare advantage	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	humana medicare advantage	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	humana medicare advantage	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	6.45	6.45	humana medicare advantage	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	6.45	6.45	humana medicare advantage	pos
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	6.45	6.45	humana medicare advantage	ppo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	6.45	6.45	humana medicare advantage	hmo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	humana medicare advantage	hmo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	humana medicare advantage	pos
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	humana medicare advantage	ppo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	27.2	27.2	humana medicare advantage	hmo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	21.21	21.21	humana medicare advantage	hmo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	21.21	21.21	humana medicare advantage	pos
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	21.21	21.21	humana medicare advantage	ppo
Organic acid level	cpt	83921	21.3	21.3	16.85	16.85	110.66	110.66	92.22	92.22	O	21.21	21.21	humana medicare advantage	hmo
Blood osmolality (concentration) measurement	cpt	83930	6.61	6.61	5.88	5.88	128.47	128.47	107.06	107.06	O	6.61	6.61	humana medicare advantage	hmo
Blood osmolality (concentration) measurement	cpt	83930	6.61	6.61	5.88	5.88	128.47	128.47	107.06	107.06	O	6.61	6.61	humana medicare advantage	pos
Blood osmolality (concentration) measurement	cpt	83930	6.61	6.61	5.88	5.88	128.47	128.47	107.06	107.06	O	6.61	6.61	humana medicare advantage	ppo
Blood osmolality (concentration) measurement	cpt	83930	6.61	6.61	5.88	5.88	128.47	128.47	107.06	107.06	O	6.61	6.61	humana medicare advantage	hmo
Urine osmolality (concentration) measurement	cpt	83935	6.82	6.82	6.07	6.07	109.39	109.39	91.16	91.16	O	6.82	6.82	humana medicare advantage	hmo
Urine osmolality (concentration) measurement	cpt	83935	6.82	6.82	6.07	6.07	109.39	109.39	91.16	91.16	O	6.82	6.82	humana medicare advantage	pos
Urine osmolality (concentration) measurement	cpt	83935	6.82	6.82	6.07	6.07	109.39	109.39	91.16	91.16	O	6.82	6.82	humana medicare advantage	ppo
Urine osmolality (concentration) measurement	cpt	83935	6.82	6.82	6.07	6.07	109.39	109.39	91.16	91.16	O	6.82	6.82	humana medicare advantage	hmo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	41.28	41.28	humana medicare advantage	hmo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	41.28	41.28	humana medicare advantage	pos
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	41.28	41.28	humana medicare advantage	ppo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	41.28	41.28	humana medicare advantage	hmo
Body fluid pH level	cpt	83986	3.58	3.58	3.58	3.58	11.34	11.34	9.45	9.45	O	3.58	3.58	humana medicare advantage	hmo
Body fluid pH level	cpt	83986	3.58	3.58	3.58	3.58	11.34	11.34	9.45	9.45	O	3.58	3.58	humana medicare advantage	pos
Body fluid pH level	cpt	83986	3.58	3.58	3.58	3.58	11.34	11.34	9.45	9.45	O	3.58	3.58	humana medicare advantage	ppo
Body fluid pH level	cpt	83986	3.58	3.58	3.58	3.58	11.34	11.34	9.45	9.45	O	3.58	3.58	humana medicare advantage	hmo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	16.3	16.3	humana medicare advantage	hmo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	16.3	16.3	humana medicare advantage	pos
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	16.3	16.3	humana medicare advantage	ppo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	16.3	16.3	humana medicare advantage	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	humana medicare advantage	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	humana medicare advantage	pos
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	humana medicare advantage	ppo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	4.74	4.74	humana medicare advantage	hmo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	16.38	16.38	humana medicare advantage	hmo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	16.38	16.38	humana medicare advantage	pos
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	16.38	16.38	humana medicare advantage	ppo
"Cortisol (hormone) measurement, free"	cpt	82530	35.81	35.81	14.86	14.86	198.43	198.43	165.36	165.36	O	16.38	16.38	humana medicare advantage	hmo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	12.41	12.41	humana medicare advantage	hmo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	12.41	12.41	humana medicare advantage	pos
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	12.41	12.41	humana medicare advantage	ppo
Copper level	cpt	82525	39.38	39.38	11.04	11.04	77.59	77.59	64.66	64.66	O	12.41	12.41	humana medicare advantage	hmo
Urine potassium level	cpt	84133	4.73	4.73	4.21	4.21	44.06	44.06	36.72	36.72	O	4.73	4.73	humana medicare advantage	hmo
Urine potassium level	cpt	84133	4.73	4.73	4.21	4.21	44.06	44.06	36.72	36.72	O	4.73	4.73	humana medicare advantage	pos
Urine potassium level	cpt	84133	4.73	4.73	4.21	4.21	44.06	44.06	36.72	36.72	O	4.73	4.73	humana medicare advantage	ppo
Urine potassium level	cpt	84133	4.73	4.73	4.21	4.21	44.06	44.06	36.72	36.72	O	4.73	4.73	humana medicare advantage	hmo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.59	14.59	humana medicare advantage	hmo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.59	14.59	humana medicare advantage	pos
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.59	14.59	humana medicare advantage	ppo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	14.59	14.59	humana medicare advantage	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	humana medicare advantage	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	humana medicare advantage	pos
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	humana medicare advantage	ppo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	3.67	3.67	humana medicare advantage	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	3.67	3.67	humana medicare advantage	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	3.67	3.67	humana medicare advantage	pos
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	3.67	3.67	humana medicare advantage	ppo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	3.67	3.67	humana medicare advantage	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.11	5.11	humana medicare advantage	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.11	5.11	humana medicare advantage	pos
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.11	5.11	humana medicare advantage	ppo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	5.11	5.11	humana medicare advantage	hmo
"Total protein level, body fluid"	cpt	84157	4	4	3.56	3.56	97.94	97.94	81.62	81.62	O	4	4	humana medicare advantage	hmo
"Total protein level, body fluid"	cpt	84157	4	4	3.56	3.56	97.94	97.94	81.62	81.62	O	4	4	humana medicare advantage	pos
"Total protein level, body fluid"	cpt	84157	4	4	3.56	3.56	97.94	97.94	81.62	81.62	O	4	4	humana medicare advantage	ppo
"Total protein level, body fluid"	cpt	84157	4	4	3.56	3.56	97.94	97.94	81.62	81.62	O	4	4	humana medicare advantage	hmo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	37.73	37.73	humana medicare advantage	hmo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	37.73	37.73	humana medicare advantage	pos
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	37.73	37.73	humana medicare advantage	ppo
"Dihydroxyvitamin D, 1, 25 level"	cpt	82652	54.56	54.56	34.25	34.25	239.14	239.14	199.28	199.28	O	37.73	37.73	humana medicare advantage	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	humana medicare advantage	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	humana medicare advantage	pos
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	humana medicare advantage	ppo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	10.74	10.74	humana medicare advantage	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	29.6	29.6	humana medicare advantage	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	29.6	29.6	humana medicare advantage	pos
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	29.6	29.6	humana medicare advantage	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	29.6	29.6	humana medicare advantage	hmo
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	humana medicare advantage	hmo
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	humana medicare advantage	pos
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	humana medicare advantage	ppo
"Protein measurement, body fluid"	cpt	84166	17.9	17.9	17.83	17.83	66.14	66.14	55.12	55.12	O	17.83	17.83	humana medicare advantage	hmo
Blood sodium level	cpt	84295	4.81	4.81	3.22	3.22	40.44	40.44	33.7	33.7	O	4.81	4.81	humana medicare advantage	hmo
Blood sodium level	cpt	84295	4.81	4.81	3.22	3.22	40.44	40.44	33.7	33.7	O	4.81	4.81	humana medicare advantage	pos
Blood sodium level	cpt	84295	4.81	4.81	3.22	3.22	40.44	40.44	33.7	33.7	O	4.81	4.81	humana medicare advantage	ppo
Blood sodium level	cpt	84295	4.81	4.81	3.22	3.22	40.44	40.44	33.7	33.7	O	4.81	4.81	humana medicare advantage	hmo
Urine sodium level	cpt	84300	5.06	5.06	4.5	4.5	42.46	42.46	35.38	35.38	O	5.06	5.06	humana medicare advantage	hmo
Urine sodium level	cpt	84300	5.06	5.06	4.5	4.5	42.46	42.46	35.38	35.38	O	5.06	5.06	humana medicare advantage	pos
Urine sodium level	cpt	84300	5.06	5.06	4.5	4.5	42.46	42.46	35.38	35.38	O	5.06	5.06	humana medicare advantage	ppo
Urine sodium level	cpt	84300	5.06	5.06	4.5	4.5	42.46	42.46	35.38	35.38	O	5.06	5.06	humana medicare advantage	hmo
Chemical analysis using spectrophotometry (light)	cpt	84311	8.13	8.13	7.2	7.2	24.3	24.3	20.25	20.25	O	8.1	8.1	humana medicare advantage	hmo
Chemical analysis using spectrophotometry (light)	cpt	84311	8.13	8.13	7.2	7.2	24.3	24.3	20.25	20.25	O	8.1	8.1	humana medicare advantage	pos
Chemical analysis using spectrophotometry (light)	cpt	84311	8.13	8.13	7.2	7.2	24.3	24.3	20.25	20.25	O	8.1	8.1	humana medicare advantage	ppo
Chemical analysis using spectrophotometry (light)	cpt	84311	8.13	8.13	7.2	7.2	24.3	24.3	20.25	20.25	O	8.1	8.1	humana medicare advantage	hmo
"Carbohydrate analysis, single qualitative"	cpt	84376	5.5	5.5	5.5	5.5	25.61	25.61	21.34	21.34	O	5.5	5.5	humana medicare advantage	hmo
"Carbohydrate analysis, single qualitative"	cpt	84376	5.5	5.5	5.5	5.5	25.61	25.61	21.34	21.34	O	5.5	5.5	humana medicare advantage	pos
"Carbohydrate analysis, single qualitative"	cpt	84376	5.5	5.5	5.5	5.5	25.61	25.61	21.34	21.34	O	5.5	5.5	humana medicare advantage	ppo
"Carbohydrate analysis, single qualitative"	cpt	84376	5.5	5.5	5.5	5.5	25.61	25.61	21.34	21.34	O	5.5	5.5	humana medicare advantage	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	25.47	25.47	humana medicare advantage	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	25.47	25.47	humana medicare advantage	pos
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	25.47	25.47	humana medicare advantage	ppo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	25.47	25.47	humana medicare advantage	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	25.81	25.81	humana medicare advantage	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	25.81	25.81	humana medicare advantage	pos
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	25.81	25.81	humana medicare advantage	ppo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	25.81	25.81	humana medicare advantage	hmo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	21.23	21.23	humana medicare advantage	hmo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	21.23	21.23	humana medicare advantage	pos
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	21.23	21.23	humana medicare advantage	ppo
Vitamin B-1 (thiamine) level	cpt	84425	23.54	23.54	18.88	18.88	148.82	148.82	124.02	124.02	O	21.23	21.23	humana medicare advantage	hmo
Thyroglobulin (thyroid related hormone) level	cpt	84432	16.13	16.13	14.29	14.29	100.49	100.49	83.74	83.74	O	16.06	16.06	humana medicare advantage	hmo
Thyroglobulin (thyroid related hormone) level	cpt	84432	16.13	16.13	14.29	14.29	100.49	100.49	83.74	83.74	O	16.06	16.06	humana medicare advantage	pos
Thyroglobulin (thyroid related hormone) level	cpt	84432	16.13	16.13	14.29	14.29	100.49	100.49	83.74	83.74	O	16.06	16.06	humana medicare advantage	ppo
Thyroglobulin (thyroid related hormone) level	cpt	84432	16.13	16.13	14.29	14.29	100.49	100.49	83.74	83.74	O	16.06	16.06	humana medicare advantage	hmo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	6.87	6.87	humana medicare advantage	hmo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	6.87	6.87	humana medicare advantage	pos
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	6.87	6.87	humana medicare advantage	ppo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	6.87	6.87	humana medicare advantage	hmo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	4.38	4.38	humana medicare advantage	hmo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	4.38	4.38	humana medicare advantage	pos
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	4.38	4.38	humana medicare advantage	ppo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	4.38	4.38	humana medicare advantage	hmo
Stool analysis for blood to screen for colon tumors	cpt	82270	4.29	4.29	4.29	4.29	39.43	39.43	32.86	32.86	E	4.29	4.29	humana medicare advantage	hmo
Stool analysis for blood to screen for colon tumors	cpt	82270	4.29	4.29	4.29	4.29	39.43	39.43	32.86	32.86	E	4.29	4.29	humana medicare advantage	pos
Stool analysis for blood to screen for colon tumors	cpt	82270	4.29	4.29	4.29	4.29	39.43	39.43	32.86	32.86	E	4.29	4.29	humana medicare advantage	ppo
Stool analysis for blood to screen for colon tumors	cpt	82270	4.29	4.29	4.29	4.29	39.43	39.43	32.86	32.86	E	4.29	4.29	humana medicare advantage	hmo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	10434.91	10434.91	humana medicare advantage	hmo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	10434.91	10434.91	humana medicare advantage	pos
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	10434.91	10434.91	humana medicare advantage	ppo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	10434.91	10434.91	humana medicare advantage	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	humana medicare advantage	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	humana medicare advantage	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	humana medicare advantage	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	humana medicare advantage	hmo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	14.18	14.18	humana medicare advantage	hmo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	14.18	14.18	humana medicare advantage	pos
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	14.18	14.18	humana medicare advantage	ppo
Vitamin E level	cpt	84446	14.18	14.18	12.66	12.66	90.31	90.31	75.26	75.26	O	14.18	14.18	humana medicare advantage	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	5.02	5.02	humana medicare advantage	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	5.02	5.02	humana medicare advantage	pos
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	5.02	5.02	humana medicare advantage	ppo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	5.02	5.02	humana medicare advantage	hmo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	5.3	5.3	humana medicare advantage	hmo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	5.3	5.3	humana medicare advantage	pos
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	5.3	5.3	humana medicare advantage	ppo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	5.3	5.3	humana medicare advantage	hmo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	humana medicare advantage	hmo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	humana medicare advantage	pos
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	humana medicare advantage	ppo
Beta-2 microglobulin (protein) level	cpt	82232	28.98	28.98	14.39	14.39	109.39	109.39	91.16	91.16	O	16.18	16.18	humana medicare advantage	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	humana medicare advantage	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	humana medicare advantage	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	humana medicare advantage	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	humana medicare advantage	hmo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	21.09	21.09	humana medicare advantage	hmo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	21.09	21.09	humana medicare advantage	pos
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	21.09	21.09	humana medicare advantage	ppo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	21.09	21.09	humana medicare advantage	hmo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	14.6	14.6	humana medicare advantage	hmo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	14.6	14.6	humana medicare advantage	pos
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	14.6	14.6	humana medicare advantage	ppo
Angiotensin l - converting enzyme (ACE) level	cpt	82164	21.69	21.69	12.99	12.99	109.39	109.39	91.16	91.16	O	14.6	14.6	humana medicare advantage	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	16.94	16.94	humana medicare advantage	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	16.94	16.94	humana medicare advantage	pos
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	16.94	16.94	humana medicare advantage	ppo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	16.94	16.94	humana medicare advantage	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	90.8	90.8	humana medicare advantage	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	90.8	90.8	humana medicare advantage	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	90.8	90.8	humana medicare advantage	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	90.8	90.8	humana medicare advantage	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	humana medicare advantage	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	humana medicare advantage	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	humana medicare advantage	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.48	6.48	humana medicare advantage	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	humana medicare advantage	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	humana medicare advantage	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	humana medicare advantage	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	12.47	12.47	humana medicare advantage	hmo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	3.95	3.95	humana medicare advantage	hmo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	3.95	3.95	humana medicare advantage	pos
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	3.95	3.95	humana medicare advantage	ppo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	3.95	3.95	humana medicare advantage	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.52	4.52	humana medicare advantage	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.52	4.52	humana medicare advantage	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.52	4.52	humana medicare advantage	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.52	4.52	humana medicare advantage	hmo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	hmo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	pos
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	ppo
Ammonia level	cpt	82140	68.52	68.52	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	hmo
Uric acid level	cpt	84560	5.08	5.08	5.08	5.08	142.14	142.14	118.45	118.45	O	5.08	5.08	humana medicare advantage	hmo
Uric acid level	cpt	84560	5.08	5.08	5.08	5.08	142.14	142.14	118.45	118.45	O	5.08	5.08	humana medicare advantage	pos
Uric acid level	cpt	84560	5.08	5.08	5.08	5.08	142.14	142.14	118.45	118.45	O	5.08	5.08	humana medicare advantage	ppo
Uric acid level	cpt	84560	5.08	5.08	5.08	5.08	142.14	142.14	118.45	118.45	O	5.08	5.08	humana medicare advantage	hmo
Vasoactive intestinal peptide (intestinal hormone) level	cpt	84586	35.33	35.33	35.33	35.33	106	106	88.33	88.33	O	35.33	35.33	humana medicare advantage	hmo
Vasoactive intestinal peptide (intestinal hormone) level	cpt	84586	35.33	35.33	35.33	35.33	106	106	88.33	88.33	O	35.33	35.33	humana medicare advantage	pos
Vasoactive intestinal peptide (intestinal hormone) level	cpt	84586	35.33	35.33	35.33	35.33	106	106	88.33	88.33	O	35.33	35.33	humana medicare advantage	ppo
Vasoactive intestinal peptide (intestinal hormone) level	cpt	84586	35.33	35.33	35.33	35.33	106	106	88.33	88.33	O	35.33	35.33	humana medicare advantage	hmo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	16.77	16.77	humana medicare advantage	hmo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	16.77	16.77	humana medicare advantage	pos
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	16.77	16.77	humana medicare advantage	ppo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	16.77	16.77	humana medicare advantage	hmo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	13.44	13.44	humana medicare advantage	hmo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	13.44	13.44	humana medicare advantage	pos
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	13.44	13.44	humana medicare advantage	ppo
"Alpha-1-antitrypsin (protein) blood test, total"	cpt	82103	13.44	13.44	11.95	11.95	80.14	80.14	66.78	66.78	O	13.44	13.44	humana medicare advantage	hmo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	20.81	20.81	humana medicare advantage	hmo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	20.81	20.81	humana medicare advantage	pos
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	20.81	20.81	humana medicare advantage	ppo
C-peptide (protein) level	cpt	84681	49.41	49.41	18.51	18.51	100.49	100.49	83.74	83.74	O	20.81	20.81	humana medicare advantage	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	humana medicare advantage	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	humana medicare advantage	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	humana medicare advantage	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	humana medicare advantage	hmo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	37.89	37.89	humana medicare advantage	hmo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	37.89	37.89	humana medicare advantage	pos
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	37.89	37.89	humana medicare advantage	ppo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	37.89	37.89	humana medicare advantage	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	8.17	8.17	humana medicare advantage	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	8.17	8.17	humana medicare advantage	pos
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	8.17	8.17	humana medicare advantage	ppo
"Ketone bodies analysis, quantitative"	cpt	82010	16.5	16.5	7.27	7.27	90.36	90.36	75.3	75.3	O	8.17	8.17	humana medicare advantage	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	3.99	3.99	humana medicare advantage	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	3.99	3.99	humana medicare advantage	pos
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	3.99	3.99	humana medicare advantage	ppo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	3.99	3.99	humana medicare advantage	hmo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	4.48	4.48	humana medicare advantage	hmo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	4.48	4.48	humana medicare advantage	pos
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	4.48	4.48	humana medicare advantage	ppo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	4.48	4.48	humana medicare advantage	hmo
Gene analysis (hemochromatosis) common variants	cpt	81256	64.05	64.05	64.05	64.05	382.87	382.87	319.06	319.06	E	64.05	64.05	humana medicare advantage	hmo
Gene analysis (hemochromatosis) common variants	cpt	81256	64.05	64.05	64.05	64.05	382.87	382.87	319.06	319.06	E	64.05	64.05	humana medicare advantage	pos
Gene analysis (hemochromatosis) common variants	cpt	81256	64.05	64.05	64.05	64.05	382.87	382.87	319.06	319.06	E	64.05	64.05	humana medicare advantage	ppo
Gene analysis (hemochromatosis) common variants	cpt	81256	64.05	64.05	64.05	64.05	382.87	382.87	319.06	319.06	E	64.05	64.05	humana medicare advantage	hmo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	3.64	3.64	humana medicare advantage	hmo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	3.64	3.64	humana medicare advantage	pos
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	3.64	3.64	humana medicare advantage	ppo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	3.64	3.64	humana medicare advantage	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	10.18	10.18	humana medicare advantage	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	10.18	10.18	humana medicare advantage	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	10.18	10.18	humana medicare advantage	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	10.18	10.18	humana medicare advantage	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	humana medicare advantage	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	humana medicare advantage	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	humana medicare advantage	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	humana medicare advantage	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	17.14	17.14	humana medicare advantage	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	17.14	17.14	humana medicare advantage	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	17.14	17.14	humana medicare advantage	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	17.14	17.14	humana medicare advantage	hmo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	15.05	15.05	humana medicare advantage	hmo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	15.05	15.05	humana medicare advantage	pos
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	15.05	15.05	humana medicare advantage	ppo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	15.05	15.05	humana medicare advantage	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	12.09	12.09	humana medicare advantage	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	12.09	12.09	humana medicare advantage	pos
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	12.09	12.09	humana medicare advantage	ppo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	12.09	12.09	humana medicare advantage	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	humana medicare advantage	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	humana medicare advantage	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	humana medicare advantage	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	humana medicare advantage	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	12.95	12.95	humana medicare advantage	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	12.95	12.95	humana medicare advantage	pos
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	12.95	12.95	humana medicare advantage	ppo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	12.95	12.95	humana medicare advantage	hmo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	humana medicare advantage	hmo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	humana medicare advantage	pos
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	humana medicare advantage	ppo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	humana medicare advantage	hmo
Theophylline level	cpt	80198	14.14	14.14	14.14	14.14	106.85	106.85	89.04	89.04	O	14.14	14.14	humana medicare advantage	hmo
Theophylline level	cpt	80198	14.14	14.14	14.14	14.14	106.85	106.85	89.04	89.04	O	14.14	14.14	humana medicare advantage	pos
Theophylline level	cpt	80198	14.14	14.14	14.14	14.14	106.85	106.85	89.04	89.04	O	14.14	14.14	humana medicare advantage	ppo
Theophylline level	cpt	80198	14.14	14.14	14.14	14.14	106.85	106.85	89.04	89.04	O	14.14	14.14	humana medicare advantage	hmo
"Measurement of complement (immune system proteins), antigen,"	cpt	86160	12.05	12.05	10.67	10.67	54.7	54.7	45.58	45.58	O	12	12	humana medicare advantage	hmo
"Measurement of complement (immune system proteins), antigen,"	cpt	86160	12.05	12.05	10.67	10.67	54.7	54.7	45.58	45.58	O	12	12	humana medicare advantage	pos
"Measurement of complement (immune system proteins), antigen,"	cpt	86160	12.05	12.05	10.67	10.67	54.7	54.7	45.58	45.58	O	12	12	humana medicare advantage	ppo
"Measurement of complement (immune system proteins), antigen,"	cpt	86160	12.05	12.05	10.67	10.67	54.7	54.7	45.58	45.58	O	12	12	humana medicare advantage	hmo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	humana medicare advantage	hmo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	humana medicare advantage	pos
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	humana medicare advantage	ppo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	humana medicare advantage	hmo
Tacrolimus level	cpt	80197	13.73	13.73	13.46	13.46	727.58	727.58	606.32	606.32	O	13.73	13.73	humana medicare advantage	hmo
Tacrolimus level	cpt	80197	13.73	13.73	13.46	13.46	727.58	727.58	606.32	606.32	O	13.73	13.73	humana medicare advantage	pos
Tacrolimus level	cpt	80197	13.73	13.73	13.46	13.46	727.58	727.58	606.32	606.32	O	13.73	13.73	humana medicare advantage	ppo
Tacrolimus level	cpt	80197	13.73	13.73	13.46	13.46	727.58	727.58	606.32	606.32	O	13.73	13.73	humana medicare advantage	hmo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	12.95	12.95	humana medicare advantage	hmo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	12.95	12.95	humana medicare advantage	pos
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	12.95	12.95	humana medicare advantage	ppo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	12.95	12.95	humana medicare advantage	hmo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	13.25	13.25	humana medicare advantage	hmo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	13.25	13.25	humana medicare advantage	pos
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	13.25	13.25	humana medicare advantage	ppo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	13.25	13.25	humana medicare advantage	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	17.93	17.93	humana medicare advantage	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	17.93	17.93	humana medicare advantage	pos
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	17.93	17.93	humana medicare advantage	ppo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	17.93	17.93	humana medicare advantage	hmo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	6.61	6.61	humana medicare advantage	hmo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	6.61	6.61	humana medicare advantage	pos
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	6.61	6.61	humana medicare advantage	ppo
Lithium level	cpt	80178	27.09	27.09	5.88	5.88	60.67	60.67	50.56	50.56	O	6.61	6.61	humana medicare advantage	hmo
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	humana medicare advantage	hmo
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	humana medicare advantage	pos
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	humana medicare advantage	ppo
Levetiracetam level	cpt	80177	13.25	13.25	11.79	11.79	77.59	77.59	64.66	64.66	O	13.25	13.25	humana medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	humana medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	humana medicare advantage	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	humana medicare advantage	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.81	20.81	humana medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 125"	cpt	86304	43.28	43.28	18.51	18.51	109.39	109.39	91.16	91.16	O	20.81	20.81	humana medicare advantage	hmo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.54	13.54	humana medicare advantage	hmo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.54	13.54	humana medicare advantage	pos
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.54	13.54	humana medicare advantage	ppo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	13.54	13.54	humana medicare advantage	hmo
Analysis for detection of tumor marker	cpt	86316	22.06	22.06	18.51	18.51	133.56	133.56	111.3	111.3	O	20.81	20.81	humana medicare advantage	hmo
Analysis for detection of tumor marker	cpt	86316	22.06	22.06	18.51	18.51	133.56	133.56	111.3	111.3	O	20.81	20.81	humana medicare advantage	pos
Analysis for detection of tumor marker	cpt	86316	22.06	22.06	18.51	18.51	133.56	133.56	111.3	111.3	O	20.81	20.81	humana medicare advantage	ppo
Analysis for detection of tumor marker	cpt	86316	22.06	22.06	18.51	18.51	133.56	133.56	111.3	111.3	O	20.81	20.81	humana medicare advantage	hmo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	13.15	13.15	humana medicare advantage	hmo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	13.15	13.15	humana medicare advantage	pos
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	13.15	13.15	humana medicare advantage	ppo
"Digoxin level, total"	cpt	80162	15.53	15.53	13.01	13.01	109.26	109.26	91.05	91.05	O	13.15	13.15	humana medicare advantage	hmo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	humana medicare advantage	hmo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	humana medicare advantage	pos
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	humana medicare advantage	ppo
Immunologic analysis technique on serum (immunofixation)	cpt	86334	22.43	22.43	19.87	19.87	142.46	142.46	118.72	118.72	O	22.34	22.34	humana medicare advantage	hmo
"Carbamazepine level, total"	cpt	80156	14.57	14.57	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	hmo
"Carbamazepine level, total"	cpt	80156	14.57	14.57	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	pos
"Carbamazepine level, total"	cpt	80156	14.57	14.57	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	ppo
"Carbamazepine level, total"	cpt	80156	14.57	14.57	12.96	12.96	117.02	117.02	97.52	97.52	O	14.57	14.57	humana medicare advantage	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	47.63	47.63	humana medicare advantage	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	47.63	47.63	humana medicare advantage	pos
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	47.63	47.63	humana medicare advantage	ppo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	47.63	47.63	humana medicare advantage	hmo
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	humana medicare advantage	hmo
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	humana medicare advantage	pos
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	humana medicare advantage	ppo
"Immunologic analysis technique on body fluid, other fluids with concentration"	cpt	86335	29.47	29.47	29.35	29.35	228.96	228.96	190.8	190.8	O	29.35	29.35	humana medicare advantage	hmo
Insulin antibody measurement	cpt	86337	21.41	21.41	19.04	19.04	109.39	109.39	91.16	91.16	O	21.41	21.41	humana medicare advantage	hmo
Insulin antibody measurement	cpt	86337	21.41	21.41	19.04	19.04	109.39	109.39	91.16	91.16	O	21.41	21.41	humana medicare advantage	pos
Insulin antibody measurement	cpt	86337	21.41	21.41	19.04	19.04	109.39	109.39	91.16	91.16	O	21.41	21.41	humana medicare advantage	ppo
Insulin antibody measurement	cpt	86337	21.41	21.41	19.04	19.04	109.39	109.39	91.16	91.16	O	21.41	21.41	humana medicare advantage	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.55	14.55	humana medicare advantage	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.55	14.55	humana medicare advantage	pos
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.55	14.55	humana medicare advantage	ppo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	14.55	14.55	humana medicare advantage	hmo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	11.54	11.54	humana medicare advantage	hmo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	11.54	11.54	humana medicare advantage	pos
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	11.54	11.54	humana medicare advantage	ppo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	11.54	11.54	humana medicare advantage	hmo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	7.01	7.01	humana medicare advantage	hmo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	7.01	7.01	humana medicare advantage	pos
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	7.01	7.01	humana medicare advantage	ppo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	7.01	7.01	humana medicare advantage	hmo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.14	6.14	humana medicare advantage	hmo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.14	6.14	humana medicare advantage	pos
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.14	6.14	humana medicare advantage	ppo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	6.14	6.14	humana medicare advantage	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	61.98	61.98	humana medicare advantage	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	61.98	61.98	humana medicare advantage	pos
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	61.98	61.98	humana medicare advantage	ppo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	61.98	61.98	humana medicare advantage	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	4.27	4.27	humana medicare advantage	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	4.27	4.27	humana medicare advantage	pos
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	4.27	4.27	humana medicare advantage	ppo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	4.27	4.27	humana medicare advantage	hmo
"Radioactive material therapy into vein, not radiolabeled"	cpt	79101	210.31	210.31	210.31	210.31	627.1	627.1	522.58	522.58	O	210.31	210.31	humana medicare advantage	hmo
"Radioactive material therapy into vein, not radiolabeled"	cpt	79101	210.31	210.31	210.31	210.31	627.1	627.1	522.58	522.58	O	210.31	210.31	humana medicare advantage	pos
"Radioactive material therapy into vein, not radiolabeled"	cpt	79101	210.31	210.31	210.31	210.31	627.1	627.1	522.58	522.58	O	210.31	210.31	humana medicare advantage	ppo
"Radioactive material therapy into vein, not radiolabeled"	cpt	79101	210.31	210.31	210.31	210.31	627.1	627.1	522.58	522.58	O	210.31	210.31	humana medicare advantage	hmo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	17.03	17.03	humana medicare advantage	hmo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	17.03	17.03	humana medicare advantage	pos
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	17.03	17.03	humana medicare advantage	ppo
Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)	cpt	86618	44.5	44.5	15.15	15.15	305.28	305.28	254.4	254.4	O	17.03	17.03	humana medicare advantage	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	humana medicare advantage	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	humana medicare advantage	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	humana medicare advantage	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	humana medicare advantage	hmo
"Nuclear medicine study of kidney with assessment of blood flow and function, with or without drugs, multiple studies"	cpt	78709	418.12	418.12	260.45	260.45	1436.09	1436.09	1196.74	1196.74	O	418.12	418.12	humana medicare advantage	hmo
"Nuclear medicine study of kidney with assessment of blood flow and function, with or without drugs, multiple studies"	cpt	78709	418.12	418.12	260.45	260.45	1436.09	1436.09	1196.74	1196.74	O	418.12	418.12	humana medicare advantage	pos
"Nuclear medicine study of kidney with assessment of blood flow and function, with or without drugs, multiple studies"	cpt	78709	418.12	418.12	260.45	260.45	1436.09	1436.09	1196.74	1196.74	O	418.12	418.12	humana medicare advantage	ppo
"Nuclear medicine study of kidney with assessment of blood flow and function, with or without drugs, multiple studies"	cpt	78709	418.12	418.12	260.45	260.45	1436.09	1436.09	1196.74	1196.74	O	418.12	418.12	humana medicare advantage	hmo
"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study, gated equilibrium"	cpt	78472	326.12	326.12	320.9	320.9	2477.86	2477.86	2064.88	2064.88	O	326.12	326.12	humana medicare advantage	hmo
"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study, gated equilibrium"	cpt	78472	326.12	326.12	320.9	320.9	2477.86	2477.86	2064.88	2064.88	O	326.12	326.12	humana medicare advantage	pos
"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study, gated equilibrium"	cpt	78472	326.12	326.12	320.9	320.9	2477.86	2477.86	2064.88	2064.88	O	326.12	326.12	humana medicare advantage	ppo
"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study, gated equilibrium"	cpt	78472	326.12	326.12	320.9	320.9	2477.86	2477.86	2064.88	2064.88	O	326.12	326.12	humana medicare advantage	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	13.19	13.19	humana medicare advantage	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	13.19	13.19	humana medicare advantage	pos
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	13.19	13.19	humana medicare advantage	ppo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	13.19	13.19	humana medicare advantage	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	19.35	19.35	humana medicare advantage	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	19.35	19.35	humana medicare advantage	pos
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	19.35	19.35	humana medicare advantage	ppo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	19.35	19.35	humana medicare advantage	hmo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	12.05	12.05	humana medicare advantage	hmo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	12.05	12.05	humana medicare advantage	pos
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	12.05	12.05	humana medicare advantage	ppo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	12.05	12.05	humana medicare advantage	hmo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	11.65	11.65	humana medicare advantage	hmo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	11.65	11.65	humana medicare advantage	pos
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	11.65	11.65	humana medicare advantage	ppo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	11.65	11.65	humana medicare advantage	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	10.74	10.74	humana medicare advantage	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	10.74	10.74	humana medicare advantage	pos
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	10.74	10.74	humana medicare advantage	ppo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	10.74	10.74	humana medicare advantage	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1127.01	1127.01	humana medicare advantage	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1127.01	1127.01	humana medicare advantage	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1127.01	1127.01	humana medicare advantage	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1127.01	1127.01	humana medicare advantage	hmo
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	11.26	11.26	humana medicare advantage	hmo
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	11.26	11.26	humana medicare advantage	pos
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	11.26	11.26	humana medicare advantage	ppo
Measurement of Hepatitis A antibody (IgM)	cpt	86709	58.16	58.16	10.02	10.02	114.6	114.6	95.5	95.5	O	11.26	11.26	humana medicare advantage	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	1127.01	1127.01	humana medicare advantage	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	1127.01	1127.01	humana medicare advantage	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	1127.01	1127.01	humana medicare advantage	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	1127.01	1127.01	humana medicare advantage	hmo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	326.12	326.12	humana medicare advantage	hmo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	326.12	326.12	humana medicare advantage	pos
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	326.12	326.12	humana medicare advantage	ppo
"Bone and/or joint imaging, whole body"	cpt	78306	522.98	522.98	227.53	227.53	1878	1878	1565	1565	O	326.12	326.12	humana medicare advantage	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	415.66	415.66	humana medicare advantage	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	415.66	415.66	humana medicare advantage	pos
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	415.66	415.66	humana medicare advantage	ppo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	415.66	415.66	humana medicare advantage	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	12.88	12.88	humana medicare advantage	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	12.88	12.88	humana medicare advantage	pos
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	12.88	12.88	humana medicare advantage	ppo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	12.88	12.88	humana medicare advantage	hmo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.91	15.91	humana medicare advantage	hmo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.91	15.91	humana medicare advantage	pos
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.91	15.91	humana medicare advantage	ppo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	15.91	15.91	humana medicare advantage	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	14.27	14.27	humana medicare advantage	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	14.27	14.27	humana medicare advantage	pos
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	14.27	14.27	humana medicare advantage	ppo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	14.27	14.27	humana medicare advantage	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	78	78	humana medicare advantage	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	78	78	humana medicare advantage	pos
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	78	78	humana medicare advantage	ppo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	78	78	humana medicare advantage	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	209.39	209.39	humana medicare advantage	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	209.39	209.39	humana medicare advantage	pos
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	209.39	209.39	humana medicare advantage	ppo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	209.39	209.39	humana medicare advantage	hmo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	29.61	29.61	humana medicare advantage	hmo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	29.61	29.61	humana medicare advantage	pos
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	29.61	29.61	humana medicare advantage	ppo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	29.61	29.61	humana medicare advantage	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	96.59	96.59	humana medicare advantage	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	96.59	96.59	humana medicare advantage	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	96.59	96.59	humana medicare advantage	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	96.59	96.59	humana medicare advantage	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	477.34	477.34	humana medicare advantage	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	477.34	477.34	humana medicare advantage	pos
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	477.34	477.34	humana medicare advantage	ppo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	477.34	477.34	humana medicare advantage	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	70.1	70.1	humana medicare advantage	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	70.1	70.1	humana medicare advantage	pos
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	70.1	70.1	humana medicare advantage	ppo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	70.1	70.1	humana medicare advantage	hmo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	467.79	467.79	humana medicare advantage	hmo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	467.79	467.79	humana medicare advantage	pos
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	467.79	467.79	humana medicare advantage	ppo
"Intensity modulated radiation therapy delivery, simple"	cpt	77385	717.88	717.88	467.79	467.79	1925.81	1925.81	1604.84	1604.84	O	467.79	467.79	humana medicare advantage	hmo
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	1536.3	1536.3	humana medicare advantage	hmo
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	1536.3	1536.3	humana medicare advantage	pos
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	1536.3	1536.3	humana medicare advantage	ppo
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	1536.3	1536.3	humana medicare advantage	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	62.74	62.74	humana medicare advantage	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	62.74	62.74	humana medicare advantage	pos
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	62.74	62.74	humana medicare advantage	ppo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	62.74	62.74	humana medicare advantage	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	296.91	296.91	humana medicare advantage	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	296.91	296.91	humana medicare advantage	pos
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	296.91	296.91	humana medicare advantage	ppo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	296.91	296.91	humana medicare advantage	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	9.44	9.44	humana medicare advantage	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	9.44	9.44	humana medicare advantage	pos
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	9.44	9.44	humana medicare advantage	ppo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	9.44	9.44	humana medicare advantage	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	112.14	112.14	humana medicare advantage	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	112.14	112.14	humana medicare advantage	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	112.14	112.14	humana medicare advantage	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	112.14	112.14	humana medicare advantage	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.44	9.44	humana medicare advantage	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.44	9.44	humana medicare advantage	pos
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.44	9.44	humana medicare advantage	ppo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	9.44	9.44	humana medicare advantage	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	8.62	8.62	humana medicare advantage	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	8.62	8.62	humana medicare advantage	pos
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	8.62	8.62	humana medicare advantage	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	8.62	8.62	humana medicare advantage	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	9.47	9.47	humana medicare advantage	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	9.47	9.47	humana medicare advantage	pos
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	9.47	9.47	humana medicare advantage	ppo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	9.47	9.47	humana medicare advantage	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	humana medicare advantage	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	humana medicare advantage	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	humana medicare advantage	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	humana medicare advantage	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	humana medicare advantage	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	humana medicare advantage	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	humana medicare advantage	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	296.91	296.91	humana medicare advantage	hmo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	6.63	6.63	humana medicare advantage	hmo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	6.63	6.63	humana medicare advantage	pos
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	6.63	6.63	humana medicare advantage	ppo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	6.63	6.63	humana medicare advantage	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	humana medicare advantage	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	humana medicare advantage	pos
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	humana medicare advantage	ppo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	humana medicare advantage	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	humana medicare advantage	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	humana medicare advantage	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	humana medicare advantage	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	humana medicare advantage	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.41	8.41	humana medicare advantage	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.41	8.41	humana medicare advantage	pos
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.41	8.41	humana medicare advantage	ppo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	8.41	8.41	humana medicare advantage	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	humana medicare advantage	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	humana medicare advantage	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	humana medicare advantage	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	humana medicare advantage	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1103.22	1103.22	humana medicare advantage	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1103.22	1103.22	humana medicare advantage	pos
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1103.22	1103.22	humana medicare advantage	ppo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	1103.22	1103.22	humana medicare advantage	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	109.9	109.9	humana medicare advantage	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	109.9	109.9	humana medicare advantage	pos
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	109.9	109.9	humana medicare advantage	ppo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	109.9	109.9	humana medicare advantage	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	8.9	8.9	humana medicare advantage	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	8.9	8.9	humana medicare advantage	pos
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	8.9	8.9	humana medicare advantage	ppo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	8.9	8.9	humana medicare advantage	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	4.75	4.75	humana medicare advantage	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	4.75	4.75	humana medicare advantage	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	4.75	4.75	humana medicare advantage	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	4.75	4.75	humana medicare advantage	hmo
"Detection of antimicrobial drug (antibiotic, antifungal, antiviral)"	cpt	87185	4.75	4.75	4.23	4.23	20.95	20.95	17.46	17.46	O	4.75	4.75	humana medicare advantage	hmo
"Detection of antimicrobial drug (antibiotic, antifungal, antiviral)"	cpt	87185	4.75	4.75	4.23	4.23	20.95	20.95	17.46	17.46	O	4.75	4.75	humana medicare advantage	pos
"Detection of antimicrobial drug (antibiotic, antifungal, antiviral)"	cpt	87185	4.75	4.75	4.23	4.23	20.95	20.95	17.46	17.46	O	4.75	4.75	humana medicare advantage	ppo
"Detection of antimicrobial drug (antibiotic, antifungal, antiviral)"	cpt	87185	4.75	4.75	4.23	4.23	20.95	20.95	17.46	17.46	O	4.75	4.75	humana medicare advantage	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	humana medicare advantage	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	humana medicare advantage	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	humana medicare advantage	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	humana medicare advantage	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.27	4.27	humana medicare advantage	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.27	4.27	humana medicare advantage	pos
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.27	4.27	humana medicare advantage	ppo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	4.27	4.27	humana medicare advantage	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1092.69	1092.69	humana medicare advantage	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1092.69	1092.69	humana medicare advantage	pos
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1092.69	1092.69	humana medicare advantage	ppo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1092.69	1092.69	humana medicare advantage	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	pos
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	ppo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	humana medicare advantage	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	humana medicare advantage	pos
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	humana medicare advantage	ppo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	296.91	296.91	humana medicare advantage	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	14.38	14.38	humana medicare advantage	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	14.38	14.38	humana medicare advantage	pos
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	14.38	14.38	humana medicare advantage	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	14.38	14.38	humana medicare advantage	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.33	10.33	humana medicare advantage	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.33	10.33	humana medicare advantage	pos
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.33	10.33	humana medicare advantage	ppo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	10.33	10.33	humana medicare advantage	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	112.14	112.14	humana medicare advantage	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	112.14	112.14	humana medicare advantage	pos
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	112.14	112.14	humana medicare advantage	ppo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	112.14	112.14	humana medicare advantage	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	24.08	24.08	humana medicare advantage	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	24.08	24.08	humana medicare advantage	pos
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	24.08	24.08	humana medicare advantage	ppo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	24.08	24.08	humana medicare advantage	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	99.29	99.29	humana medicare advantage	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	99.29	99.29	humana medicare advantage	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	99.29	99.29	humana medicare advantage	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	99.29	99.29	humana medicare advantage	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	pos
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	ppo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	11.98	11.98	humana medicare advantage	hmo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	99.29	99.29	humana medicare advantage	hmo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	99.29	99.29	humana medicare advantage	pos
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	99.29	99.29	humana medicare advantage	ppo
X-ray survey of forearm or wrist bone density	cpt	77075	99.29	99.29	61.44	61.44	747.94	747.94	623.28	623.28	O	99.29	99.29	humana medicare advantage	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	humana medicare advantage	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	humana medicare advantage	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	humana medicare advantage	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	humana medicare advantage	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	humana medicare advantage	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	humana medicare advantage	pos
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	humana medicare advantage	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	37.27	37.27	humana medicare advantage	hmo
"Detection test by nucleic acid for cytomegalovirus, quantification"	cpt	87497	42.84	42.84	38.11	38.11	250.58	250.58	208.82	208.82	O	42.84	42.84	humana medicare advantage	hmo
"Detection test by nucleic acid for cytomegalovirus, quantification"	cpt	87497	42.84	42.84	38.11	38.11	250.58	250.58	208.82	208.82	O	42.84	42.84	humana medicare advantage	pos
"Detection test by nucleic acid for cytomegalovirus, quantification"	cpt	87497	42.84	42.84	38.11	38.11	250.58	250.58	208.82	208.82	O	42.84	42.84	humana medicare advantage	ppo
"Detection test by nucleic acid for cytomegalovirus, quantification"	cpt	87497	42.84	42.84	38.11	38.11	250.58	250.58	208.82	208.82	O	42.84	42.84	humana medicare advantage	hmo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	99.29	99.29	humana medicare advantage	hmo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	99.29	99.29	humana medicare advantage	pos
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	99.29	99.29	humana medicare advantage	ppo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	99.29	99.29	humana medicare advantage	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	humana medicare advantage	hmo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	42.84	42.84	humana medicare advantage	hmo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	42.84	42.84	humana medicare advantage	pos
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	42.84	42.84	humana medicare advantage	ppo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	42.84	42.84	humana medicare advantage	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	35.09	35.09	humana medicare advantage	pos
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	35.09	35.09	humana medicare advantage	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	35.09	35.09	humana medicare advantage	pos
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	35.09	35.09	humana medicare advantage	ppo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	humana medicare advantage	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	humana medicare advantage	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	humana medicare advantage	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	humana medicare advantage	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	35.09	35.09	humana medicare advantage	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	35.09	35.09	humana medicare advantage	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	35.09	35.09	humana medicare advantage	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	35.09	35.09	humana medicare advantage	hmo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	257.45	257.45	humana medicare advantage	hmo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	257.45	257.45	humana medicare advantage	pos
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	257.45	257.45	humana medicare advantage	ppo
Analysis test by nucleic acid for Hepatitis C virus	cpt	87902	257.45	257.45	73.57	73.57	889.13	889.13	740.94	740.94	O	257.45	257.45	humana medicare advantage	hmo
"Screening examination of specimen cells, extended study"	cpt	88162	50.58	50.58	43.82	43.82	580.98	580.98	484.15	484.15	O	43.82	43.82	humana medicare advantage	hmo
"Screening examination of specimen cells, extended study"	cpt	88162	50.58	50.58	43.82	43.82	580.98	580.98	484.15	484.15	O	43.82	43.82	humana medicare advantage	pos
"Screening examination of specimen cells, extended study"	cpt	88162	50.58	50.58	43.82	43.82	580.98	580.98	484.15	484.15	O	43.82	43.82	humana medicare advantage	ppo
"Screening examination of specimen cells, extended study"	cpt	88162	50.58	50.58	43.82	43.82	580.98	580.98	484.15	484.15	O	43.82	43.82	humana medicare advantage	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	26.61	26.61	humana medicare advantage	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	26.61	26.61	humana medicare advantage	pos
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	26.61	26.61	humana medicare advantage	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	26.61	26.61	humana medicare advantage	hmo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	99.29	99.29	humana medicare advantage	hmo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	99.29	99.29	humana medicare advantage	pos
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	99.29	99.29	humana medicare advantage	ppo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	99.29	99.29	humana medicare advantage	hmo
"Flow cytometry technique for DNA or cell analysis, first marker"	cpt	88184	121.47	121.47	121.47	121.47	180	180	150	150	O	121.47	121.47	humana medicare advantage	hmo
"Flow cytometry technique for DNA or cell analysis, first marker"	cpt	88184	121.47	121.47	121.47	121.47	180	180	150	150	O	121.47	121.47	humana medicare advantage	pos
"Flow cytometry technique for DNA or cell analysis, first marker"	cpt	88184	121.47	121.47	121.47	121.47	180	180	150	150	O	121.47	121.47	humana medicare advantage	ppo
"Flow cytometry technique for DNA or cell analysis, first marker"	cpt	88184	121.47	121.47	121.47	121.47	180	180	150	150	O	121.47	121.47	humana medicare advantage	hmo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	99.29	99.29	humana medicare advantage	pos
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	99.29	99.29	humana medicare advantage	ppo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	99.29	99.29	humana medicare advantage	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	43.82	43.82	humana medicare advantage	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	43.82	43.82	humana medicare advantage	pos
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	43.82	43.82	humana medicare advantage	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	43.82	43.82	humana medicare advantage	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	99.29	99.29	humana medicare advantage	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	99.29	99.29	humana medicare advantage	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	99.29	99.29	humana medicare advantage	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	99.29	99.29	humana medicare advantage	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	humana medicare advantage	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	humana medicare advantage	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	humana medicare advantage	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	99.29	99.29	humana medicare advantage	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	70.7	70.7	humana medicare advantage	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	70.7	70.7	humana medicare advantage	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	70.7	70.7	humana medicare advantage	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	70.7	70.7	humana medicare advantage	hmo
"Special stained specimen slides to examine tissue, each multiplex procedure"	cpt	88344	251.07	251.07	251.07	251.07	452.83	452.83	377.36	377.36	O	251.07	251.07	humana medicare advantage	hmo
"Special stained specimen slides to examine tissue, each multiplex procedure"	cpt	88344	251.07	251.07	251.07	251.07	452.83	452.83	377.36	377.36	O	251.07	251.07	humana medicare advantage	pos
"Special stained specimen slides to examine tissue, each multiplex procedure"	cpt	88344	251.07	251.07	251.07	251.07	452.83	452.83	377.36	377.36	O	251.07	251.07	humana medicare advantage	ppo
"Special stained specimen slides to examine tissue, each multiplex procedure"	cpt	88344	251.07	251.07	251.07	251.07	452.83	452.83	377.36	377.36	O	251.07	251.07	humana medicare advantage	hmo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	31.15	31.15	humana medicare advantage	hmo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	31.15	31.15	humana medicare advantage	pos
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	31.15	31.15	humana medicare advantage	ppo
"Microscopic genetic analysis of tumor, manual"	cpt	88360	175.74	175.74	31.15	31.15	375.3	375.3	312.75	312.75	O	31.15	31.15	humana medicare advantage	hmo
"Microscopic genetic analysis of tissue, manual, initial procedure"	cpt	88368	295	295	295	295	360	360	300	300	O	295	295	humana medicare advantage	hmo
"Microscopic genetic analysis of tissue, manual, initial procedure"	cpt	88368	295	295	295	295	360	360	300	300	O	295	295	humana medicare advantage	pos
"Microscopic genetic analysis of tissue, manual, initial procedure"	cpt	88368	295	295	295	295	360	360	300	300	O	295	295	humana medicare advantage	ppo
"Microscopic genetic analysis of tissue, manual, initial procedure"	cpt	88368	295	295	295	295	360	360	300	300	O	295	295	humana medicare advantage	hmo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	5.6	5.6	humana medicare advantage	hmo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	5.6	5.6	humana medicare advantage	pos
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	5.6	5.6	humana medicare advantage	ppo
Body fluid cell count with cell identification	cpt	89051	19.36	19.36	4.98	4.98	45.91	45.91	38.26	38.26	O	5.6	5.6	humana medicare advantage	hmo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	7.33	7.33	humana medicare advantage	hmo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	7.33	7.33	humana medicare advantage	pos
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	7.33	7.33	humana medicare advantage	ppo
Crystal identification from tissue or body fluid	cpt	89060	18.24	18.24	6.52	6.52	43.25	43.25	36.04	36.04	O	7.33	7.33	humana medicare advantage	hmo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	439.28	439.28	humana medicare advantage	hmo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	439.28	439.28	humana medicare advantage	pos
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	439.28	439.28	humana medicare advantage	ppo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	439.28	439.28	humana medicare advantage	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	humana medicare advantage	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	humana medicare advantage	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	humana medicare advantage	hmo
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	8959.3	8959.3	humana medicare advantage	hmo
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	8959.3	8959.3	humana medicare advantage	pos
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	8959.3	8959.3	humana medicare advantage	ppo
"Vaccine for influenza for injection into muscle, inactivated"	cpt	90653	8959.3	8959.3	1971.24	1971.24	14798.04	14798.04	12331.7	12331.7	E	8959.3	8959.3	humana medicare advantage	hmo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	50.63	50.63	humana medicare advantage	hmo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	50.63	50.63	humana medicare advantage	pos
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	50.63	50.63	humana medicare advantage	ppo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	50.63	50.63	humana medicare advantage	hmo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	2132.69	2132.69	2132.69	2132.69	16906.38	16906.38	14088.65	14088.65	E	2132.69	2132.69	humana medicare advantage	hmo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	2132.69	2132.69	2132.69	2132.69	16906.38	16906.38	14088.65	14088.65	E	2132.69	2132.69	humana medicare advantage	pos
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	2132.69	2132.69	2132.69	2132.69	16906.38	16906.38	14088.65	14088.65	E	2132.69	2132.69	humana medicare advantage	ppo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	2132.69	2132.69	2132.69	2132.69	16906.38	16906.38	14088.65	14088.65	E	2132.69	2132.69	humana medicare advantage	hmo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	601.12	601.12	humana medicare advantage	hmo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	601.12	601.12	humana medicare advantage	pos
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	601.12	601.12	humana medicare advantage	ppo
"Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, for injection into muscle, 0.5 ml dosage"	cpt	90694	14191.44	14191.44	356.43	356.43	2486.09	2486.09	2071.74	2071.74	O	601.12	601.12	humana medicare advantage	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	517.94	517.94	humana medicare advantage	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	517.94	517.94	humana medicare advantage	pos
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	517.94	517.94	humana medicare advantage	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	517.94	517.94	humana medicare advantage	hmo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	2455.02	2455.02	humana medicare advantage	hmo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	2455.02	2455.02	humana medicare advantage	pos
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	2455.02	2455.02	humana medicare advantage	ppo
Radiological supervision and interpretation of imaging of arteries of both arms or legs	cpt	75716	2455.02	2455.02	66.75	66.75	7289.83	7289.83	6074.86	6074.86	O	2455.02	2455.02	humana medicare advantage	hmo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	405.38	405.38	humana medicare advantage	hmo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	405.38	405.38	humana medicare advantage	pos
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	405.38	405.38	humana medicare advantage	ppo
CT scan of abdominal aorta and both leg arteries with contrast	cpt	75635	557.59	557.59	155.02	155.02	1985.59	1985.59	1654.66	1654.66	O	405.38	405.38	humana medicare advantage	hmo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2455.02	2455.02	humana medicare advantage	hmo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2455.02	2455.02	humana medicare advantage	pos
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2455.02	2455.02	humana medicare advantage	ppo
Radiological supervision and interpretation X-ray of abdominal aorta	cpt	75625	2526.65	2526.65	57.78	57.78	10861.61	10861.61	9051.34	9051.34	O	2455.02	2455.02	humana medicare advantage	hmo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	601.12	601.12	humana medicare advantage	hmo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	601.12	601.12	humana medicare advantage	pos
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	601.12	601.12	humana medicare advantage	ppo
"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older"	cpt	90732	21516.54	21516.54	70.16	70.16	420	420	350	350	O	601.12	601.12	humana medicare advantage	hmo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	2193.6	2193.6	2042.78	2042.78	18736.39	18736.39	15613.66	15613.66	E	2193.6	2193.6	humana medicare advantage	hmo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	2193.6	2193.6	2042.78	2042.78	18736.39	18736.39	15613.66	15613.66	E	2193.6	2193.6	humana medicare advantage	pos
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	2193.6	2193.6	2042.78	2042.78	18736.39	18736.39	15613.66	15613.66	E	2193.6	2193.6	humana medicare advantage	ppo
"Treatment of speech, language, voice, communication, and/or hearing processing disorder"	cpt	92507	2193.6	2193.6	2042.78	2042.78	18736.39	18736.39	15613.66	15613.66	E	2193.6	2193.6	humana medicare advantage	hmo
Evaluation of speech sound production with evaluation of language comprehension and expression	cpt	92523	2123.04	2123.04	1479.91	1479.91	16598.95	16598.95	13832.46	13832.46	E	2123.04	2123.04	humana medicare advantage	hmo
Evaluation of speech sound production with evaluation of language comprehension and expression	cpt	92523	2123.04	2123.04	1479.91	1479.91	16598.95	16598.95	13832.46	13832.46	E	2123.04	2123.04	humana medicare advantage	pos
Evaluation of speech sound production with evaluation of language comprehension and expression	cpt	92523	2123.04	2123.04	1479.91	1479.91	16598.95	16598.95	13832.46	13832.46	E	2123.04	2123.04	humana medicare advantage	ppo
Evaluation of speech sound production with evaluation of language comprehension and expression	cpt	92523	2123.04	2123.04	1479.91	1479.91	16598.95	16598.95	13832.46	13832.46	E	2123.04	2123.04	humana medicare advantage	hmo
Treatment of swallowing and/or oral feeding function	cpt	92526	2091.88	2091.88	2082.43	2082.43	12510.68	12510.68	10425.57	10425.57	E	2091.88	2091.88	humana medicare advantage	hmo
Treatment of swallowing and/or oral feeding function	cpt	92526	2091.88	2091.88	2082.43	2082.43	12510.68	12510.68	10425.57	10425.57	E	2091.88	2091.88	humana medicare advantage	pos
Treatment of swallowing and/or oral feeding function	cpt	92526	2091.88	2091.88	2082.43	2082.43	12510.68	12510.68	10425.57	10425.57	E	2091.88	2091.88	humana medicare advantage	ppo
Treatment of swallowing and/or oral feeding function	cpt	92526	2091.88	2091.88	2082.43	2082.43	12510.68	12510.68	10425.57	10425.57	E	2091.88	2091.88	humana medicare advantage	hmo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2052.6	2052.6	humana medicare advantage	hmo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2052.6	2052.6	humana medicare advantage	pos
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2052.6	2052.6	humana medicare advantage	ppo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2052.6	2052.6	humana medicare advantage	hmo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	2121.81	2121.81	1025.79	1025.79	17671.8	17671.8	14726.5	14726.5	E	2121.81	2121.81	humana medicare advantage	hmo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	2121.81	2121.81	1025.79	1025.79	17671.8	17671.8	14726.5	14726.5	E	2121.81	2121.81	humana medicare advantage	pos
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	2121.81	2121.81	1025.79	1025.79	17671.8	17671.8	14726.5	14726.5	E	2121.81	2121.81	humana medicare advantage	ppo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	2121.81	2121.81	1025.79	1025.79	17671.8	17671.8	14726.5	14726.5	E	2121.81	2121.81	humana medicare advantage	hmo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	humana medicare advantage	hmo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	humana medicare advantage	pos
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	humana medicare advantage	ppo
CT scan of heart with evaluation of blood vessel calcium	cpt	75571	69.57	69.57	50	50	60	60	50	50	O	50	50	humana medicare advantage	hmo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	273.17	273.17	humana medicare advantage	hmo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	273.17	273.17	humana medicare advantage	pos
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	273.17	273.17	humana medicare advantage	ppo
Fluoroscopic and video recorded motion evaluation of swallowing function	cpt	92611	358.77	358.77	124.04	124.04	1200.5	1200.5	1000.42	1000.42	O	273.17	273.17	humana medicare advantage	hmo
"Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin), each additional artery or branch"	cpt	92920	13866.64	13866.64	4401.96	4401.96	62794.31	62794.31	52328.59	52328.59	E	4401.96	4401.96	humana medicare advantage	hmo
"Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin), each additional artery or branch"	cpt	92920	13866.64	13866.64	4401.96	4401.96	62794.31	62794.31	52328.59	52328.59	E	4401.96	4401.96	humana medicare advantage	pos
"Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin), each additional artery or branch"	cpt	92920	13866.64	13866.64	4401.96	4401.96	62794.31	62794.31	52328.59	52328.59	E	4401.96	4401.96	humana medicare advantage	ppo
"Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin), each additional artery or branch"	cpt	92920	13866.64	13866.64	4401.96	4401.96	62794.31	62794.31	52328.59	52328.59	E	4401.96	4401.96	humana medicare advantage	hmo
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	8777.72	8777.72	humana medicare advantage	hmo
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	8777.72	8777.72	humana medicare advantage	pos
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	8777.72	8777.72	humana medicare advantage	ppo
"Ultrasound evaluation of heart blood vessel or graft, initial vessel"	cpt	92978	14120.9	14120.9	8630.33	8630.33	84420.37	84420.37	70350.31	70350.31	O	8777.72	8777.72	humana medicare advantage	hmo
Attempt to restart heart and lungs	cpt	92950	2333.86	2333.86	671.16	671.16	3861.56	3861.56	3217.97	3217.97	E	671.16	671.16	humana medicare advantage	hmo
Attempt to restart heart and lungs	cpt	92950	2333.86	2333.86	671.16	671.16	3861.56	3861.56	3217.97	3217.97	E	671.16	671.16	humana medicare advantage	pos
Attempt to restart heart and lungs	cpt	92950	2333.86	2333.86	671.16	671.16	3861.56	3861.56	3217.97	3217.97	E	671.16	671.16	humana medicare advantage	ppo
Attempt to restart heart and lungs	cpt	92950	2333.86	2333.86	671.16	671.16	3861.56	3861.56	3217.97	3217.97	E	671.16	671.16	humana medicare advantage	hmo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	475.24	475.24	humana medicare advantage	hmo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	475.24	475.24	humana medicare advantage	pos
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	475.24	475.24	humana medicare advantage	ppo
External shock to heart to regulate heart beat	cpt	92960	1660.63	1660.63	475.24	475.24	4018.85	4018.85	3349.04	3349.04	O	475.24	475.24	humana medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.89	1914.89	humana medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.89	1914.89	humana medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.89	1914.89	humana medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1914.89	1914.89	humana medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	133.77	133.77	humana medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	133.77	133.77	humana medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	133.77	133.77	humana medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	133.77	133.77	humana medicare advantage	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.2	8.2	humana medicare advantage	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.2	8.2	humana medicare advantage	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.2	8.2	humana medicare advantage	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.2	8.2	humana medicare advantage	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	161.43	161.43	humana medicare advantage	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	161.43	161.43	humana medicare advantage	pos
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	161.43	161.43	humana medicare advantage	ppo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	161.43	161.43	humana medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	humana medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	humana medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	humana medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	humana medicare advantage	hmo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	humana medicare advantage	hmo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	humana medicare advantage	pos
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	humana medicare advantage	ppo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	161.43	161.43	humana medicare advantage	hmo
complications of treatment without cc/mcc	ms-drg	921	4711.5	4711.5	4681.41	4681.41	36520.37	36520.37	30433.64	30433.64	I	4681.41	4681.41	humana medicare advantage	hmo
complications of treatment without cc/mcc	ms-drg	921	4711.5	4711.5	4681.41	4681.41	36520.37	36520.37	30433.64	30433.64	I	4681.41	4681.41	humana medicare advantage	pos
complications of treatment without cc/mcc	ms-drg	921	4711.5	4711.5	4681.41	4681.41	36520.37	36520.37	30433.64	30433.64	I	4681.41	4681.41	humana medicare advantage	ppo
complications of treatment without cc/mcc	ms-drg	921	4711.5	4711.5	4681.41	4681.41	36520.37	36520.37	30433.64	30433.64	I	4681.41	4681.41	humana medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	humana medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	humana medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	humana medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1127.01	1127.01	humana medicare advantage	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	pos
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	ppo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	hmo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	161.43	161.43	humana medicare advantage	hmo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	161.43	161.43	humana medicare advantage	pos
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	161.43	161.43	humana medicare advantage	ppo
Imaging for evaluation of swallowing function	cpt	74230	337.93	337.93	86.52	86.52	845.88	845.88	704.9	704.9	O	161.43	161.43	humana medicare advantage	hmo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	161.43	161.43	humana medicare advantage	hmo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	161.43	161.43	humana medicare advantage	pos
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	161.43	161.43	humana medicare advantage	ppo
X-ray of esophagus with single contrast	cpt	74220	161.43	161.43	106.05	106.05	595.3	595.3	496.08	496.08	O	161.43	161.43	humana medicare advantage	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	pos
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	ppo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	96.59	96.59	humana medicare advantage	hmo
MRI scan of abdomen before and after contrast	cpt	74183	338.27	338.27	335.57	335.57	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of abdomen before and after contrast	cpt	74183	338.27	338.27	335.57	335.57	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	pos
MRI scan of abdomen before and after contrast	cpt	74183	338.27	338.27	335.57	335.57	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	ppo
MRI scan of abdomen before and after contrast	cpt	74183	338.27	338.27	335.57	335.57	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	hmo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	32.11	32.11	humana medicare advantage	pos
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	32.11	32.11	humana medicare advantage	ppo
"Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician analysis, review, and report"	cpt	93280	71.59	71.59	31.6	31.6	245.5	245.5	204.58	204.58	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, single lead defibrillator system"	cpt	93282	61.52	61.52	32.11	32.11	237.86	237.86	198.22	198.22	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, single lead defibrillator system"	cpt	93282	61.52	61.52	32.11	32.11	237.86	237.86	198.22	198.22	O	32.11	32.11	humana medicare advantage	pos
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, single lead defibrillator system"	cpt	93282	61.52	61.52	32.11	32.11	237.86	237.86	198.22	198.22	O	32.11	32.11	humana medicare advantage	ppo
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, single lead defibrillator system"	cpt	93282	61.52	61.52	32.11	32.11	237.86	237.86	198.22	198.22	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, dual lead defibrillator system"	cpt	93283	32.11	32.11	31.6	31.6	293.83	293.83	244.86	244.86	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, dual lead defibrillator system"	cpt	93283	32.11	32.11	31.6	31.6	293.83	293.83	244.86	244.86	O	32.11	32.11	humana medicare advantage	pos
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, dual lead defibrillator system"	cpt	93283	32.11	32.11	31.6	31.6	293.83	293.83	244.86	244.86	O	32.11	32.11	humana medicare advantage	ppo
"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report, dual lead defibrillator system"	cpt	93283	32.11	32.11	31.6	31.6	293.83	293.83	244.86	244.86	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	humana medicare advantage	pos
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	humana medicare advantage	ppo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	32.11	32.11	humana medicare advantage	hmo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	32.11	32.11	humana medicare advantage	pos
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	32.11	32.11	humana medicare advantage	ppo
"Evaluation of defibrillator including connection, recording and disconnection"	cpt	93289	76.59	76.59	31.86	31.86	222.6	222.6	185.5	185.5	O	32.11	32.11	humana medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	humana medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	humana medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	humana medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	1965.52	1965.52	humana medicare advantage	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	338.27	338.27	humana medicare advantage	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	338.27	338.27	humana medicare advantage	pos
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	338.27	338.27	humana medicare advantage	ppo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	338.27	338.27	humana medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	humana medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	humana medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	humana medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	humana medicare advantage	hmo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	206.45	206.45	humana medicare advantage	hmo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	206.45	206.45	humana medicare advantage	pos
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	206.45	206.45	humana medicare advantage	ppo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	206.45	206.45	humana medicare advantage	hmo
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report	cpt	93312	2524.71	2524.71	426.62	426.62	2675.2	2675.2	2229.33	2229.33	O	1475.67	1475.67	humana medicare advantage	hmo
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report	cpt	93312	2524.71	2524.71	426.62	426.62	2675.2	2675.2	2229.33	2229.33	O	1475.67	1475.67	humana medicare advantage	pos
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report	cpt	93312	2524.71	2524.71	426.62	426.62	2675.2	2675.2	2229.33	2229.33	O	1475.67	1475.67	humana medicare advantage	ppo
Insertion of probe in esophagus for heart ultrasound examination including interpretation and report	cpt	93312	2524.71	2524.71	426.62	426.62	2675.2	2675.2	2229.33	2229.33	O	1475.67	1475.67	humana medicare advantage	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	206.45	206.45	humana medicare advantage	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	206.45	206.45	humana medicare advantage	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	206.45	206.45	humana medicare advantage	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	206.45	206.45	humana medicare advantage	hmo
Insertion of catheter into right and left heart for diagnosis	cpt	93453	2524.71	2524.71	2524.71	2524.71	18938.18	18938.18	15781.82	15781.82	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter into right and left heart for diagnosis	cpt	93453	2524.71	2524.71	2524.71	2524.71	18938.18	18938.18	15781.82	15781.82	O	2524.71	2524.71	humana medicare advantage	pos
Insertion of catheter into right and left heart for diagnosis	cpt	93453	2524.71	2524.71	2524.71	2524.71	18938.18	18938.18	15781.82	15781.82	O	2524.71	2524.71	humana medicare advantage	ppo
Insertion of catheter into right and left heart for diagnosis	cpt	93453	2524.71	2524.71	2524.71	2524.71	18938.18	18938.18	15781.82	15781.82	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	3445.85	3445.85	humana medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	3445.85	3445.85	humana medicare advantage	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	3445.85	3445.85	humana medicare advantage	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	3445.85	3445.85	humana medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	humana medicare advantage	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	humana medicare advantage	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	8777.72	8777.72	humana medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	8777.72	8777.72	humana medicare advantage	pos
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	8777.72	8777.72	humana medicare advantage	ppo
Insertion of catheter in left heart for imaging of blood vessels and/or grafts and left lower heart including imaging interpretation and supervision and injection	cpt	93459	8777.72	8777.72	2524.71	2524.71	36788.04	36788.04	30656.7	30656.7	O	8777.72	8777.72	humana medicare advantage	hmo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	humana medicare advantage	pos
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	humana medicare advantage	ppo
Insertion of catheter in right and left heart and left lower heart including imaging interpretation and supervision and injection	cpt	93460	2524.71	2524.71	2405.95	2405.95	19303.09	19303.09	16085.91	16085.91	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection	cpt	93461	2524.71	2524.71	2524.71	2524.71	24264.78	24264.78	20220.65	20220.65	O	2524.71	2524.71	humana medicare advantage	hmo
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection	cpt	93461	2524.71	2524.71	2524.71	2524.71	24264.78	24264.78	20220.65	20220.65	O	2524.71	2524.71	humana medicare advantage	pos
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection	cpt	93461	2524.71	2524.71	2524.71	2524.71	24264.78	24264.78	20220.65	20220.65	O	2524.71	2524.71	humana medicare advantage	ppo
Insertion of catheter in right and left heart and left lower heart for imaging of blood vessels and/or grafts including imaging interpretation and supervision and injection	cpt	93461	2524.71	2524.71	2524.71	2524.71	24264.78	24264.78	20220.65	20220.65	O	2524.71	2524.71	humana medicare advantage	hmo
Injection for X-ray imaging of aorta above heart valve	cpt	93567	2524.71	2524.71	2524.71	2524.71	22959.67	22959.67	19133.06	19133.06	O	2524.71	2524.71	humana medicare advantage	hmo
Injection for X-ray imaging of aorta above heart valve	cpt	93567	2524.71	2524.71	2524.71	2524.71	22959.67	22959.67	19133.06	19133.06	O	2524.71	2524.71	humana medicare advantage	pos
Injection for X-ray imaging of aorta above heart valve	cpt	93567	2524.71	2524.71	2524.71	2524.71	22959.67	22959.67	19133.06	19133.06	O	2524.71	2524.71	humana medicare advantage	ppo
Injection for X-ray imaging of aorta above heart valve	cpt	93567	2524.71	2524.71	2524.71	2524.71	22959.67	22959.67	19133.06	19133.06	O	2524.71	2524.71	humana medicare advantage	hmo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	4401.96	4401.96	4388.57	4388.57	51639.92	51639.92	43033.27	43033.27	E	4401.96	4401.96	humana medicare advantage	hmo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	4401.96	4401.96	4388.57	4388.57	51639.92	51639.92	43033.27	43033.27	E	4401.96	4401.96	humana medicare advantage	pos
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	4401.96	4401.96	4388.57	4388.57	51639.92	51639.92	43033.27	43033.27	E	4401.96	4401.96	humana medicare advantage	ppo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, initial vessel"	cpt	93571	4401.96	4401.96	4388.57	4388.57	51639.92	51639.92	43033.27	43033.27	E	4401.96	4401.96	humana medicare advantage	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	206.45	206.45	humana medicare advantage	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	206.45	206.45	humana medicare advantage	pos
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	206.45	206.45	humana medicare advantage	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	206.45	206.45	humana medicare advantage	hmo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, each additional vessel"	cpt	93572	4401.96	4401.96	4388.57	4388.57	51044.06	51044.06	42536.72	42536.72	E	4401.96	4401.96	humana medicare advantage	hmo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, each additional vessel"	cpt	93572	4401.96	4401.96	4388.57	4388.57	51044.06	51044.06	42536.72	42536.72	E	4401.96	4401.96	humana medicare advantage	pos
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, each additional vessel"	cpt	93572	4401.96	4401.96	4388.57	4388.57	51044.06	51044.06	42536.72	42536.72	E	4401.96	4401.96	humana medicare advantage	ppo
"Ultrasound evaluation of heart blood vessel during diagnosis or treatment, each additional vessel"	cpt	93572	4401.96	4401.96	4388.57	4388.57	51044.06	51044.06	42536.72	42536.72	E	4401.96	4401.96	humana medicare advantage	hmo
CT scan of abdominal blood vessels with contrast	cpt	74175	161.43	161.43	161.43	161.43	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	hmo
CT scan of abdominal blood vessels with contrast	cpt	74175	161.43	161.43	161.43	161.43	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	pos
CT scan of abdominal blood vessels with contrast	cpt	74175	161.43	161.43	161.43	161.43	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	ppo
CT scan of abdominal blood vessels with contrast	cpt	74175	161.43	161.43	161.43	161.43	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	hmo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	338.27	338.27	humana medicare advantage	hmo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	338.27	338.27	humana medicare advantage	pos
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	338.27	338.27	humana medicare advantage	ppo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	632.1	632.1	332.86	332.86	1872.38	1872.38	1560.32	1560.32	O	338.27	338.27	humana medicare advantage	hmo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	754.26	754.26	242.37	242.37	1872.38	1872.38	1560.32	1560.32	E	754.26	754.26	humana medicare advantage	hmo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	754.26	754.26	242.37	242.37	1872.38	1872.38	1560.32	1560.32	E	754.26	754.26	humana medicare advantage	pos
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	754.26	754.26	242.37	242.37	1872.38	1872.38	1560.32	1560.32	E	754.26	754.26	humana medicare advantage	ppo
CT scan of abdominal and pelvic blood vessels with contrast	cpt	74174	754.26	754.26	242.37	242.37	1872.38	1872.38	1560.32	1560.32	E	754.26	754.26	humana medicare advantage	hmo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	877.23	877.23	humana medicare advantage	hmo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	877.23	877.23	humana medicare advantage	pos
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	877.23	877.23	humana medicare advantage	ppo
Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session	cpt	93798	1250	1250	479.55	479.55	1591.92	1591.92	1326.6	1326.6	O	877.23	877.23	humana medicare advantage	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	90	90	humana medicare advantage	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	90	90	humana medicare advantage	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	90	90	humana medicare advantage	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	90	90	humana medicare advantage	hmo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	161.43	161.43	humana medicare advantage	hmo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	161.43	161.43	humana medicare advantage	pos
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	161.43	161.43	humana medicare advantage	ppo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	161.43	161.43	humana medicare advantage	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	206.45	206.45	humana medicare advantage	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	206.45	206.45	humana medicare advantage	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	206.45	206.45	humana medicare advantage	hmo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	96.08	96.08	humana medicare advantage	hmo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	96.08	96.08	humana medicare advantage	pos
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	96.08	96.08	humana medicare advantage	ppo
"Ultrasound study of arteries of both arms and legs, limited"	cpt	93922	286.66	286.66	88.23	88.23	419.76	419.76	349.8	349.8	O	96.08	96.08	humana medicare advantage	hmo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	hmo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	pos
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	ppo
CT scan abdomen	cpt	74150	592.16	592.16	86.75	86.75	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	pos
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	ppo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	99.29	99.29	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	99.29	99.29	humana medicare advantage	pos
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	99.29	99.29	humana medicare advantage	ppo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	99.29	99.29	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	humana medicare advantage	pos
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	humana medicare advantage	ppo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	pos
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	ppo
Ultrasound study of arteries and arterial grafts of both arms	cpt	93930	282.79	282.79	206.45	206.45	783.55	783.55	652.96	652.96	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	206.45	206.45	humana medicare advantage	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	206.45	206.45	humana medicare advantage	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	206.45	206.45	humana medicare advantage	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	573.24	573.24	136.54	136.54	1129.54	1129.54	941.28	941.28	E	206.45	206.45	humana medicare advantage	hmo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	99.29	99.29	humana medicare advantage	pos
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	humana medicare advantage	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	humana medicare advantage	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	99.29	99.29	humana medicare advantage	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	99.29	99.29	humana medicare advantage	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	99.29	99.29	humana medicare advantage	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	99.29	99.29	humana medicare advantage	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	99.29	99.29	humana medicare advantage	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	99.29	99.29	humana medicare advantage	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of abdomen, 2 views"	cpt	74019	99.29	99.29	20.35	20.35	380.71	380.71	317.26	317.26	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of abdomen, 2 views"	cpt	74019	99.29	99.29	20.35	20.35	380.71	380.71	317.26	317.26	O	99.29	99.29	humana medicare advantage	pos
"X-ray of abdomen, 2 views"	cpt	74019	99.29	99.29	20.35	20.35	380.71	380.71	317.26	317.26	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of abdomen, 2 views"	cpt	74019	99.29	99.29	20.35	20.35	380.71	380.71	317.26	317.26	O	99.29	99.29	humana medicare advantage	hmo
"Ventilation assistance and management, hospital inpatient or observation, initial day"	cpt	94002	1466.26	1466.26	1199.26	1199.26	13744.27	13744.27	11453.56	11453.56	O	1466.26	1466.26	humana medicare advantage	hmo
"Ventilation assistance and management, hospital inpatient or observation, initial day"	cpt	94002	1466.26	1466.26	1199.26	1199.26	13744.27	13744.27	11453.56	11453.56	O	1466.26	1466.26	humana medicare advantage	pos
"Ventilation assistance and management, hospital inpatient or observation, initial day"	cpt	94002	1466.26	1466.26	1199.26	1199.26	13744.27	13744.27	11453.56	11453.56	O	1466.26	1466.26	humana medicare advantage	ppo
"Ventilation assistance and management, hospital inpatient or observation, initial day"	cpt	94002	1466.26	1466.26	1199.26	1199.26	13744.27	13744.27	11453.56	11453.56	O	1466.26	1466.26	humana medicare advantage	hmo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	224.22	224.22	humana medicare advantage	hmo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	224.22	224.22	humana medicare advantage	pos
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	224.22	224.22	humana medicare advantage	ppo
Measurement and graphic recording of total and timed exhaled air capacity	cpt	94010	608.56	608.56	122.56	122.56	501.17	501.17	417.64	417.64	O	224.22	224.22	humana medicare advantage	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	224.22	224.22	humana medicare advantage	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	224.22	224.22	humana medicare advantage	pos
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	224.22	224.22	humana medicare advantage	ppo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	224.22	224.22	humana medicare advantage	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	humana medicare advantage	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	humana medicare advantage	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	humana medicare advantage	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	humana medicare advantage	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	humana medicare advantage	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1952.13	1952.13	humana medicare advantage	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	1523.14	1523.14	humana medicare advantage	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	1523.14	1523.14	humana medicare advantage	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	1523.14	1523.14	humana medicare advantage	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	1523.14	1523.14	humana medicare advantage	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1914.89	1914.89	humana medicare advantage	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1914.89	1914.89	humana medicare advantage	pos
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1914.89	1914.89	humana medicare advantage	ppo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	1914.89	1914.89	humana medicare advantage	hmo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	338.27	338.27	humana medicare advantage	pos
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	338.27	338.27	humana medicare advantage	ppo
MRI scan of leg joint before and after contrast	cpt	73723	1807.46	1807.46	338.27	338.27	3531.07	3531.07	2942.56	2942.56	O	338.27	338.27	humana medicare advantage	hmo
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1914.89	1914.89	humana medicare advantage	hmo
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1914.89	1914.89	humana medicare advantage	pos
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1914.89	1914.89	humana medicare advantage	ppo
Initiation and management of continued pressured respiratory assistance by mask or breathing tube	cpt	94660	1995.04	1995.04	404.51	404.51	12147.43	12147.43	10122.86	10122.86	E	1914.89	1914.89	humana medicare advantage	hmo
"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device"	cpt	94664	2121.81	2121.81	216.25	216.25	2288.58	2288.58	1907.15	1907.15	E	2121.81	2121.81	humana medicare advantage	hmo
"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device"	cpt	94664	2121.81	2121.81	216.25	216.25	2288.58	2288.58	1907.15	1907.15	E	2121.81	2121.81	humana medicare advantage	pos
"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device"	cpt	94664	2121.81	2121.81	216.25	216.25	2288.58	2288.58	1907.15	1907.15	E	2121.81	2121.81	humana medicare advantage	ppo
"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device"	cpt	94664	2121.81	2121.81	216.25	216.25	2288.58	2288.58	1907.15	1907.15	E	2121.81	2121.81	humana medicare advantage	hmo
Manual maneuvers to chest wall to assist movement of lung secretions	cpt	94668	2485.45	2485.45	1462.18	1462.18	21306.34	21306.34	17755.28	17755.28	E	1462.18	1462.18	humana medicare advantage	hmo
Manual maneuvers to chest wall to assist movement of lung secretions	cpt	94668	2485.45	2485.45	1462.18	1462.18	21306.34	21306.34	17755.28	17755.28	E	1462.18	1462.18	humana medicare advantage	pos
Manual maneuvers to chest wall to assist movement of lung secretions	cpt	94668	2485.45	2485.45	1462.18	1462.18	21306.34	21306.34	17755.28	17755.28	E	1462.18	1462.18	humana medicare advantage	ppo
Manual maneuvers to chest wall to assist movement of lung secretions	cpt	94668	2485.45	2485.45	1462.18	1462.18	21306.34	21306.34	17755.28	17755.28	E	1462.18	1462.18	humana medicare advantage	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	pos
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	ppo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	hmo
MRI scan of leg before and after contrast	cpt	73720	338.27	338.27	245.38	245.38	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of leg before and after contrast	cpt	73720	338.27	338.27	245.38	245.38	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	humana medicare advantage	pos
MRI scan of leg before and after contrast	cpt	73720	338.27	338.27	245.38	245.38	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	humana medicare advantage	ppo
MRI scan of leg before and after contrast	cpt	73720	338.27	338.27	245.38	245.38	3107.5	3107.5	2589.58	2589.58	O	338.27	338.27	humana medicare advantage	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	pos
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	ppo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	224.22	224.22	humana medicare advantage	hmo
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1952.13	1952.13	humana medicare advantage	hmo
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1952.13	1952.13	humana medicare advantage	pos
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1952.13	1952.13	humana medicare advantage	ppo
Pulmonary service or operation	cpt	94799	1995.04	1995.04	716.79	716.79	15027.26	15027.26	12522.72	12522.72	E	1952.13	1952.13	humana medicare advantage	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	humana medicare advantage	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	humana medicare advantage	pos
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	humana medicare advantage	ppo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	humana medicare advantage	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	805.22	805.22	humana medicare advantage	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	805.22	805.22	humana medicare advantage	pos
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	805.22	805.22	humana medicare advantage	ppo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	805.22	805.22	humana medicare advantage	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	121.34	121.34	humana medicare advantage	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	121.34	121.34	humana medicare advantage	pos
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	121.34	121.34	humana medicare advantage	ppo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	121.34	121.34	humana medicare advantage	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	2034.24	2034.24	1892.2	1892.2	17941.79	17941.79	14951.49	14951.49	E	2034.24	2034.24	humana medicare advantage	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	2034.24	2034.24	1892.2	1892.2	17941.79	17941.79	14951.49	14951.49	E	2034.24	2034.24	humana medicare advantage	pos
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	2034.24	2034.24	1892.2	1892.2	17941.79	17941.79	14951.49	14951.49	E	2034.24	2034.24	humana medicare advantage	ppo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	2034.24	2034.24	1892.2	1892.2	17941.79	17941.79	14951.49	14951.49	E	2034.24	2034.24	humana medicare advantage	hmo
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	98.3	98.3	humana medicare advantage	hmo
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	98.3	98.3	humana medicare advantage	pos
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	98.3	98.3	humana medicare advantage	ppo
CT scan leg	cpt	73700	739.85	739.85	93.83	93.83	1504.78	1504.78	1253.98	1253.98	E	98.3	98.3	humana medicare advantage	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	222.88	222.88	humana medicare advantage	hmo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	222.88	222.88	humana medicare advantage	pos
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	222.88	222.88	humana medicare advantage	ppo
"Measurement and recording of brain wave (EEG) activity, awake and asleep"	cpt	95819	1179.83	1179.83	222.88	222.88	840.79	840.79	700.66	700.66	O	222.88	222.88	humana medicare advantage	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	837.93	837.93	humana medicare advantage	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	837.93	837.93	humana medicare advantage	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	837.93	837.93	humana medicare advantage	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	837.93	837.93	humana medicare advantage	hmo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	pos
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	601.12	601.12	humana medicare advantage	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	601.12	601.12	humana medicare advantage	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	601.12	601.12	humana medicare advantage	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	601.12	601.12	humana medicare advantage	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	926.03	926.03	humana medicare advantage	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	926.03	926.03	humana medicare advantage	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	926.03	926.03	humana medicare advantage	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	926.03	926.03	humana medicare advantage	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	2742.85	2742.85	humana medicare advantage	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	2742.85	2742.85	humana medicare advantage	pos
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	2742.85	2742.85	humana medicare advantage	ppo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	2742.85	2742.85	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1914.89	1914.89	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1914.89	1914.89	humana medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1914.89	1914.89	humana medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1914.89	1914.89	humana medicare advantage	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.7	70.7	humana medicare advantage	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	70.7	70.7	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	763.52	763.52	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	763.52	763.52	humana medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	763.52	763.52	humana medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	763.52	763.52	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1952.13	1952.13	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1952.13	1952.13	humana medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1952.13	1952.13	humana medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	1952.13	1952.13	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	2332.81	2332.81	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	2332.81	2332.81	humana medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	2332.81	2332.81	humana medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	2332.81	2332.81	humana medicare advantage	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	1952.13	1952.13	655.54	655.54	8924.22	8924.22	7436.85	7436.85	E	1952.13	1952.13	humana medicare advantage	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	1952.13	1952.13	655.54	655.54	8924.22	8924.22	7436.85	7436.85	E	1952.13	1952.13	humana medicare advantage	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	1952.13	1952.13	655.54	655.54	8924.22	8924.22	7436.85	7436.85	E	1952.13	1952.13	humana medicare advantage	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	1952.13	1952.13	655.54	655.54	8924.22	8924.22	7436.85	7436.85	E	1952.13	1952.13	humana medicare advantage	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	3984.02	3984.02	humana medicare advantage	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	3984.02	3984.02	humana medicare advantage	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	3984.02	3984.02	humana medicare advantage	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	3984.02	3984.02	humana medicare advantage	hmo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	pos
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of foot, 2 views"	cpt	73620	70.7	70.7	16.76	16.76	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	1462.18	1462.18	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	1462.18	1462.18	humana medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	1462.18	1462.18	humana medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	1462.18	1462.18	humana medicare advantage	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	pos
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	977.57	977.57	humana medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	977.57	977.57	humana medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	977.57	977.57	humana medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	5988.6	5988.6	977.57	977.57	18431.28	18431.28	15359.4	15359.4	O	977.57	977.57	humana medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	humana medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	humana medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	humana medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1952.13	1952.13	humana medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	humana medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	humana medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	humana medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	humana medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	947.72	947.72	humana medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	947.72	947.72	humana medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	947.72	947.72	humana medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	947.72	947.72	humana medicare advantage	hmo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	pos
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of lower leg, 2 views"	cpt	73590	197.67	197.67	18.86	18.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	3069.64	3069.64	humana medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	3069.64	3069.64	humana medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	3069.64	3069.64	humana medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	3069.64	3069.64	humana medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	humana medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	humana medicare advantage	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	humana medicare advantage	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1952.13	1952.13	humana medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4309.68	4309.68	humana medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4309.68	4309.68	humana medicare advantage	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4309.68	4309.68	humana medicare advantage	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4309.68	4309.68	humana medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1965.52	1965.52	humana medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1965.52	1965.52	humana medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1965.52	1965.52	humana medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1965.52	1965.52	humana medicare advantage	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	99.29	99.29	humana medicare advantage	pos
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	99.29	99.29	humana medicare advantage	hmo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	10727.89	10727.89	humana medicare advantage	hmo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	10727.89	10727.89	humana medicare advantage	pos
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	10727.89	10727.89	humana medicare advantage	ppo
Application of on-body injector for injection under skin	cpt	96377	13222.87	13222.87	6746.76	6746.76	42194.78	42194.78	35162.32	35162.32	O	10727.89	10727.89	humana medicare advantage	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	1204.76	1204.76	humana medicare advantage	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	1204.76	1204.76	humana medicare advantage	pos
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	1204.76	1204.76	humana medicare advantage	ppo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	1204.76	1204.76	humana medicare advantage	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	800.92	800.92	humana medicare advantage	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	800.92	800.92	humana medicare advantage	pos
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	800.92	800.92	humana medicare advantage	ppo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	800.92	800.92	humana medicare advantage	hmo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	7692.75	7692.75	humana medicare advantage	hmo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	7692.75	7692.75	humana medicare advantage	pos
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	7692.75	7692.75	humana medicare advantage	ppo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	7692.75	7692.75	humana medicare advantage	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	pos
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	977.57	977.57	humana medicare advantage	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	977.57	977.57	humana medicare advantage	pos
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	977.57	977.57	humana medicare advantage	ppo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	977.57	977.57	humana medicare advantage	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	5404.77	5404.77	humana medicare advantage	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	5404.77	5404.77	humana medicare advantage	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	5404.77	5404.77	humana medicare advantage	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	5404.77	5404.77	humana medicare advantage	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4235.47	4235.47	humana medicare advantage	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4235.47	4235.47	humana medicare advantage	pos
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4235.47	4235.47	humana medicare advantage	ppo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	4235.47	4235.47	humana medicare advantage	hmo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	pos
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	70.7	70.7	humana medicare advantage	pos
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of femur, minimum 2 views"	cpt	73552	163.85	163.85	21.25	21.25	314.4	314.4	262	262	O	70.7	70.7	humana medicare advantage	hmo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	957.13	957.13	humana medicare advantage	hmo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	957.13	957.13	humana medicare advantage	pos
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	957.13	957.13	humana medicare advantage	ppo
Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours	cpt	96416	8184.57	8184.57	957.13	957.13	19972.8	19972.8	16644	16644	O	957.13	957.13	humana medicare advantage	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5391.96	5391.96	humana medicare advantage	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5391.96	5391.96	humana medicare advantage	pos
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5391.96	5391.96	humana medicare advantage	ppo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	5391.96	5391.96	humana medicare advantage	hmo
Radiological supervision and interpretation X-ray of hip joint	cpt	73525	338.27	338.27	332.86	332.86	1232.57	1232.57	1027.14	1027.14	O	338.27	338.27	humana medicare advantage	hmo
Radiological supervision and interpretation X-ray of hip joint	cpt	73525	338.27	338.27	332.86	332.86	1232.57	1232.57	1027.14	1027.14	O	338.27	338.27	humana medicare advantage	pos
Radiological supervision and interpretation X-ray of hip joint	cpt	73525	338.27	338.27	332.86	332.86	1232.57	1232.57	1027.14	1027.14	O	338.27	338.27	humana medicare advantage	ppo
Radiological supervision and interpretation X-ray of hip joint	cpt	73525	338.27	338.27	332.86	332.86	1232.57	1232.57	1027.14	1027.14	O	338.27	338.27	humana medicare advantage	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	99.29	99.29	humana medicare advantage	pos
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	99.29	99.29	humana medicare advantage	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	496.33	496.33	humana medicare advantage	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	496.33	496.33	humana medicare advantage	pos
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	496.33	496.33	humana medicare advantage	ppo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	496.33	496.33	humana medicare advantage	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	99.29	99.29	97.3	97.3	727.58	727.58	606.32	606.32	E	97.3	97.3	humana medicare advantage	hmo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	99.29	99.29	97.3	97.3	727.58	727.58	606.32	606.32	E	97.3	97.3	humana medicare advantage	pos
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	99.29	99.29	97.3	97.3	727.58	727.58	606.32	606.32	E	97.3	97.3	humana medicare advantage	ppo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	99.29	99.29	97.3	97.3	727.58	727.58	606.32	606.32	E	97.3	97.3	humana medicare advantage	hmo
"Application of electrical stimulation to 1 or more areas, each 15 minutes"	cpt	97032	421.07	421.07	14.45	14.45	9230.88	9230.88	7692.4	7692.4	O	421.07	421.07	humana medicare advantage	hmo
"Application of electrical stimulation to 1 or more areas, each 15 minutes"	cpt	97032	421.07	421.07	14.45	14.45	9230.88	9230.88	7692.4	7692.4	O	421.07	421.07	humana medicare advantage	pos
"Application of electrical stimulation to 1 or more areas, each 15 minutes"	cpt	97032	421.07	421.07	14.45	14.45	9230.88	9230.88	7692.4	7692.4	O	421.07	421.07	humana medicare advantage	ppo
"Application of electrical stimulation to 1 or more areas, each 15 minutes"	cpt	97032	421.07	421.07	14.45	14.45	9230.88	9230.88	7692.4	7692.4	O	421.07	421.07	humana medicare advantage	hmo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	496.33	496.33	humana medicare advantage	hmo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	496.33	496.33	humana medicare advantage	pos
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	496.33	496.33	humana medicare advantage	ppo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	496.33	496.33	humana medicare advantage	hmo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	626.66	626.66	humana medicare advantage	hmo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	626.66	626.66	humana medicare advantage	pos
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	626.66	626.66	humana medicare advantage	ppo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	626.66	626.66	humana medicare advantage	hmo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	670.65	670.65	humana medicare advantage	hmo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	670.65	670.65	humana medicare advantage	pos
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	670.65	670.65	humana medicare advantage	ppo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	670.65	670.65	humana medicare advantage	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3069.09	3069.09	2002.28	2002.28	49620.42	49620.42	41350.35	41350.35	E	3069.09	3069.09	humana medicare advantage	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3069.09	3069.09	2002.28	2002.28	49620.42	49620.42	41350.35	41350.35	E	3069.09	3069.09	humana medicare advantage	pos
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3069.09	3069.09	2002.28	2002.28	49620.42	49620.42	41350.35	41350.35	E	3069.09	3069.09	humana medicare advantage	ppo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3069.09	3069.09	2002.28	2002.28	49620.42	49620.42	41350.35	41350.35	E	3069.09	3069.09	humana medicare advantage	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	70.7	70.7	humana medicare advantage	pos
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	70.7	70.7	humana medicare advantage	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	600.02	600.02	humana medicare advantage	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	600.02	600.02	humana medicare advantage	pos
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	600.02	600.02	humana medicare advantage	ppo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	600.02	600.02	humana medicare advantage	hmo
MRI scan of arm joint before and after contrast	cpt	73223	338.27	338.27	338.27	338.27	3431.14	3431.14	2859.28	2859.28	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of arm joint before and after contrast	cpt	73223	338.27	338.27	338.27	338.27	3431.14	3431.14	2859.28	2859.28	O	338.27	338.27	humana medicare advantage	pos
MRI scan of arm joint before and after contrast	cpt	73223	338.27	338.27	338.27	338.27	3431.14	3431.14	2859.28	2859.28	O	338.27	338.27	humana medicare advantage	ppo
MRI scan of arm joint before and after contrast	cpt	73223	338.27	338.27	338.27	338.27	3431.14	3431.14	2859.28	2859.28	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	603.12	603.12	humana medicare advantage	hmo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	603.12	603.12	humana medicare advantage	pos
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	603.12	603.12	humana medicare advantage	ppo
MRI scan of arm joint with contrast	cpt	73222	891.88	891.88	603.12	603.12	3107.5	3107.5	2589.58	2589.58	O	603.12	603.12	humana medicare advantage	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	641.96	641.96	humana medicare advantage	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	641.96	641.96	humana medicare advantage	pos
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	641.96	641.96	humana medicare advantage	ppo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	641.96	641.96	humana medicare advantage	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2121.81	2121.81	2052.62	2052.62	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2121.81	2121.81	2052.62	2052.62	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	pos
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2121.81	2121.81	2052.62	2052.62	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	ppo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2121.81	2121.81	2052.62	2052.62	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	468.06	468.06	humana medicare advantage	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	468.06	468.06	humana medicare advantage	pos
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	468.06	468.06	humana medicare advantage	ppo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	468.06	468.06	humana medicare advantage	hmo
"Self-care or home management training, each 15 minutes"	cpt	97535	2121.81	2121.81	2102.95	2102.95	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	hmo
"Self-care or home management training, each 15 minutes"	cpt	97535	2121.81	2121.81	2102.95	2102.95	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	pos
"Self-care or home management training, each 15 minutes"	cpt	97535	2121.81	2121.81	2102.95	2102.95	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	ppo
"Self-care or home management training, each 15 minutes"	cpt	97535	2121.81	2121.81	2102.95	2102.95	32128.06	32128.06	26773.38	26773.38	E	2121.81	2121.81	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2136.63	2136.63	2034.73	2034.73	15002.65	15002.65	12502.21	12502.21	E	2034.73	2034.73	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2136.63	2136.63	2034.73	2034.73	15002.65	15002.65	12502.21	12502.21	E	2034.73	2034.73	humana medicare advantage	pos
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2136.63	2136.63	2034.73	2034.73	15002.65	15002.65	12502.21	12502.21	E	2034.73	2034.73	humana medicare advantage	ppo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2136.63	2136.63	2034.73	2034.73	15002.65	15002.65	12502.21	12502.21	E	2034.73	2034.73	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	426.92	426.92	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	426.92	426.92	humana medicare advantage	pos
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	426.92	426.92	humana medicare advantage	ppo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	426.92	426.92	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2102.95	2102.95	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2102.95	2102.95	humana medicare advantage	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2102.95	2102.95	humana medicare advantage	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2102.95	2102.95	humana medicare advantage	hmo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	288.39	288.39	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	288.39	288.39	humana medicare advantage	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	288.39	288.39	humana medicare advantage	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	288.39	288.39	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2102.95	2102.95	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2102.95	2102.95	humana medicare advantage	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2102.95	2102.95	humana medicare advantage	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2102.95	2102.95	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	290.36	290.36	humana medicare advantage	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	290.36	290.36	humana medicare advantage	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	290.36	290.36	humana medicare advantage	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	290.36	290.36	humana medicare advantage	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	2121.81	2121.81	2052.6	2052.6	19215.01	19215.01	16012.51	16012.51	E	2121.81	2121.81	humana medicare advantage	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	2121.81	2121.81	2052.6	2052.6	19215.01	19215.01	16012.51	16012.51	E	2121.81	2121.81	humana medicare advantage	pos
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	2121.81	2121.81	2052.6	2052.6	19215.01	19215.01	16012.51	16012.51	E	2121.81	2121.81	humana medicare advantage	ppo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	2121.81	2121.81	2052.6	2052.6	19215.01	19215.01	16012.51	16012.51	E	2121.81	2121.81	humana medicare advantage	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	369.79	369.79	humana medicare advantage	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	369.79	369.79	humana medicare advantage	pos
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	369.79	369.79	humana medicare advantage	ppo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	369.79	369.79	humana medicare advantage	hmo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	hmo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	pos
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	ppo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2102.95	2102.95	humana medicare advantage	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2102.95	2102.95	humana medicare advantage	pos
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2102.95	2102.95	humana medicare advantage	ppo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2102.95	2102.95	humana medicare advantage	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	421.07	421.07	humana medicare advantage	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	421.07	421.07	humana medicare advantage	pos
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	421.07	421.07	humana medicare advantage	ppo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	1099.17	1099.17	362.14	362.14	2913.61	2913.61	2428.01	2428.01	O	421.07	421.07	humana medicare advantage	hmo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	pos
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	70.7	70.7	humana medicare advantage	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	humana medicare advantage	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	humana medicare advantage	pos
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	humana medicare advantage	ppo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	154.79	154.79	humana medicare advantage	hmo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	humana medicare advantage	hmo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	humana medicare advantage	pos
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	humana medicare advantage	ppo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	154.79	154.79	humana medicare advantage	hmo
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session	cpt	97607	581.83	581.83	258.55	258.55	3116.82	3116.82	2597.35	2597.35	O	581.83	581.83	humana medicare advantage	hmo
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session	cpt	97607	581.83	581.83	258.55	258.55	3116.82	3116.82	2597.35	2597.35	O	581.83	581.83	humana medicare advantage	pos
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session	cpt	97607	581.83	581.83	258.55	258.55	3116.82	3116.82	2597.35	2597.35	O	581.83	581.83	humana medicare advantage	ppo
Negative pressure wound therapy surface area less than or equal to 50 square centimeters per session	cpt	97607	581.83	581.83	258.55	258.55	3116.82	3116.82	2597.35	2597.35	O	581.83	581.83	humana medicare advantage	hmo
"Medical nutrition therapy, assessment and intervention, each 15 minutes"	cpt	97802	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	hmo
"Medical nutrition therapy, assessment and intervention, each 15 minutes"	cpt	97802	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	pos
"Medical nutrition therapy, assessment and intervention, each 15 minutes"	cpt	97802	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	ppo
"Medical nutrition therapy, assessment and intervention, each 15 minutes"	cpt	97802	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	hmo
"Medical nutrition therapy re-assessment and intervention, each 15 minutes"	cpt	97803	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	hmo
"Medical nutrition therapy re-assessment and intervention, each 15 minutes"	cpt	97803	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	pos
"Medical nutrition therapy re-assessment and intervention, each 15 minutes"	cpt	97803	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	ppo
"Medical nutrition therapy re-assessment and intervention, each 15 minutes"	cpt	97803	8113.12	8113.12	1959.82	1959.82	27273.68	27273.68	22728.07	22728.07	E	1959.82	1959.82	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	6589.84	6589.84	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	6589.84	6589.84	humana medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	6589.84	6589.84	humana medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	6589.84	6589.84	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2531.41	2531.41	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2531.41	2531.41	humana medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2531.41	2531.41	humana medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	2531.41	2531.41	humana medicare advantage	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	70.7	70.7	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	8791.16	8791.16	1723.62	1723.62	51580.72	51580.72	42983.93	42983.93	E	6589.84	6589.84	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	8791.16	8791.16	1723.62	1723.62	51580.72	51580.72	42983.93	42983.93	E	6589.84	6589.84	humana medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	8791.16	8791.16	1723.62	1723.62	51580.72	51580.72	42983.93	42983.93	E	6589.84	6589.84	humana medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	8791.16	8791.16	1723.62	1723.62	51580.72	51580.72	42983.93	42983.93	E	6589.84	6589.84	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2524.71	2524.71	humana medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2524.71	2524.71	humana medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2524.71	2524.71	humana medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	2524.71	2524.71	humana medicare advantage	hmo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	97.7	97.7	humana medicare advantage	hmo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	97.7	97.7	humana medicare advantage	pos
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	97.7	97.7	humana medicare advantage	ppo
"X-ray of hand, 2 views"	cpt	73120	99.29	99.29	18.26	18.26	221.7	221.7	184.75	184.75	O	97.7	97.7	humana medicare advantage	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	pos
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	pos
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	70.7	70.7	humana medicare advantage	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	humana medicare advantage	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	humana medicare advantage	pos
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	humana medicare advantage	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	humana medicare advantage	hmo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	65.75	65.75	humana medicare advantage	hmo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	65.75	65.75	humana medicare advantage	pos
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	65.75	65.75	humana medicare advantage	ppo
"X-ray of forearm, 2 views"	cpt	73090	127.09	127.09	17.06	17.06	249.31	249.31	207.76	207.76	O	65.75	65.75	humana medicare advantage	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	humana medicare advantage	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	humana medicare advantage	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	humana medicare advantage	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	humana medicare advantage	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	humana medicare advantage	pos
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	70.7	70.7	humana medicare advantage	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	846.44	846.44	humana medicare advantage	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	846.44	846.44	humana medicare advantage	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	846.44	846.44	humana medicare advantage	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	846.44	846.44	humana medicare advantage	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	humana medicare advantage	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	humana medicare advantage	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	humana medicare advantage	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	humana medicare advantage	hmo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	pos
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of elbow, 2 views"	cpt	73070	141.16	141.16	16.76	16.76	116	116	96.67	96.67	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	pos
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	128.03	128.03	18.36	18.36	249.31	249.31	207.76	207.76	O	70.7	70.7	humana medicare advantage	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1466.26	1466.26	humana medicare advantage	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1466.26	1466.26	humana medicare advantage	pos
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1466.26	1466.26	humana medicare advantage	ppo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1466.26	1466.26	humana medicare advantage	hmo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	338.27	338.27	humana medicare advantage	hmo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	338.27	338.27	humana medicare advantage	pos
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	338.27	338.27	humana medicare advantage	ppo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	338.27	338.27	humana medicare advantage	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	humana medicare advantage	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	humana medicare advantage	pos
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	humana medicare advantage	ppo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	4282.09	4282.09	humana medicare advantage	hmo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	humana medicare advantage	hmo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	humana medicare advantage	pos
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	humana medicare advantage	ppo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	humana medicare advantage	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	553.72	553.72	humana medicare advantage	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	553.72	553.72	humana medicare advantage	pos
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	553.72	553.72	humana medicare advantage	ppo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	553.72	553.72	humana medicare advantage	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	70.7	70.7	humana medicare advantage	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	70.7	70.7	humana medicare advantage	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1079.07	1079.07	humana medicare advantage	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1079.07	1079.07	humana medicare advantage	pos
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1079.07	1079.07	humana medicare advantage	ppo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	1079.07	1079.07	humana medicare advantage	hmo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	1791.13	1791.13	humana medicare advantage	hmo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	1791.13	1791.13	humana medicare advantage	pos
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	1791.13	1791.13	humana medicare advantage	ppo
"Removal of cataract with insertion of lens, simple"	cpt	66984	7851.31	7851.31	1636.08	1636.08	14699.72	14699.72	12249.77	12249.77	O	1791.13	1791.13	humana medicare advantage	hmo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	805.22	805.22	humana medicare advantage	hmo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	805.22	805.22	humana medicare advantage	pos
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	805.22	805.22	humana medicare advantage	ppo
Sleep monitoring of patient (6 years or older) in sleep lab	cpt	95810	2442.48	2442.48	792.34	792.34	4724.57	4724.57	3937.14	3937.14	O	805.22	805.22	humana medicare advantage	hmo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	97.3	97.3	humana medicare advantage	hmo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	97.3	97.3	humana medicare advantage	pos
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	97.3	97.3	humana medicare advantage	ppo
"X-ray of sacroiliac joints, 3 or more views"	cpt	72202	97.3	97.3	21.76	21.76	272.21	272.21	226.84	226.84	O	97.3	97.3	humana medicare advantage	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2102.95	2102.95	2102.95	2102.95	25974.02	25974.02	21645.02	21645.02	E	2102.95	2102.95	humana medicare advantage	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2102.95	2102.95	2102.95	2102.95	25974.02	25974.02	21645.02	21645.02	E	2102.95	2102.95	humana medicare advantage	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2102.95	2102.95	2102.95	2102.95	25974.02	25974.02	21645.02	21645.02	E	2102.95	2102.95	humana medicare advantage	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2102.95	2102.95	2102.95	2102.95	25974.02	25974.02	21645.02	21645.02	E	2102.95	2102.95	humana medicare advantage	hmo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	337.39	337.39	humana medicare advantage	hmo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	337.39	337.39	humana medicare advantage	pos
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	337.39	337.39	humana medicare advantage	ppo
MRI scan of pelvis before and after contrast	cpt	72197	868.48	868.48	288.37	288.37	3107.5	3107.5	2589.58	2589.58	O	337.39	337.39	humana medicare advantage	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	626.66	626.66	humana medicare advantage	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	626.66	626.66	humana medicare advantage	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	626.66	626.66	humana medicare advantage	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	626.66	626.66	humana medicare advantage	hmo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	hmo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	pos
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	ppo
CT scan pelvis	cpt	72192	559.23	559.23	99.29	99.29	1367.4	1367.4	1139.5	1139.5	O	99.29	99.29	humana medicare advantage	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	humana medicare advantage	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	humana medicare advantage	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	humana medicare advantage	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	humana medicare advantage	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	99.29	99.29	humana medicare advantage	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	99.29	99.29	humana medicare advantage	pos
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	99.29	99.29	humana medicare advantage	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	99.29	99.29	humana medicare advantage	hmo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	pos
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	ppo
MRI scan of lower spinal canal before and after contrast	cpt	72158	419.53	419.53	218.02	218.02	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of lower spinal canal before and after contrast	cpt	72158	338.27	338.27	218.02	218.02	4123.82	4123.82	3436.52	3436.52	E	338.27	338.27	humana medicare advantage	hmo
MRI scan of lower spinal canal before and after contrast	cpt	72158	338.27	338.27	218.02	218.02	4123.82	4123.82	3436.52	3436.52	E	338.27	338.27	humana medicare advantage	pos
MRI scan of lower spinal canal before and after contrast	cpt	72158	338.27	338.27	218.02	218.02	4123.82	4123.82	3436.52	3436.52	E	338.27	338.27	humana medicare advantage	ppo
MRI scan of lower spinal canal before and after contrast	cpt	72158	338.27	338.27	218.02	218.02	4123.82	4123.82	3436.52	3436.52	E	338.27	338.27	humana medicare advantage	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	99.29	99.29	humana medicare advantage	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	99.29	99.29	humana medicare advantage	pos
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	99.29	99.29	humana medicare advantage	ppo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	99.29	99.29	humana medicare advantage	hmo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	hmo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	pos
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	ppo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	338.27	338.27	humana medicare advantage	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	pos
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	hmo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	766.68	766.68	humana medicare advantage	hmo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	766.68	766.68	humana medicare advantage	pos
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	766.68	766.68	humana medicare advantage	ppo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	766.68	766.68	humana medicare advantage	hmo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	humana medicare advantage	hmo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	humana medicare advantage	pos
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	humana medicare advantage	ppo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	humana medicare advantage	hmo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	756.35	756.35	humana medicare advantage	hmo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	756.35	756.35	humana medicare advantage	pos
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	756.35	756.35	humana medicare advantage	ppo
MRI scan of upper spinal canal before and after contrast	cpt	72156	756.35	756.35	218.62	218.62	4123.82	4123.82	3436.52	3436.52	O	756.35	756.35	humana medicare advantage	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	humana medicare advantage	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	humana medicare advantage	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	humana medicare advantage	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	humana medicare advantage	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	408.55	408.55	humana medicare advantage	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	408.55	408.55	humana medicare advantage	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	408.55	408.55	humana medicare advantage	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	408.55	408.55	humana medicare advantage	hmo
MRI scan of middle spinal canal	cpt	72146	481.19	481.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	E	481.19	481.19	humana medicare advantage	hmo
MRI scan of middle spinal canal	cpt	72146	481.19	481.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	E	481.19	481.19	humana medicare advantage	pos
MRI scan of middle spinal canal	cpt	72146	481.19	481.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	E	481.19	481.19	humana medicare advantage	ppo
MRI scan of middle spinal canal	cpt	72146	481.19	481.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	E	481.19	481.19	humana medicare advantage	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	99.29	99.29	humana medicare advantage	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	99.29	99.29	humana medicare advantage	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	99.29	99.29	humana medicare advantage	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	99.29	99.29	humana medicare advantage	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	99.29	99.29	humana medicare advantage	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	99.29	99.29	humana medicare advantage	pos
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	99.29	99.29	humana medicare advantage	ppo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	99.29	99.29	humana medicare advantage	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	99.29	99.29	humana medicare advantage	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	99.29	99.29	humana medicare advantage	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	99.29	99.29	humana medicare advantage	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	99.29	99.29	humana medicare advantage	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	99.29	99.29	humana medicare advantage	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	99.29	99.29	humana medicare advantage	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	99.29	99.29	humana medicare advantage	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	83.77	83.77	humana medicare advantage	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	83.77	83.77	humana medicare advantage	pos
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	83.77	83.77	humana medicare advantage	ppo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	83.77	83.77	humana medicare advantage	hmo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	pos
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	ppo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	106.79	106.79	humana medicare advantage	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	106.79	106.79	humana medicare advantage	pos
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	106.79	106.79	humana medicare advantage	ppo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	106.79	106.79	humana medicare advantage	hmo
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	hmo
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	pos
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	ppo
CT scan of lower spine	cpt	72131	876.81	876.81	90.7	90.7	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	humana medicare advantage	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	humana medicare advantage	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	humana medicare advantage	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	humana medicare advantage	hmo
CT scan of middle spine	cpt	72128	155.14	155.14	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
CT scan of middle spine	cpt	72128	155.14	155.14	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	pos
CT scan of middle spine	cpt	72128	155.14	155.14	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	ppo
CT scan of middle spine	cpt	72128	155.14	155.14	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
"limb reattachment, hip and femur procedures for multiple significant trauma"	ms-drg	956	19361.18	19361.18	520.19	520.19	76918.36	76918.36	64098.63	64098.63	I	520.19	520.19	humana medicare advantage	hmo
"limb reattachment, hip and femur procedures for multiple significant trauma"	ms-drg	956	19361.18	19361.18	520.19	520.19	76918.36	76918.36	64098.63	64098.63	I	520.19	520.19	humana medicare advantage	pos
"limb reattachment, hip and femur procedures for multiple significant trauma"	ms-drg	956	19361.18	19361.18	520.19	520.19	76918.36	76918.36	64098.63	64098.63	I	520.19	520.19	humana medicare advantage	ppo
"limb reattachment, hip and femur procedures for multiple significant trauma"	ms-drg	956	19361.18	19361.18	520.19	520.19	76918.36	76918.36	64098.63	64098.63	I	520.19	520.19	humana medicare advantage	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	pos
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	ppo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	humana medicare advantage	hmo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	humana medicare advantage	pos
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	humana medicare advantage	ppo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	696.23	696.23	humana medicare advantage	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	pos
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	ppo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	156.86	156.86	humana medicare advantage	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	2683.78	2683.78	1571.32	1571.32	16653.78	16653.78	13878.15	13878.15	E	2683.78	2683.78	humana medicare advantage	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	2683.78	2683.78	1571.32	1571.32	16653.78	16653.78	13878.15	13878.15	E	2683.78	2683.78	humana medicare advantage	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	2683.78	2683.78	1571.32	1571.32	16653.78	16653.78	13878.15	13878.15	E	2683.78	2683.78	humana medicare advantage	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	2683.78	2683.78	1571.32	1571.32	16653.78	16653.78	13878.15	13878.15	E	2683.78	2683.78	humana medicare advantage	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1034.59	1034.59	humana medicare advantage	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1034.59	1034.59	humana medicare advantage	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1034.59	1034.59	humana medicare advantage	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	1034.59	1034.59	humana medicare advantage	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2598.04	2598.04	2598.04	2598.04	16897.38	16897.38	14081.15	14081.15	E	2598.04	2598.04	humana medicare advantage	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2598.04	2598.04	2598.04	2598.04	16897.38	16897.38	14081.15	14081.15	E	2598.04	2598.04	humana medicare advantage	pos
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2598.04	2598.04	2598.04	2598.04	16897.38	16897.38	14081.15	14081.15	E	2598.04	2598.04	humana medicare advantage	ppo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2598.04	2598.04	2598.04	2598.04	16897.38	16897.38	14081.15	14081.15	E	2598.04	2598.04	humana medicare advantage	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	99.29	99.29	humana medicare advantage	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	99.29	99.29	humana medicare advantage	pos
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	99.29	99.29	humana medicare advantage	ppo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	99.29	99.29	humana medicare advantage	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	676.71	676.71	humana medicare advantage	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	676.71	676.71	humana medicare advantage	pos
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	676.71	676.71	humana medicare advantage	ppo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	676.71	676.71	humana medicare advantage	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1237.74	1237.74	humana medicare advantage	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1237.74	1237.74	humana medicare advantage	pos
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1237.74	1237.74	humana medicare advantage	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1237.74	1237.74	humana medicare advantage	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	1334.43	1334.43	humana medicare advantage	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	1334.43	1334.43	humana medicare advantage	pos
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	1334.43	1334.43	humana medicare advantage	ppo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	1334.43	1334.43	humana medicare advantage	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	99.29	99.29	humana medicare advantage	pos
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	99.29	99.29	humana medicare advantage	hmo
slings	cpt	A4565	9081.99	9081.99	4904.09	4904.09	42712.72	42712.72	35593.93	35593.93	E	8959.3	8959.3	humana medicare advantage	hmo
slings	cpt	A4565	9081.99	9081.99	4904.09	4904.09	42712.72	42712.72	35593.93	35593.93	E	8959.3	8959.3	humana medicare advantage	pos
slings	cpt	A4565	9081.99	9081.99	4904.09	4904.09	42712.72	42712.72	35593.93	35593.93	E	8959.3	8959.3	humana medicare advantage	ppo
slings	cpt	A4565	9081.99	9081.99	4904.09	4904.09	42712.72	42712.72	35593.93	35593.93	E	8959.3	8959.3	humana medicare advantage	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	70.7	70.7	humana medicare advantage	pos
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	70.7	70.7	humana medicare advantage	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	humana medicare advantage	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	humana medicare advantage	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	humana medicare advantage	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	humana medicare advantage	hmo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	pos
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	humana medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	humana medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	humana medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	humana medicare advantage	hmo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	5459.75	5459.75	humana medicare advantage	hmo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	5459.75	5459.75	humana medicare advantage	pos
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	5459.75	5459.75	humana medicare advantage	ppo
seizures without mcc	ms-drg	101	6886.91	6886.91	3126.2	3126.2	31623.19	31623.19	26352.66	26352.66	I	5459.75	5459.75	humana medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	humana medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	humana medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	humana medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	humana medicare advantage	hmo
"X-ray of middle spine, 2 views"	cpt	72070	99.29	99.29	17.96	17.96	328.18	328.18	273.48	273.48	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of middle spine, 2 views"	cpt	72070	99.29	99.29	17.96	17.96	328.18	328.18	273.48	273.48	O	99.29	99.29	humana medicare advantage	pos
"X-ray of middle spine, 2 views"	cpt	72070	99.29	99.29	17.96	17.96	328.18	328.18	273.48	273.48	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of middle spine, 2 views"	cpt	72070	99.29	99.29	17.96	17.96	328.18	328.18	273.48	273.48	O	99.29	99.29	humana medicare advantage	hmo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9569.15	9569.15	humana medicare advantage	hmo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9569.15	9569.15	humana medicare advantage	pos
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9569.15	9569.15	humana medicare advantage	ppo
other multiple significant trauma with cc	ms-drg	964	9633.01	9633.01	7146.66	7146.66	32160.8	32160.8	26800.67	26800.67	I	9569.15	9569.15	humana medicare advantage	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	humana medicare advantage	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	humana medicare advantage	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	humana medicare advantage	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	13.39	13.39	humana medicare advantage	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	humana medicare advantage	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	humana medicare advantage	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	humana medicare advantage	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	humana medicare advantage	hmo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	99.29	99.29	humana medicare advantage	pos
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	99.29	99.29	humana medicare advantage	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	8.68	8.68	humana medicare advantage	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	8.68	8.68	humana medicare advantage	pos
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	8.68	8.68	humana medicare advantage	ppo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	8.68	8.68	humana medicare advantage	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	pos
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	99.29	99.29	humana medicare advantage	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	humana medicare advantage	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	humana medicare advantage	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	humana medicare advantage	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	humana medicare advantage	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	humana medicare advantage	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	humana medicare advantage	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	humana medicare advantage	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	humana medicare advantage	hmo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	70.7	70.7	humana medicare advantage	pos
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	70.7	70.7	humana medicare advantage	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	pos
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	humana medicare advantage	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	humana medicare advantage	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	humana medicare advantage	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	humana medicare advantage	hmo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	18.39	18.39	humana medicare advantage	hmo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	18.39	18.39	humana medicare advantage	pos
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	18.39	18.39	humana medicare advantage	ppo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	18.39	18.39	humana medicare advantage	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	161.43	161.43	humana medicare advantage	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	161.43	161.43	humana medicare advantage	pos
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	161.43	161.43	humana medicare advantage	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	161.43	161.43	humana medicare advantage	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	humana medicare advantage	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	humana medicare advantage	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	humana medicare advantage	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	humana medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	90	90	humana medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	90	90	humana medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	90	90	humana medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	90	90	humana medicare advantage	hmo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	161.43	161.43	humana medicare advantage	hmo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	161.43	161.43	humana medicare advantage	pos
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	161.43	161.43	humana medicare advantage	ppo
CT scan chest before and after contrast	cpt	71270	808.13	808.13	158.85	158.85	2753.88	2753.88	2294.9	2294.9	O	161.43	161.43	humana medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	humana medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	humana medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	humana medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	humana medicare advantage	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	humana medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	humana medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	humana medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	humana medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	humana medicare advantage	hmo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	8752.86	8752.86	humana medicare advantage	hmo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	8752.86	8752.86	humana medicare advantage	pos
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	8752.86	8752.86	humana medicare advantage	ppo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	8752.86	8752.86	humana medicare advantage	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	humana medicare advantage	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	humana medicare advantage	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	humana medicare advantage	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	humana medicare advantage	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	406.78	406.78	humana medicare advantage	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	406.78	406.78	humana medicare advantage	pos
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	406.78	406.78	humana medicare advantage	ppo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	406.78	406.78	humana medicare advantage	hmo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	pos
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	ppo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	99.29	99.29	humana medicare advantage	hmo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	429.57	429.57	humana medicare advantage	hmo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	429.57	429.57	humana medicare advantage	pos
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	429.57	429.57	humana medicare advantage	ppo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	429.57	429.57	humana medicare advantage	hmo
bls	cpt	A0428	911.16	911.16	251.75	251.75	819.6	819.6	683	683	O	572.32	572.32	humana medicare advantage	hmo
bls	cpt	A0428	911.16	911.16	251.75	251.75	819.6	819.6	683	683	O	572.32	572.32	humana medicare advantage	pos
bls	cpt	A0428	911.16	911.16	251.75	251.75	819.6	819.6	683	683	O	572.32	572.32	humana medicare advantage	ppo
bls	cpt	A0428	911.16	911.16	251.75	251.75	819.6	819.6	683	683	O	572.32	572.32	humana medicare advantage	hmo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	380.3	380.3	humana medicare advantage	hmo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	380.3	380.3	humana medicare advantage	pos
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	380.3	380.3	humana medicare advantage	ppo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	380.3	380.3	humana medicare advantage	hmo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	1974.1	1974.1	humana medicare advantage	hmo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	1974.1	1974.1	humana medicare advantage	pos
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	1974.1	1974.1	humana medicare advantage	ppo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	1974.1	1974.1	humana medicare advantage	hmo
"X-ray of both sides of the ribs including the chest, minimum of 4 views"	cpt	71111	99.29	99.29	29.33	29.33	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of both sides of the ribs including the chest, minimum of 4 views"	cpt	71111	99.29	99.29	29.33	29.33	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	pos
"X-ray of both sides of the ribs including the chest, minimum of 4 views"	cpt	71111	99.29	99.29	29.33	29.33	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of both sides of the ribs including the chest, minimum of 4 views"	cpt	71111	99.29	99.29	29.33	29.33	384.14	384.14	320.12	320.12	O	99.29	99.29	humana medicare advantage	hmo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	1103.22	1103.22	humana medicare advantage	hmo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	1103.22	1103.22	humana medicare advantage	pos
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	1103.22	1103.22	humana medicare advantage	ppo
implantable tissue marker	cpt	A4648	8915.14	8915.14	1103.22	1103.22	32134.67	32134.67	26778.89	26778.89	O	1103.22	1103.22	humana medicare advantage	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	95.82	95.82	humana medicare advantage	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	95.82	95.82	humana medicare advantage	pos
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	95.82	95.82	humana medicare advantage	ppo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	95.82	95.82	humana medicare advantage	hmo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	102.7	102.7	humana medicare advantage	hmo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	102.7	102.7	humana medicare advantage	pos
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	102.7	102.7	humana medicare advantage	ppo
alginate dressing <=16 sq in	cpt	A6196	725.19	725.19	65.7	65.7	1176.96	1176.96	980.8	980.8	O	102.7	102.7	humana medicare advantage	hmo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	70.7	70.7	humana medicare advantage	pos
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of ribs of one side of body, 2 views"	cpt	71100	213.26	213.26	20.29	20.29	433.75	433.75	361.46	361.46	O	70.7	70.7	humana medicare advantage	hmo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	278.29	278.29	humana medicare advantage	hmo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	278.29	278.29	humana medicare advantage	pos
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	278.29	278.29	humana medicare advantage	ppo
alginate drsg >16 <=48 sq in	cpt	A6197	616.41	616.41	64.43	64.43	1471.2	1471.2	1226	1226	O	278.29	278.29	humana medicare advantage	hmo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	humana medicare advantage	hmo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	humana medicare advantage	pos
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	humana medicare advantage	ppo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	humana medicare advantage	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	humana medicare advantage	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	humana medicare advantage	pos
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	humana medicare advantage	ppo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	humana medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.7	70.7	humana medicare advantage	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.7	70.7	humana medicare advantage	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	humana medicare advantage	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	humana medicare advantage	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	humana medicare advantage	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1127.01	1127.01	humana medicare advantage	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	664.39	664.39	humana medicare advantage	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	664.39	664.39	humana medicare advantage	pos
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	664.39	664.39	humana medicare advantage	ppo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	664.39	664.39	humana medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	70.7	70.7	humana medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	70.7	70.7	humana medicare advantage	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	70.7	70.7	humana medicare advantage	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	70.7	70.7	humana medicare advantage	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	415.66	415.66	humana medicare advantage	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	415.66	415.66	humana medicare advantage	pos
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	415.66	415.66	humana medicare advantage	ppo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	415.66	415.66	humana medicare advantage	hmo
tc99m pyrophosphate	cpt	A9538	326.12	326.12	320.9	320.9	2718.01	2718.01	2265.01	2265.01	O	326.12	326.12	humana medicare advantage	hmo
tc99m pyrophosphate	cpt	A9538	326.12	326.12	320.9	320.9	2718.01	2718.01	2265.01	2265.01	O	326.12	326.12	humana medicare advantage	pos
tc99m pyrophosphate	cpt	A9538	326.12	326.12	320.9	320.9	2718.01	2718.01	2265.01	2265.01	O	326.12	326.12	humana medicare advantage	ppo
tc99m pyrophosphate	cpt	A9538	326.12	326.12	320.9	320.9	2718.01	2718.01	2265.01	2265.01	O	326.12	326.12	humana medicare advantage	hmo
tc99m pentetate	cpt	A9539	421.27	421.27	260.45	260.45	1775.23	1775.23	1479.36	1479.36	O	418.12	418.12	humana medicare advantage	hmo
tc99m pentetate	cpt	A9539	421.27	421.27	260.45	260.45	1775.23	1775.23	1479.36	1479.36	O	418.12	418.12	humana medicare advantage	pos
tc99m pentetate	cpt	A9539	421.27	421.27	260.45	260.45	1775.23	1775.23	1479.36	1479.36	O	418.12	418.12	humana medicare advantage	ppo
tc99m pentetate	cpt	A9539	421.27	421.27	260.45	260.45	1775.23	1775.23	1479.36	1479.36	O	418.12	418.12	humana medicare advantage	hmo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	326.12	326.12	humana medicare advantage	hmo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	326.12	326.12	humana medicare advantage	pos
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	326.12	326.12	humana medicare advantage	ppo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	326.12	326.12	humana medicare advantage	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	humana medicare advantage	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	humana medicare advantage	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	humana medicare advantage	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	humana medicare advantage	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	1952.13	1952.13	1005.31	1005.31	14304.31	14304.31	11920.26	11920.26	E	1952.13	1952.13	humana medicare advantage	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	1952.13	1952.13	1005.31	1005.31	14304.31	14304.31	11920.26	11920.26	E	1952.13	1952.13	humana medicare advantage	pos
"gad-base mr contrast nos,1ml"	cpt	A9579	1952.13	1952.13	1005.31	1005.31	14304.31	14304.31	11920.26	11920.26	E	1952.13	1952.13	humana medicare advantage	ppo
"gad-base mr contrast nos,1ml"	cpt	A9579	1952.13	1952.13	1005.31	1005.31	14304.31	14304.31	11920.26	11920.26	E	1952.13	1952.13	humana medicare advantage	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	humana medicare advantage	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	humana medicare advantage	pos
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	humana medicare advantage	ppo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	70.7	70.7	humana medicare advantage	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	338.27	338.27	humana medicare advantage	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	338.27	338.27	humana medicare advantage	pos
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	338.27	338.27	humana medicare advantage	ppo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	338.27	338.27	humana medicare advantage	hmo
radium ra223 dichloride ther	cpt	A9606	20035.66	20035.66	20035.66	20035.66	85087.9	85087.9	70906.58	70906.58	O	20035.66	20035.66	humana medicare advantage	hmo
radium ra223 dichloride ther	cpt	A9606	20035.66	20035.66	20035.66	20035.66	85087.9	85087.9	70906.58	70906.58	O	20035.66	20035.66	humana medicare advantage	pos
radium ra223 dichloride ther	cpt	A9606	20035.66	20035.66	20035.66	20035.66	85087.9	85087.9	70906.58	70906.58	O	20035.66	20035.66	humana medicare advantage	ppo
radium ra223 dichloride ther	cpt	A9606	20035.66	20035.66	20035.66	20035.66	85087.9	85087.9	70906.58	70906.58	O	20035.66	20035.66	humana medicare advantage	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	8777.72	8777.72	1569.38	1569.38	43374.37	43374.37	36145.31	36145.31	E	8777.72	8777.72	humana medicare advantage	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	8777.72	8777.72	1569.38	1569.38	43374.37	43374.37	36145.31	36145.31	E	8777.72	8777.72	humana medicare advantage	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	8777.72	8777.72	1569.38	1569.38	43374.37	43374.37	36145.31	36145.31	E	8777.72	8777.72	humana medicare advantage	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	8777.72	8777.72	1569.38	1569.38	43374.37	43374.37	36145.31	36145.31	E	8777.72	8777.72	humana medicare advantage	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	5249.25	5249.25	humana medicare advantage	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	5249.25	5249.25	humana medicare advantage	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	5249.25	5249.25	humana medicare advantage	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	5249.25	5249.25	humana medicare advantage	hmo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	11449.31	11449.31	humana medicare advantage	hmo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	11449.31	11449.31	humana medicare advantage	pos
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	11449.31	11449.31	humana medicare advantage	ppo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	11449.31	11449.31	humana medicare advantage	hmo
"aicd, dual chamber"	cpt	C1721	28598.55	28598.55	19750.59	19750.59	107408.74	107408.74	89507.28	89507.28	O	28598.55	28598.55	humana medicare advantage	hmo
"aicd, dual chamber"	cpt	C1721	28598.55	28598.55	19750.59	19750.59	107408.74	107408.74	89507.28	89507.28	O	28598.55	28598.55	humana medicare advantage	pos
"aicd, dual chamber"	cpt	C1721	28598.55	28598.55	19750.59	19750.59	107408.74	107408.74	89507.28	89507.28	O	28598.55	28598.55	humana medicare advantage	ppo
"aicd, dual chamber"	cpt	C1721	28598.55	28598.55	19750.59	19750.59	107408.74	107408.74	89507.28	89507.28	O	28598.55	28598.55	humana medicare advantage	hmo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	humana medicare advantage	hmo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	humana medicare advantage	pos
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	humana medicare advantage	ppo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	humana medicare advantage	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	70.7	70.7	humana medicare advantage	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	70.7	70.7	humana medicare advantage	pos
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	70.7	70.7	humana medicare advantage	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	70.7	70.7	humana medicare advantage	hmo
"cath, translumin non-laser"	cpt	C1725	13873.2	13873.2	6589.84	6589.84	75620.26	75620.26	63016.88	63016.88	E	6589.84	6589.84	humana medicare advantage	hmo
"cath, translumin non-laser"	cpt	C1725	13873.2	13873.2	6589.84	6589.84	75620.26	75620.26	63016.88	63016.88	E	6589.84	6589.84	humana medicare advantage	pos
"cath, translumin non-laser"	cpt	C1725	13873.2	13873.2	6589.84	6589.84	75620.26	75620.26	63016.88	63016.88	E	6589.84	6589.84	humana medicare advantage	ppo
"cath, translumin non-laser"	cpt	C1725	13873.2	13873.2	6589.84	6589.84	75620.26	75620.26	63016.88	63016.88	E	6589.84	6589.84	humana medicare advantage	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	8777.72	8777.72	humana medicare advantage	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	8777.72	8777.72	humana medicare advantage	pos
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	8777.72	8777.72	humana medicare advantage	ppo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	8777.72	8777.72	humana medicare advantage	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	humana medicare advantage	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	humana medicare advantage	pos
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	humana medicare advantage	ppo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	humana medicare advantage	hmo
"cath, hemodialysis,long-term"	cpt	C1750	2455.02	2455.02	2415.74	2415.74	19732.02	19732.02	16443.35	16443.35	O	2455.02	2455.02	humana medicare advantage	hmo
"cath, hemodialysis,long-term"	cpt	C1750	2455.02	2455.02	2415.74	2415.74	19732.02	19732.02	16443.35	16443.35	O	2455.02	2455.02	humana medicare advantage	pos
"cath, hemodialysis,long-term"	cpt	C1750	2455.02	2455.02	2415.74	2415.74	19732.02	19732.02	16443.35	16443.35	O	2455.02	2455.02	humana medicare advantage	ppo
"cath, hemodialysis,long-term"	cpt	C1750	2455.02	2455.02	2415.74	2415.74	19732.02	19732.02	16443.35	16443.35	O	2455.02	2455.02	humana medicare advantage	hmo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	humana medicare advantage	hmo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	humana medicare advantage	pos
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	humana medicare advantage	ppo
"cath, inf, per/cent/midline"	cpt	C1751	14345.81	14345.81	2405.95	2405.95	20727.73	20727.73	17273.11	17273.11	O	2524.71	2524.71	humana medicare advantage	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	pos
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	ppo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	206.45	206.45	humana medicare advantage	hmo
"cath, intravas ultrasound"	cpt	C1753	14120.9	14120.9	8777.72	8777.72	81705.65	81705.65	68088.04	68088.04	O	14120.9	14120.9	humana medicare advantage	hmo
"cath, intravas ultrasound"	cpt	C1753	14120.9	14120.9	8777.72	8777.72	81705.65	81705.65	68088.04	68088.04	O	14120.9	14120.9	humana medicare advantage	pos
"cath, intravas ultrasound"	cpt	C1753	14120.9	14120.9	8777.72	8777.72	81705.65	81705.65	68088.04	68088.04	O	14120.9	14120.9	humana medicare advantage	ppo
"cath, intravas ultrasound"	cpt	C1753	14120.9	14120.9	8777.72	8777.72	81705.65	81705.65	68088.04	68088.04	O	14120.9	14120.9	humana medicare advantage	hmo
"cath, pacing, transesoph"	cpt	C1756	6636.16	6636.16	6636.16	6636.16	71969.58	71969.58	59974.65	59974.65	O	6636.16	6636.16	humana medicare advantage	hmo
"cath, pacing, transesoph"	cpt	C1756	6636.16	6636.16	6636.16	6636.16	71969.58	71969.58	59974.65	59974.65	O	6636.16	6636.16	humana medicare advantage	pos
"cath, pacing, transesoph"	cpt	C1756	6636.16	6636.16	6636.16	6636.16	71969.58	71969.58	59974.65	59974.65	O	6636.16	6636.16	humana medicare advantage	ppo
"cath, pacing, transesoph"	cpt	C1756	6636.16	6636.16	6636.16	6636.16	71969.58	71969.58	59974.65	59974.65	O	6636.16	6636.16	humana medicare advantage	hmo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	3676.69	3676.69	humana medicare advantage	hmo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	3676.69	3676.69	humana medicare advantage	pos
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	3676.69	3676.69	humana medicare advantage	ppo
"catheter, ureteral"	cpt	C1758	4681.97	4681.97	1541.69	1541.69	22733.84	22733.84	18944.87	18944.87	O	3676.69	3676.69	humana medicare advantage	hmo
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	8777.72	8777.72	humana medicare advantage	hmo
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	8777.72	8777.72	humana medicare advantage	pos
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	8777.72	8777.72	humana medicare advantage	ppo
"closure dev, vasc"	cpt	C1760	8777.72	8777.72	706.25	706.25	78433.24	78433.24	65361.03	65361.03	O	8777.72	8777.72	humana medicare advantage	hmo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	4401.96	4401.96	humana medicare advantage	hmo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	4401.96	4401.96	humana medicare advantage	pos
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	4401.96	4401.96	humana medicare advantage	ppo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	4401.96	4401.96	humana medicare advantage	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	4388.57	4388.57	humana medicare advantage	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	4388.57	4388.57	humana medicare advantage	pos
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	4388.57	4388.57	humana medicare advantage	ppo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	4388.57	4388.57	humana medicare advantage	hmo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	338.27	338.27	humana medicare advantage	hmo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	338.27	338.27	humana medicare advantage	pos
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	338.27	338.27	humana medicare advantage	ppo
"MRI scan bones of the eye, face, and/or neck before and after contrast"	cpt	70543	481.31	481.31	287.84	287.84	2275.61	2275.61	1896.34	1896.34	O	338.27	338.27	humana medicare advantage	hmo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	hmo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	pos
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	ppo
CT scan of neck blood vessels with contrast	cpt	70498	465.78	465.78	158.85	158.85	1985.59	1985.59	1654.66	1654.66	O	161.43	161.43	humana medicare advantage	hmo
"lead, aicd, endo single coil"	cpt	C1777	28598.55	28598.55	26166.91	26166.91	118891.24	118891.24	99076.03	99076.03	O	28598.55	28598.55	humana medicare advantage	hmo
"lead, aicd, endo single coil"	cpt	C1777	28598.55	28598.55	26166.91	26166.91	118891.24	118891.24	99076.03	99076.03	O	28598.55	28598.55	humana medicare advantage	pos
"lead, aicd, endo single coil"	cpt	C1777	28598.55	28598.55	26166.91	26166.91	118891.24	118891.24	99076.03	99076.03	O	28598.55	28598.55	humana medicare advantage	ppo
"lead, aicd, endo single coil"	cpt	C1777	28598.55	28598.55	26166.91	26166.91	118891.24	118891.24	99076.03	99076.03	O	28598.55	28598.55	humana medicare advantage	hmo
CT scan of neck blood vessels with contrast	cpt	70498	408.55	408.55	168.41	168.41	1985.59	1985.59	1654.66	1654.66	E	408.55	408.55	humana medicare advantage	hmo
CT scan of neck blood vessels with contrast	cpt	70498	408.55	408.55	168.41	168.41	1985.59	1985.59	1654.66	1654.66	E	408.55	408.55	humana medicare advantage	pos
CT scan of neck blood vessels with contrast	cpt	70498	408.55	408.55	168.41	168.41	1985.59	1985.59	1654.66	1654.66	E	408.55	408.55	humana medicare advantage	ppo
CT scan of neck blood vessels with contrast	cpt	70498	408.55	408.55	168.41	168.41	1985.59	1985.59	1654.66	1654.66	E	408.55	408.55	humana medicare advantage	hmo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	4282.09	4282.09	humana medicare advantage	hmo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	4282.09	4282.09	humana medicare advantage	pos
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	4282.09	4282.09	humana medicare advantage	ppo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	4282.09	4282.09	humana medicare advantage	hmo
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	pos
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	ppo
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	9007.23	9007.23	40080.85	40080.85	33400.71	33400.71	O	9081.99	9081.99	humana medicare advantage	hmo
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	9007.23	9007.23	40080.85	40080.85	33400.71	33400.71	O	9081.99	9081.99	humana medicare advantage	pos
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	9007.23	9007.23	40080.85	40080.85	33400.71	33400.71	O	9081.99	9081.99	humana medicare advantage	ppo
"pmkr, dual, rate-resp"	cpt	C1785	9081.99	9081.99	9007.23	9007.23	40080.85	40080.85	33400.71	33400.71	O	9081.99	9081.99	humana medicare advantage	hmo
"pmkr, single, rate-resp"	cpt	C1786	8928.51	8928.51	6769.76	6769.76	33957.7	33957.7	28298.08	28298.08	O	6769.76	6769.76	humana medicare advantage	hmo
"pmkr, single, rate-resp"	cpt	C1786	8928.51	8928.51	6769.76	6769.76	33957.7	33957.7	28298.08	28298.08	O	6769.76	6769.76	humana medicare advantage	pos
"pmkr, single, rate-resp"	cpt	C1786	8928.51	8928.51	6769.76	6769.76	33957.7	33957.7	28298.08	28298.08	O	6769.76	6769.76	humana medicare advantage	ppo
"pmkr, single, rate-resp"	cpt	C1786	8928.51	8928.51	6769.76	6769.76	33957.7	33957.7	28298.08	28298.08	O	6769.76	6769.76	humana medicare advantage	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2418.19	2418.19	humana medicare advantage	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2418.19	2418.19	humana medicare advantage	pos
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2418.19	2418.19	humana medicare advantage	ppo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2418.19	2418.19	humana medicare advantage	hmo
"stent, coated/cov w/del sys"	cpt	C1874	13873.2	13873.2	8777.72	8777.72	83814.13	83814.13	69845.11	69845.11	E	8777.72	8777.72	humana medicare advantage	hmo
"stent, coated/cov w/del sys"	cpt	C1874	13873.2	13873.2	8777.72	8777.72	83814.13	83814.13	69845.11	69845.11	E	8777.72	8777.72	humana medicare advantage	pos
"stent, coated/cov w/del sys"	cpt	C1874	13873.2	13873.2	8777.72	8777.72	83814.13	83814.13	69845.11	69845.11	E	8777.72	8777.72	humana medicare advantage	ppo
"stent, coated/cov w/del sys"	cpt	C1874	13873.2	13873.2	8777.72	8777.72	83814.13	83814.13	69845.11	69845.11	E	8777.72	8777.72	humana medicare advantage	hmo
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	8777.72	8777.72	humana medicare advantage	hmo
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	8777.72	8777.72	humana medicare advantage	pos
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	8777.72	8777.72	humana medicare advantage	ppo
"stent, coated/cov w/del sys"	cpt	C1874	14156.17	14156.17	7176.4	7176.4	75662.39	75662.39	63051.99	63051.99	O	8777.72	8777.72	humana medicare advantage	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	8777.72	8777.72	3748.71	3748.71	57546.59	57546.59	47955.49	47955.49	E	8777.72	8777.72	humana medicare advantage	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	8777.72	8777.72	3748.71	3748.71	57546.59	57546.59	47955.49	47955.49	E	8777.72	8777.72	humana medicare advantage	pos
"stent, non-coa/non-cov w/del"	cpt	C1876	8777.72	8777.72	3748.71	3748.71	57546.59	57546.59	47955.49	47955.49	E	8777.72	8777.72	humana medicare advantage	ppo
"stent, non-coa/non-cov w/del"	cpt	C1876	8777.72	8777.72	3748.71	3748.71	57546.59	57546.59	47955.49	47955.49	E	8777.72	8777.72	humana medicare advantage	hmo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	161.43	161.43	humana medicare advantage	hmo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	161.43	161.43	humana medicare advantage	pos
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	161.43	161.43	humana medicare advantage	ppo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	161.43	161.43	humana medicare advantage	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	3748.71	3748.71	humana medicare advantage	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	3748.71	3748.71	humana medicare advantage	pos
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	3748.71	3748.71	humana medicare advantage	ppo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	3748.71	3748.71	humana medicare advantage	hmo
embolization protect syst	cpt	C1884	11328.88	11328.88	6589.84	6589.84	72908.51	72908.51	60757.09	60757.09	E	6589.84	6589.84	humana medicare advantage	hmo
embolization protect syst	cpt	C1884	11328.88	11328.88	6589.84	6589.84	72908.51	72908.51	60757.09	60757.09	E	6589.84	6589.84	humana medicare advantage	pos
embolization protect syst	cpt	C1884	11328.88	11328.88	6589.84	6589.84	72908.51	72908.51	60757.09	60757.09	E	6589.84	6589.84	humana medicare advantage	ppo
embolization protect syst	cpt	C1884	11328.88	11328.88	6589.84	6589.84	72908.51	72908.51	60757.09	60757.09	E	6589.84	6589.84	humana medicare advantage	hmo
CT scan of neck with contrast	cpt	70491	161.43	161.43	112.47	112.47	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	hmo
CT scan of neck with contrast	cpt	70491	161.43	161.43	112.47	112.47	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	pos
CT scan of neck with contrast	cpt	70491	161.43	161.43	112.47	112.47	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	ppo
CT scan of neck with contrast	cpt	70491	161.43	161.43	112.47	112.47	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8777.72	8777.72	humana medicare advantage	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8777.72	8777.72	humana medicare advantage	pos
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8777.72	8777.72	humana medicare advantage	ppo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	8777.72	8777.72	humana medicare advantage	hmo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	humana medicare advantage	hmo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	humana medicare advantage	pos
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	humana medicare advantage	ppo
CT scan of neck	cpt	70490	214.42	214.42	84.5	84.5	1366.13	1366.13	1138.44	1138.44	O	214.42	214.42	humana medicare advantage	hmo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	4401.96	4401.96	humana medicare advantage	hmo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	4401.96	4401.96	humana medicare advantage	pos
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	4401.96	4401.96	humana medicare advantage	ppo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	4401.96	4401.96	humana medicare advantage	hmo
CT scan of face with contrast	cpt	70487	161.43	161.43	93.52	93.52	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	hmo
CT scan of face with contrast	cpt	70487	161.43	161.43	93.52	93.52	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	pos
CT scan of face with contrast	cpt	70487	161.43	161.43	93.52	93.52	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	ppo
CT scan of face with contrast	cpt	70487	161.43	161.43	93.52	93.52	1507.32	1507.32	1256.1	1256.1	E	161.43	161.43	humana medicare advantage	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	8777.72	8777.72	humana medicare advantage	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	8777.72	8777.72	humana medicare advantage	pos
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	8777.72	8777.72	humana medicare advantage	ppo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	8777.72	8777.72	humana medicare advantage	hmo
"intro/sheath,fixed,peel-away"	cpt	C1892	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"intro/sheath,fixed,peel-away"	cpt	C1892	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	pos
"intro/sheath,fixed,peel-away"	cpt	C1892	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	ppo
"intro/sheath,fixed,peel-away"	cpt	C1892	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	18840.27	18840.27	humana medicare advantage	hmo
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	18840.27	18840.27	humana medicare advantage	pos
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	18840.27	18840.27	humana medicare advantage	ppo
"intro/sheath,fixed,peel-away"	cpt	C1892	18840.27	18840.27	2410.83	2410.83	40076.36	40076.36	33396.97	33396.97	O	18840.27	18840.27	humana medicare advantage	hmo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	8777.72	8777.72	humana medicare advantage	hmo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	8777.72	8777.72	humana medicare advantage	pos
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	8777.72	8777.72	humana medicare advantage	ppo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	8777.72	8777.72	humana medicare advantage	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	4202.35	4202.35	humana medicare advantage	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	4202.35	4202.35	humana medicare advantage	pos
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	4202.35	4202.35	humana medicare advantage	ppo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	4202.35	4202.35	humana medicare advantage	hmo
"lead, pmkr, other than trans"	cpt	C1898	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"lead, pmkr, other than trans"	cpt	C1898	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	pos
"lead, pmkr, other than trans"	cpt	C1898	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	ppo
"lead, pmkr, other than trans"	cpt	C1898	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"lead, pmkr, other than trans"	cpt	C1898	26166.91	26166.91	9081.99	9081.99	40405.91	40405.91	33671.59	33671.59	O	18840.27	18840.27	humana medicare advantage	hmo
"lead, pmkr, other than trans"	cpt	C1898	26166.91	26166.91	9081.99	9081.99	40405.91	40405.91	33671.59	33671.59	O	18840.27	18840.27	humana medicare advantage	pos
"lead, pmkr, other than trans"	cpt	C1898	26166.91	26166.91	9081.99	9081.99	40405.91	40405.91	33671.59	33671.59	O	18840.27	18840.27	humana medicare advantage	ppo
"lead, pmkr, other than trans"	cpt	C1898	26166.91	26166.91	9081.99	9081.99	40405.91	40405.91	33671.59	33671.59	O	18840.27	18840.27	humana medicare advantage	hmo
"stent, non-cor, tem w/o del"	cpt	C2617	3748.71	3748.71	2631.27	2631.27	31516.26	31516.26	26263.55	26263.55	E	3748.71	3748.71	humana medicare advantage	hmo
"stent, non-cor, tem w/o del"	cpt	C2617	3748.71	3748.71	2631.27	2631.27	31516.26	31516.26	26263.55	26263.55	E	3748.71	3748.71	humana medicare advantage	pos
"stent, non-cor, tem w/o del"	cpt	C2617	3748.71	3748.71	2631.27	2631.27	31516.26	31516.26	26263.55	26263.55	E	3748.71	3748.71	humana medicare advantage	ppo
"stent, non-cor, tem w/o del"	cpt	C2617	3748.71	3748.71	2631.27	2631.27	31516.26	31516.26	26263.55	26263.55	E	3748.71	3748.71	humana medicare advantage	hmo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	hmo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	pos
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	ppo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	hmo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	2674.06	2674.06	humana medicare advantage	hmo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	2674.06	2674.06	humana medicare advantage	pos
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	2674.06	2674.06	humana medicare advantage	ppo
"stent, non-cor, tem w/o del"	cpt	C2617	8848.19	8848.19	2456.25	2456.25	22769.68	22769.68	18974.73	18974.73	O	2674.06	2674.06	humana medicare advantage	hmo
"cath, translumin, drug-coat"	cpt	C2623	11375.62	11375.62	4318.35	4318.35	105399.55	105399.55	87832.96	87832.96	O	8646.05	8646.05	humana medicare advantage	hmo
"cath, translumin, drug-coat"	cpt	C2623	11375.62	11375.62	4318.35	4318.35	105399.55	105399.55	87832.96	87832.96	O	8646.05	8646.05	humana medicare advantage	pos
"cath, translumin, drug-coat"	cpt	C2623	11375.62	11375.62	4318.35	4318.35	105399.55	105399.55	87832.96	87832.96	O	8646.05	8646.05	humana medicare advantage	ppo
"cath, translumin, drug-coat"	cpt	C2623	11375.62	11375.62	4318.35	4318.35	105399.55	105399.55	87832.96	87832.96	O	8646.05	8646.05	humana medicare advantage	hmo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	3679.64	3679.64	humana medicare advantage	hmo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	3679.64	3679.64	humana medicare advantage	pos
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	3679.64	3679.64	humana medicare advantage	ppo
"intro/sheath, laser"	cpt	C2629	4436.99	4436.99	2985.59	2985.59	26294.69	26294.69	21912.24	21912.24	O	3679.64	3679.64	humana medicare advantage	hmo
perc drug-el cor stent sing	cpt	C9600	11328.88	11328.88	8777.72	8777.72	81384.32	81384.32	67820.27	67820.27	E	8777.72	8777.72	humana medicare advantage	hmo
perc drug-el cor stent sing	cpt	C9600	11328.88	11328.88	8777.72	8777.72	81384.32	81384.32	67820.27	67820.27	E	8777.72	8777.72	humana medicare advantage	pos
perc drug-el cor stent sing	cpt	C9600	11328.88	11328.88	8777.72	8777.72	81384.32	81384.32	67820.27	67820.27	E	8777.72	8777.72	humana medicare advantage	ppo
perc drug-el cor stent sing	cpt	C9600	11328.88	11328.88	8777.72	8777.72	81384.32	81384.32	67820.27	67820.27	E	8777.72	8777.72	humana medicare advantage	hmo
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	8777.72	8777.72	humana medicare advantage	hmo
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	8777.72	8777.72	humana medicare advantage	pos
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	8777.72	8777.72	humana medicare advantage	ppo
perc drug-el cor stent sing	cpt	C9600	14191.44	14191.44	4401.38	4401.38	76664.45	76664.45	63887.04	63887.04	O	8777.72	8777.72	humana medicare advantage	hmo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	99.29	99.29	humana medicare advantage	hmo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	99.29	99.29	humana medicare advantage	pos
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	99.29	99.29	humana medicare advantage	ppo
"X-ray of mandible, minimum of 4 views"	cpt	70110	99.29	99.29	70.78	70.78	443.93	443.93	369.94	369.94	O	99.29	99.29	humana medicare advantage	hmo
perc drug-el cor stent bran	cpt	C9601	8777.72	8777.72	8643.45	8643.45	92532.48	92532.48	77110.4	77110.4	E	8777.72	8777.72	humana medicare advantage	hmo
perc drug-el cor stent bran	cpt	C9601	8777.72	8777.72	8643.45	8643.45	92532.48	92532.48	77110.4	77110.4	E	8777.72	8777.72	humana medicare advantage	pos
perc drug-el cor stent bran	cpt	C9601	8777.72	8777.72	8643.45	8643.45	92532.48	92532.48	77110.4	77110.4	E	8777.72	8777.72	humana medicare advantage	ppo
perc drug-el cor stent bran	cpt	C9601	8777.72	8777.72	8643.45	8643.45	92532.48	92532.48	77110.4	77110.4	E	8777.72	8777.72	humana medicare advantage	hmo
Removal of implanted eardrum tube under anesthesia	cpt	69424	4492.07	4492.07	2320.38	2320.38	12184.91	12184.91	10154.09	10154.09	O	2320.38	2320.38	humana medicare advantage	hmo
Removal of implanted eardrum tube under anesthesia	cpt	69424	4492.07	4492.07	2320.38	2320.38	12184.91	12184.91	10154.09	10154.09	O	2320.38	2320.38	humana medicare advantage	pos
Removal of implanted eardrum tube under anesthesia	cpt	69424	4492.07	4492.07	2320.38	2320.38	12184.91	12184.91	10154.09	10154.09	O	2320.38	2320.38	humana medicare advantage	ppo
Removal of implanted eardrum tube under anesthesia	cpt	69424	4492.07	4492.07	2320.38	2320.38	12184.91	12184.91	10154.09	10154.09	O	2320.38	2320.38	humana medicare advantage	hmo
perc d-e cor revasc t cabg s	cpt	C9604	8777.72	8777.72	8777.72	8777.72	62252.08	62252.08	51876.73	51876.73	O	8777.72	8777.72	humana medicare advantage	hmo
perc d-e cor revasc t cabg s	cpt	C9604	8777.72	8777.72	8777.72	8777.72	62252.08	62252.08	51876.73	51876.73	O	8777.72	8777.72	humana medicare advantage	pos
perc d-e cor revasc t cabg s	cpt	C9604	8777.72	8777.72	8777.72	8777.72	62252.08	62252.08	51876.73	51876.73	O	8777.72	8777.72	humana medicare advantage	ppo
perc d-e cor revasc t cabg s	cpt	C9604	8777.72	8777.72	8777.72	8777.72	62252.08	62252.08	51876.73	51876.73	O	8777.72	8777.72	humana medicare advantage	hmo
perc d-e cor revasc chro sin	cpt	C9607	14120.9	14120.9	13866.64	13866.64	83863.39	83863.39	69886.16	69886.16	O	14120.9	14120.9	humana medicare advantage	hmo
perc d-e cor revasc chro sin	cpt	C9607	14120.9	14120.9	13866.64	13866.64	83863.39	83863.39	69886.16	69886.16	O	14120.9	14120.9	humana medicare advantage	pos
perc d-e cor revasc chro sin	cpt	C9607	14120.9	14120.9	13866.64	13866.64	83863.39	83863.39	69886.16	69886.16	O	14120.9	14120.9	humana medicare advantage	ppo
perc d-e cor revasc chro sin	cpt	C9607	14120.9	14120.9	13866.64	13866.64	83863.39	83863.39	69886.16	69886.16	O	14120.9	14120.9	humana medicare advantage	hmo
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	2173.49	2173.49	humana medicare advantage	hmo
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	2173.49	2173.49	humana medicare advantage	pos
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	2173.49	2173.49	humana medicare advantage	ppo
admin influenza virus vac	cpt	G0008	2173.49	2173.49	617.1	617.1	15661.25	15661.25	13051.04	13051.04	E	2173.49	2173.49	humana medicare advantage	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	325.88	325.88	humana medicare advantage	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	325.88	325.88	humana medicare advantage	pos
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	325.88	325.88	humana medicare advantage	ppo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	325.88	325.88	humana medicare advantage	hmo
"Partial removal of eye fluid between the lens and retina, subtotal removal with mechanical vitrectomy"	cpt	67010	1791.13	1791.13	1791.13	1791.13	32535.89	32535.89	27113.24	27113.24	O	1791.13	1791.13	humana medicare advantage	hmo
"Partial removal of eye fluid between the lens and retina, subtotal removal with mechanical vitrectomy"	cpt	67010	1791.13	1791.13	1791.13	1791.13	32535.89	32535.89	27113.24	27113.24	O	1791.13	1791.13	humana medicare advantage	pos
"Partial removal of eye fluid between the lens and retina, subtotal removal with mechanical vitrectomy"	cpt	67010	1791.13	1791.13	1791.13	1791.13	32535.89	32535.89	27113.24	27113.24	O	1791.13	1791.13	humana medicare advantage	ppo
"Partial removal of eye fluid between the lens and retina, subtotal removal with mechanical vitrectomy"	cpt	67010	1791.13	1791.13	1791.13	1791.13	32535.89	32535.89	27113.24	27113.24	O	1791.13	1791.13	humana medicare advantage	hmo
admin pneumococcal vaccine	cpt	G0009	601.12	601.12	94.36	94.36	488.4	488.4	407	407	O	601.12	601.12	humana medicare advantage	hmo
admin pneumococcal vaccine	cpt	G0009	601.12	601.12	94.36	94.36	488.4	488.4	407	407	O	601.12	601.12	humana medicare advantage	pos
admin pneumococcal vaccine	cpt	G0009	601.12	601.12	94.36	94.36	488.4	488.4	407	407	O	601.12	601.12	humana medicare advantage	ppo
admin pneumococcal vaccine	cpt	G0009	601.12	601.12	94.36	94.36	488.4	488.4	407	407	O	601.12	601.12	humana medicare advantage	hmo
"Removal of cataract with insertion of lens, complex"	cpt	66982	3382.58	3382.58	1639	1639	16101.53	16101.53	13417.94	13417.94	O	1791.13	1791.13	humana medicare advantage	hmo
"Removal of cataract with insertion of lens, complex"	cpt	66982	3382.58	3382.58	1639	1639	16101.53	16101.53	13417.94	13417.94	O	1791.13	1791.13	humana medicare advantage	pos
"Removal of cataract with insertion of lens, complex"	cpt	66982	3382.58	3382.58	1639	1639	16101.53	16101.53	13417.94	13417.94	O	1791.13	1791.13	humana medicare advantage	ppo
"Removal of cataract with insertion of lens, complex"	cpt	66982	3382.58	3382.58	1639	1639	16101.53	16101.53	13417.94	13417.94	O	1791.13	1791.13	humana medicare advantage	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	66.53	66.53	humana medicare advantage	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	66.53	66.53	humana medicare advantage	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	66.53	66.53	humana medicare advantage	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	66.53	66.53	humana medicare advantage	hmo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	676.71	676.71	humana medicare advantage	hmo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	676.71	676.71	humana medicare advantage	pos
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	676.71	676.71	humana medicare advantage	ppo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	676.71	676.71	humana medicare advantage	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	676.71	676.71	humana medicare advantage	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	676.71	676.71	humana medicare advantage	pos
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	676.71	676.71	humana medicare advantage	ppo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	676.71	676.71	humana medicare advantage	hmo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	1523.14	1523.14	humana medicare advantage	hmo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	1523.14	1523.14	humana medicare advantage	pos
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	1523.14	1523.14	humana medicare advantage	ppo
Release and/or relocation of median nerve of hand	cpt	64721	8300.35	8300.35	1419	1419	15750.1	15750.1	13125.08	13125.08	O	1523.14	1523.14	humana medicare advantage	hmo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	553.72	553.72	humana medicare advantage	hmo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	553.72	553.72	humana medicare advantage	pos
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	553.72	553.72	humana medicare advantage	ppo
inj for sacroiliac jt anesth	cpt	G0260	1055.98	1055.98	505.78	505.78	2273.46	2273.46	1894.55	1894.55	O	553.72	553.72	humana medicare advantage	hmo
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	8777.72	8777.72	humana medicare advantage	hmo
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	8777.72	8777.72	humana medicare advantage	pos
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	8777.72	8777.72	humana medicare advantage	ppo
occlusive device in vein art	cpt	G0269	11308.3	11308.3	706.25	706.25	78373.13	78373.13	65310.94	65310.94	O	8777.72	8777.72	humana medicare advantage	hmo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	1523.14	1523.14	humana medicare advantage	hmo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	1523.14	1523.14	humana medicare advantage	pos
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	1523.14	1523.14	humana medicare advantage	ppo
Release and/or relocation of ulnar nerve at elbow	cpt	64718	9882.2	9882.2	1399	1399	16931.99	16931.99	14109.99	14109.99	O	1523.14	1523.14	humana medicare advantage	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	176.85	176.85	humana medicare advantage	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	176.85	176.85	humana medicare advantage	pos
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	176.85	176.85	humana medicare advantage	ppo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	176.85	176.85	humana medicare advantage	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	719.38	719.38	humana medicare advantage	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	719.38	719.38	humana medicare advantage	pos
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	719.38	719.38	humana medicare advantage	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	719.38	719.38	humana medicare advantage	hmo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	872.07	872.07	humana medicare advantage	hmo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	872.07	872.07	humana medicare advantage	pos
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	872.07	872.07	humana medicare advantage	ppo
elec stim other than wound	cpt	G0283	1387.03	1387.03	314.31	314.31	5001.5	5001.5	4167.92	4167.92	O	872.07	872.07	humana medicare advantage	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70.7	70.7	humana medicare advantage	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70.7	70.7	humana medicare advantage	pos
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70.7	70.7	humana medicare advantage	ppo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	70.7	70.7	humana medicare advantage	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	719.38	719.38	humana medicare advantage	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	719.38	719.38	humana medicare advantage	pos
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	719.38	719.38	humana medicare advantage	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	719.38	719.38	humana medicare advantage	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1952.13	1952.13	humana medicare advantage	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1952.13	1952.13	humana medicare advantage	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1952.13	1952.13	humana medicare advantage	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	1952.13	1952.13	humana medicare advantage	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6263.22	6263.22	humana medicare advantage	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6263.22	6263.22	humana medicare advantage	pos
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6263.22	6263.22	humana medicare advantage	ppo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6263.22	6263.22	humana medicare advantage	hmo
"prostate biopsy, any mthd"	cpt	G0416	3688.73	3688.73	696.23	696.23	5130.25	5130.25	4275.21	4275.21	O	3680.94	3680.94	humana medicare advantage	hmo
"prostate biopsy, any mthd"	cpt	G0416	3688.73	3688.73	696.23	696.23	5130.25	5130.25	4275.21	4275.21	O	3680.94	3680.94	humana medicare advantage	pos
"prostate biopsy, any mthd"	cpt	G0416	3688.73	3688.73	696.23	696.23	5130.25	5130.25	4275.21	4275.21	O	3680.94	3680.94	humana medicare advantage	ppo
"prostate biopsy, any mthd"	cpt	G0416	3688.73	3688.73	696.23	696.23	5130.25	5130.25	4275.21	4275.21	O	3680.94	3680.94	humana medicare advantage	hmo
hospital outpt clinic visit	cpt	G0463	2553.53	2553.53	1934.02	1934.02	23345.64	23345.64	19454.7	19454.7	E	2553.53	2553.53	humana medicare advantage	hmo
hospital outpt clinic visit	cpt	G0463	2553.53	2553.53	1934.02	1934.02	23345.64	23345.64	19454.7	19454.7	E	2553.53	2553.53	humana medicare advantage	pos
hospital outpt clinic visit	cpt	G0463	2553.53	2553.53	1934.02	1934.02	23345.64	23345.64	19454.7	19454.7	E	2553.53	2553.53	humana medicare advantage	ppo
hospital outpt clinic visit	cpt	G0463	2553.53	2553.53	1934.02	1934.02	23345.64	23345.64	19454.7	19454.7	E	2553.53	2553.53	humana medicare advantage	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	719.38	719.38	humana medicare advantage	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	719.38	719.38	humana medicare advantage	pos
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	719.38	719.38	humana medicare advantage	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	719.38	719.38	humana medicare advantage	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	humana medicare advantage	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	humana medicare advantage	pos
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	humana medicare advantage	ppo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	102.7	102.7	humana medicare advantage	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	1079.07	1079.07	humana medicare advantage	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	1079.07	1079.07	humana medicare advantage	pos
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	1079.07	1079.07	humana medicare advantage	ppo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	1079.07	1079.07	humana medicare advantage	hmo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	788.92	788.92	humana medicare advantage	hmo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	788.92	788.92	humana medicare advantage	pos
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	788.92	788.92	humana medicare advantage	ppo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	788.92	788.92	humana medicare advantage	hmo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	2425.05	2425.05	humana medicare advantage	hmo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	2425.05	2425.05	humana medicare advantage	pos
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	2425.05	2425.05	humana medicare advantage	ppo
Injection of anesthetic agent and/or steroid into brachial nerve bundle of arm	cpt	64415	12067.91	12067.91	2425.05	2425.05	31973.23	31973.23	26644.36	26644.36	O	2425.05	2425.05	humana medicare advantage	hmo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	5299.29	5299.29	humana medicare advantage	hmo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	5299.29	5299.29	humana medicare advantage	pos
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	5299.29	5299.29	humana medicare advantage	ppo
"Partial removal of middle spine bone with release of spinal cord and/or nerves, lower back (lumbar) area"	cpt	63047	10903.98	10903.98	5299.29	5299.29	28469	28469	23724.17	23724.17	O	5299.29	5299.29	humana medicare advantage	hmo
"Re-exploration of spine repair with release of lower spinal cord or nerves, single interspace"	cpt	63042	10573.89	10573.89	5299.29	5299.29	30661.06	30661.06	25550.88	25550.88	O	10573.89	10573.89	humana medicare advantage	hmo
"Re-exploration of spine repair with release of lower spinal cord or nerves, single interspace"	cpt	63042	10573.89	10573.89	5299.29	5299.29	30661.06	30661.06	25550.88	25550.88	O	10573.89	10573.89	humana medicare advantage	pos
"Re-exploration of spine repair with release of lower spinal cord or nerves, single interspace"	cpt	63042	10573.89	10573.89	5299.29	5299.29	30661.06	30661.06	25550.88	25550.88	O	10573.89	10573.89	humana medicare advantage	ppo
"Re-exploration of spine repair with release of lower spinal cord or nerves, single interspace"	cpt	63042	10573.89	10573.89	5299.29	5299.29	30661.06	30661.06	25550.88	25550.88	O	10573.89	10573.89	humana medicare advantage	hmo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	553.72	553.72	humana medicare advantage	hmo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	553.72	553.72	humana medicare advantage	pos
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	553.72	553.72	humana medicare advantage	ppo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	553.72	553.72	humana medicare advantage	hmo
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1913.09	1913.09	humana medicare advantage	hmo
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1913.09	1913.09	humana medicare advantage	pos
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1913.09	1913.09	humana medicare advantage	ppo
azithromycin	cpt	J0456	1995.04	1995.04	1115	1115	13115.71	13115.71	10929.76	10929.76	E	1913.09	1913.09	humana medicare advantage	hmo
Injection of substance into spinal canal of upper or middle back	cpt	62320	553.72	553.72	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	553.72	553.72	humana medicare advantage	hmo
Injection of substance into spinal canal of upper or middle back	cpt	62320	553.72	553.72	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	553.72	553.72	humana medicare advantage	pos
Injection of substance into spinal canal of upper or middle back	cpt	62320	553.72	553.72	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	553.72	553.72	humana medicare advantage	ppo
Injection of substance into spinal canal of upper or middle back	cpt	62320	553.72	553.72	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	553.72	553.72	humana medicare advantage	hmo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	928.87	928.87	humana medicare advantage	hmo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	928.87	928.87	humana medicare advantage	pos
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	928.87	928.87	humana medicare advantage	ppo
leucovorin calcium injection	cpt	J0640	6054.77	6054.77	928.87	928.87	19517.57	19517.57	16264.64	16264.64	O	928.87	928.87	humana medicare advantage	hmo
Total removal of thyroid lobe on one side of the neck	cpt	60220	4282.09	4282.09	4282.09	4282.09	22389.71	22389.71	18658.09	18658.09	O	4282.09	4282.09	humana medicare advantage	hmo
Total removal of thyroid lobe on one side of the neck	cpt	60220	4282.09	4282.09	4282.09	4282.09	22389.71	22389.71	18658.09	18658.09	O	4282.09	4282.09	humana medicare advantage	pos
Total removal of thyroid lobe on one side of the neck	cpt	60220	4282.09	4282.09	4282.09	4282.09	22389.71	22389.71	18658.09	18658.09	O	4282.09	4282.09	humana medicare advantage	ppo
Total removal of thyroid lobe on one side of the neck	cpt	60220	4282.09	4282.09	4282.09	4282.09	22389.71	22389.71	18658.09	18658.09	O	4282.09	4282.09	humana medicare advantage	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	275.46	275.46	humana medicare advantage	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	275.46	275.46	humana medicare advantage	pos
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	275.46	275.46	humana medicare advantage	ppo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	275.46	275.46	humana medicare advantage	hmo
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	216.73	216.73	humana medicare advantage	hmo
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	216.73	216.73	humana medicare advantage	pos
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	216.73	216.73	humana medicare advantage	ppo
"darbepoetin alfa, non-esrd"	cpt	J0881	868.67	868.67	216.73	216.73	1457.28	1457.28	1214.4	1214.4	O	216.73	216.73	humana medicare advantage	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1664.34	1664.34	humana medicare advantage	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1664.34	1664.34	humana medicare advantage	pos
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1664.34	1664.34	humana medicare advantage	ppo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1664.34	1664.34	humana medicare advantage	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	5412.23	5412.23	humana medicare advantage	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	5412.23	5412.23	humana medicare advantage	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	5412.23	5412.23	humana medicare advantage	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	5412.23	5412.23	humana medicare advantage	hmo
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance	cpt	55876	1103.22	1103.22	1103.22	1103.22	41954.78	41954.78	34962.32	34962.32	O	1103.22	1103.22	humana medicare advantage	hmo
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance	cpt	55876	1103.22	1103.22	1103.22	1103.22	41954.78	41954.78	34962.32	34962.32	O	1103.22	1103.22	humana medicare advantage	pos
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance	cpt	55876	1103.22	1103.22	1103.22	1103.22	41954.78	41954.78	34962.32	34962.32	O	1103.22	1103.22	humana medicare advantage	ppo
Insertion of radiation therapy devices in prostate gland for radiation therapy guidance	cpt	55876	1103.22	1103.22	1103.22	1103.22	41954.78	41954.78	34962.32	34962.32	O	1103.22	1103.22	humana medicare advantage	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	474.34	474.34	humana medicare advantage	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	474.34	474.34	humana medicare advantage	pos
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	474.34	474.34	humana medicare advantage	ppo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	474.34	474.34	humana medicare advantage	hmo
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	cpt	52601	3688.73	3688.73	3525.75	3525.75	28529.81	28529.81	23774.84	23774.84	O	3680.94	3680.94	humana medicare advantage	hmo
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	cpt	52601	3688.73	3688.73	3525.75	3525.75	28529.81	28529.81	23774.84	23774.84	O	3680.94	3680.94	humana medicare advantage	pos
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	cpt	52601	3688.73	3688.73	3525.75	3525.75	28529.81	28529.81	23774.84	23774.84	O	3680.94	3680.94	humana medicare advantage	ppo
Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	cpt	52601	3688.73	3688.73	3525.75	3525.75	28529.81	28529.81	23774.84	23774.84	O	3680.94	3680.94	humana medicare advantage	hmo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	665.73	665.73	humana medicare advantage	hmo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	665.73	665.73	humana medicare advantage	pos
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	665.73	665.73	humana medicare advantage	ppo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	665.73	665.73	humana medicare advantage	hmo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	3679.64	3679.64	humana medicare advantage	hmo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	3679.64	3679.64	humana medicare advantage	pos
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	3679.64	3679.64	humana medicare advantage	ppo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	8848.19	8848.19	3451.31	3451.31	26122.61	26122.61	21768.84	21768.84	O	3679.64	3679.64	humana medicare advantage	hmo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	3748.71	3748.71	3748.71	3748.71	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	hmo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	3748.71	3748.71	3748.71	3748.71	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	pos
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	3748.71	3748.71	3748.71	3748.71	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	ppo
Crushing of stone in urinary duct (ureter) with stent using an endoscope	cpt	52356	3748.71	3748.71	3748.71	3748.71	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	7649.74	7649.74	humana medicare advantage	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	7649.74	7649.74	humana medicare advantage	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	7649.74	7649.74	humana medicare advantage	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	7649.74	7649.74	humana medicare advantage	hmo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	2674.06	2674.06	humana medicare advantage	hmo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	2674.06	2674.06	humana medicare advantage	pos
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	2674.06	2674.06	humana medicare advantage	ppo
Insertion of stent in urinary duct (ureter) using an endoscope	cpt	52332	4436.99	4436.99	2466.29	2466.29	26802.56	26802.56	22335.47	22335.47	O	2674.06	2674.06	humana medicare advantage	hmo
Dilation of bladder canal (urethra) using an endoscope	cpt	52281	1569.38	1569.38	1569.38	1569.38	15026.72	15026.72	12522.27	12522.27	O	1569.38	1569.38	humana medicare advantage	hmo
Dilation of bladder canal (urethra) using an endoscope	cpt	52281	1569.38	1569.38	1569.38	1569.38	15026.72	15026.72	12522.27	12522.27	O	1569.38	1569.38	humana medicare advantage	pos
Dilation of bladder canal (urethra) using an endoscope	cpt	52281	1569.38	1569.38	1569.38	1569.38	15026.72	15026.72	12522.27	12522.27	O	1569.38	1569.38	humana medicare advantage	ppo
Dilation of bladder canal (urethra) using an endoscope	cpt	52281	1569.38	1569.38	1569.38	1569.38	15026.72	15026.72	12522.27	12522.27	O	1569.38	1569.38	humana medicare advantage	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	48.73	48.73	humana medicare advantage	hmo
Destruction and/or removal of large growths of the bladder using an endoscope	cpt	52240	3748.71	3748.71	3680.94	3680.94	24722.98	24722.98	20602.48	20602.48	O	3680.94	3680.94	humana medicare advantage	hmo
Destruction and/or removal of large growths of the bladder using an endoscope	cpt	52240	3748.71	3748.71	3680.94	3680.94	24722.98	24722.98	20602.48	20602.48	O	3680.94	3680.94	humana medicare advantage	pos
Destruction and/or removal of large growths of the bladder using an endoscope	cpt	52240	3748.71	3748.71	3680.94	3680.94	24722.98	24722.98	20602.48	20602.48	O	3680.94	3680.94	humana medicare advantage	ppo
Destruction and/or removal of large growths of the bladder using an endoscope	cpt	52240	3748.71	3748.71	3680.94	3680.94	24722.98	24722.98	20602.48	20602.48	O	3680.94	3680.94	humana medicare advantage	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1913.09	1913.09	humana medicare advantage	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1913.09	1913.09	humana medicare advantage	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1913.09	1913.09	humana medicare advantage	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	1913.09	1913.09	humana medicare advantage	hmo
Instillation of anti-cancer drug into bladder	cpt	51720	3748.71	3748.71	2631.27	2631.27	24225.89	24225.89	20188.24	20188.24	O	3748.71	3748.71	humana medicare advantage	hmo
Instillation of anti-cancer drug into bladder	cpt	51720	3748.71	3748.71	2631.27	2631.27	24225.89	24225.89	20188.24	20188.24	O	3748.71	3748.71	humana medicare advantage	pos
Instillation of anti-cancer drug into bladder	cpt	51720	3748.71	3748.71	2631.27	2631.27	24225.89	24225.89	20188.24	20188.24	O	3748.71	3748.71	humana medicare advantage	ppo
Instillation of anti-cancer drug into bladder	cpt	51720	3748.71	3748.71	2631.27	2631.27	24225.89	24225.89	20188.24	20188.24	O	3748.71	3748.71	humana medicare advantage	hmo
"Insertion of indwelling bladder catheter, simple"	cpt	51702	1952.13	1952.13	241.84	241.84	6324.92	6324.92	5270.77	5270.77	E	1952.13	1952.13	humana medicare advantage	hmo
"Insertion of indwelling bladder catheter, simple"	cpt	51702	1952.13	1952.13	241.84	241.84	6324.92	6324.92	5270.77	5270.77	E	1952.13	1952.13	humana medicare advantage	pos
"Insertion of indwelling bladder catheter, simple"	cpt	51702	1952.13	1952.13	241.84	241.84	6324.92	6324.92	5270.77	5270.77	E	1952.13	1952.13	humana medicare advantage	ppo
"Insertion of indwelling bladder catheter, simple"	cpt	51702	1952.13	1952.13	241.84	241.84	6324.92	6324.92	5270.77	5270.77	E	1952.13	1952.13	humana medicare advantage	hmo
Insertion of temporary bladder catheter	cpt	51701	1979.81	1979.81	754.97	754.97	7201.2	7201.2	6001	6001	E	1979.81	1979.81	humana medicare advantage	hmo
Insertion of temporary bladder catheter	cpt	51701	1979.81	1979.81	754.97	754.97	7201.2	7201.2	6001	6001	E	1979.81	1979.81	humana medicare advantage	pos
Insertion of temporary bladder catheter	cpt	51701	1979.81	1979.81	754.97	754.97	7201.2	7201.2	6001	6001	E	1979.81	1979.81	humana medicare advantage	ppo
Insertion of temporary bladder catheter	cpt	51701	1979.81	1979.81	754.97	754.97	7201.2	7201.2	6001	6001	E	1979.81	1979.81	humana medicare advantage	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	4187.14	4187.14	humana medicare advantage	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	4187.14	4187.14	humana medicare advantage	pos
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	4187.14	4187.14	humana medicare advantage	ppo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	4187.14	4187.14	humana medicare advantage	hmo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	2626.48	2626.48	humana medicare advantage	hmo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	2626.48	2626.48	humana medicare advantage	pos
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	2626.48	2626.48	humana medicare advantage	ppo
Shock wave crushing of kidney stones	cpt	50590	11999.48	11999.48	2548.78	2548.78	29214.35	29214.35	24345.29	24345.29	O	2626.48	2626.48	humana medicare advantage	hmo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7309.85	7309.85	humana medicare advantage	hmo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7309.85	7309.85	humana medicare advantage	pos
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7309.85	7309.85	humana medicare advantage	ppo
"Repair of incisional hernia using an endoscope, initial or primary"	cpt	49654	7600.98	7600.98	6846.43	6846.43	32178.7	32178.7	26815.58	26815.58	O	7309.85	7309.85	humana medicare advantage	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	humana medicare advantage	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	humana medicare advantage	pos
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	humana medicare advantage	ppo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	humana medicare advantage	hmo
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	1176.54	1176.54	humana medicare advantage	hmo
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	1176.54	1176.54	humana medicare advantage	pos
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	1176.54	1176.54	humana medicare advantage	ppo
"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through skin"	cpt	49465	1176.54	1176.54	284.66	284.66	2474.03	2474.03	2061.69	2061.69	E	1176.54	1176.54	humana medicare advantage	hmo
Insertion of abdominal cavity catheter using an endoscope	cpt	49324	4282.09	4282.09	3925.09	3925.09	21801.68	21801.68	18168.07	18168.07	O	4282.09	4282.09	humana medicare advantage	hmo
Insertion of abdominal cavity catheter using an endoscope	cpt	49324	4282.09	4282.09	3925.09	3925.09	21801.68	21801.68	18168.07	18168.07	O	4282.09	4282.09	humana medicare advantage	pos
Insertion of abdominal cavity catheter using an endoscope	cpt	49324	4282.09	4282.09	3925.09	3925.09	21801.68	21801.68	18168.07	18168.07	O	4282.09	4282.09	humana medicare advantage	ppo
Insertion of abdominal cavity catheter using an endoscope	cpt	49324	4282.09	4282.09	3925.09	3925.09	21801.68	21801.68	18168.07	18168.07	O	4282.09	4282.09	humana medicare advantage	hmo
"Needle biopsy of abdominal cavity growth, accessed through the skin"	cpt	49180	1215.96	1215.96	1199.67	1199.67	9084.9	9084.9	7570.75	7570.75	O	1215.96	1215.96	humana medicare advantage	hmo
"Needle biopsy of abdominal cavity growth, accessed through the skin"	cpt	49180	1215.96	1215.96	1199.67	1199.67	9084.9	9084.9	7570.75	7570.75	O	1215.96	1215.96	humana medicare advantage	pos
"Needle biopsy of abdominal cavity growth, accessed through the skin"	cpt	49180	1215.96	1215.96	1199.67	1199.67	9084.9	9084.9	7570.75	7570.75	O	1215.96	1215.96	humana medicare advantage	ppo
"Needle biopsy of abdominal cavity growth, accessed through the skin"	cpt	49180	1215.96	1215.96	1199.67	1199.67	9084.9	9084.9	7570.75	7570.75	O	1215.96	1215.96	humana medicare advantage	hmo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	2769.52	2769.52	889.02	889.02	10792.44	10792.44	8993.7	8993.7	E	2769.52	2769.52	humana medicare advantage	hmo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	2769.52	2769.52	889.02	889.02	10792.44	10792.44	8993.7	8993.7	E	2769.52	2769.52	humana medicare advantage	pos
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	2769.52	2769.52	889.02	889.02	10792.44	10792.44	8993.7	8993.7	E	2769.52	2769.52	humana medicare advantage	ppo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	2769.52	2769.52	889.02	889.02	10792.44	10792.44	8993.7	8993.7	E	2769.52	2769.52	humana medicare advantage	hmo
Drainage of fluid from abdominal cavity	cpt	49082	2769.52	2769.52	1596.53	1596.53	8858.04	8858.04	7381.7	7381.7	E	2769.52	2769.52	humana medicare advantage	hmo
Drainage of fluid from abdominal cavity	cpt	49082	2769.52	2769.52	1596.53	1596.53	8858.04	8858.04	7381.7	7381.7	E	2769.52	2769.52	humana medicare advantage	pos
Drainage of fluid from abdominal cavity	cpt	49082	2769.52	2769.52	1596.53	1596.53	8858.04	8858.04	7381.7	7381.7	E	2769.52	2769.52	humana medicare advantage	ppo
Drainage of fluid from abdominal cavity	cpt	49082	2769.52	2769.52	1596.53	1596.53	8858.04	8858.04	7381.7	7381.7	E	2769.52	2769.52	humana medicare advantage	hmo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	4242.22	4242.22	humana medicare advantage	hmo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	4242.22	4242.22	humana medicare advantage	pos
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	4242.22	4242.22	humana medicare advantage	ppo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	4242.22	4242.22	humana medicare advantage	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	2425.05	2425.05	humana medicare advantage	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	2425.05	2425.05	humana medicare advantage	pos
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	2425.05	2425.05	humana medicare advantage	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	2425.05	2425.05	humana medicare advantage	hmo
"Needle biopsy of liver, accessed through the skin"	cpt	47000	1559.48	1559.48	1215.96	1215.96	10715.04	10715.04	8929.2	8929.2	O	1215.96	1215.96	humana medicare advantage	hmo
"Needle biopsy of liver, accessed through the skin"	cpt	47000	1559.48	1559.48	1215.96	1215.96	10715.04	10715.04	8929.2	8929.2	O	1215.96	1215.96	humana medicare advantage	pos
"Needle biopsy of liver, accessed through the skin"	cpt	47000	1559.48	1559.48	1215.96	1215.96	10715.04	10715.04	8929.2	8929.2	O	1215.96	1215.96	humana medicare advantage	ppo
"Needle biopsy of liver, accessed through the skin"	cpt	47000	1559.48	1559.48	1215.96	1215.96	10715.04	10715.04	8929.2	8929.2	O	1215.96	1215.96	humana medicare advantage	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4579.24	4579.24	humana medicare advantage	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4579.24	4579.24	humana medicare advantage	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4579.24	4579.24	humana medicare advantage	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4579.24	4579.24	humana medicare advantage	hmo
Stapling of internal hemorrhoid	cpt	46947	2076.66	2076.66	2076.66	2076.66	21249.76	21249.76	17708.13	17708.13	O	2076.66	2076.66	humana medicare advantage	hmo
Stapling of internal hemorrhoid	cpt	46947	2076.66	2076.66	2076.66	2076.66	21249.76	21249.76	17708.13	17708.13	O	2076.66	2076.66	humana medicare advantage	pos
Stapling of internal hemorrhoid	cpt	46947	2076.66	2076.66	2076.66	2076.66	21249.76	21249.76	17708.13	17708.13	O	2076.66	2076.66	humana medicare advantage	ppo
Stapling of internal hemorrhoid	cpt	46947	2076.66	2076.66	2076.66	2076.66	21249.76	21249.76	17708.13	17708.13	O	2076.66	2076.66	humana medicare advantage	hmo
Removal of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46320	979.27	979.27	898.18	898.18	1077.82	1077.82	898.18	898.18	E	898.18	898.18	humana medicare advantage	hmo
Removal of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46320	979.27	979.27	898.18	898.18	1077.82	1077.82	898.18	898.18	E	898.18	898.18	humana medicare advantage	pos
Removal of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46320	979.27	979.27	898.18	898.18	1077.82	1077.82	898.18	898.18	E	898.18	898.18	humana medicare advantage	ppo
Removal of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46320	979.27	979.27	898.18	898.18	1077.82	1077.82	898.18	898.18	E	898.18	898.18	humana medicare advantage	hmo
Removal of single external and internal hemorrhoid group	cpt	46255	2076.66	2076.66	1557.5	1557.5	16490.1	16490.1	13741.75	13741.75	O	2076.66	2076.66	humana medicare advantage	hmo
Removal of single external and internal hemorrhoid group	cpt	46255	2076.66	2076.66	1557.5	1557.5	16490.1	16490.1	13741.75	13741.75	O	2076.66	2076.66	humana medicare advantage	pos
Removal of single external and internal hemorrhoid group	cpt	46255	2076.66	2076.66	1557.5	1557.5	16490.1	16490.1	13741.75	13741.75	O	2076.66	2076.66	humana medicare advantage	ppo
Removal of single external and internal hemorrhoid group	cpt	46255	2076.66	2076.66	1557.5	1557.5	16490.1	16490.1	13741.75	13741.75	O	2076.66	2076.66	humana medicare advantage	hmo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	405.94	405.94	humana medicare advantage	hmo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	405.94	405.94	humana medicare advantage	pos
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	405.94	405.94	humana medicare advantage	ppo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	405.94	405.94	humana medicare advantage	hmo
"Drainage of rectal abscess, superficial, surrounding the anus"	cpt	46050	874.56	874.56	798.85	798.85	1153.27	1153.27	961.06	961.06	E	874.56	874.56	humana medicare advantage	hmo
"Drainage of rectal abscess, superficial, surrounding the anus"	cpt	46050	874.56	874.56	798.85	798.85	1153.27	1153.27	961.06	961.06	E	874.56	874.56	humana medicare advantage	pos
"Drainage of rectal abscess, superficial, surrounding the anus"	cpt	46050	874.56	874.56	798.85	798.85	1153.27	1153.27	961.06	961.06	E	874.56	874.56	humana medicare advantage	ppo
"Drainage of rectal abscess, superficial, surrounding the anus"	cpt	46050	874.56	874.56	798.85	798.85	1153.27	1153.27	961.06	961.06	E	874.56	874.56	humana medicare advantage	hmo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1307.74	1307.74	humana medicare advantage	hmo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1307.74	1307.74	humana medicare advantage	pos
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1307.74	1307.74	humana medicare advantage	ppo
"Injections beneath lining of large bowel, using a flexible endoscope"	cpt	45381	1913.87	1913.87	1240.48	1240.48	6346.84	6346.84	5289.03	5289.03	O	1307.74	1307.74	humana medicare advantage	hmo
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)	cpt	45331	1034.59	1034.59	692.36	692.36	4956.14	4956.14	4130.12	4130.12	O	1034.59	1034.59	humana medicare advantage	hmo
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)	cpt	45331	1034.59	1034.59	692.36	692.36	4956.14	4956.14	4130.12	4130.12	O	1034.59	1034.59	humana medicare advantage	pos
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)	cpt	45331	1034.59	1034.59	692.36	692.36	4956.14	4956.14	4130.12	4130.12	O	1034.59	1034.59	humana medicare advantage	ppo
Biopsy of the lower large bowel using an endoscope (sigmoidoscopy)	cpt	45331	1034.59	1034.59	692.36	692.36	4956.14	4956.14	4130.12	4130.12	O	1034.59	1034.59	humana medicare advantage	hmo
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1913.09	1913.09	humana medicare advantage	hmo
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1913.09	1913.09	humana medicare advantage	pos
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1913.09	1913.09	humana medicare advantage	ppo
methylprednisolone injection	cpt	J2920	2485.45	2485.45	1913.09	1913.09	13577.17	13577.17	11314.31	11314.31	E	1913.09	1913.09	humana medicare advantage	hmo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	676.71	676.71	humana medicare advantage	hmo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	676.71	676.71	humana medicare advantage	pos
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	676.71	676.71	humana medicare advantage	ppo
Diagnostic examination of the lower portion of the large bowel using an endoscope	cpt	45330	2049.34	2049.34	676.71	676.71	3987.61	3987.61	3323.01	3323.01	O	676.71	676.71	humana medicare advantage	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	4579.24	4579.24	humana medicare advantage	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	4579.24	4579.24	humana medicare advantage	pos
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	4579.24	4579.24	humana medicare advantage	ppo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	4579.24	4579.24	humana medicare advantage	hmo
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	1176.54	1176.54	humana medicare advantage	hmo
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	1176.54	1176.54	humana medicare advantage	pos
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	1176.54	1176.54	humana medicare advantage	ppo
Replacement of stomach stoma tube accessed through skin	cpt	43762	1176.54	1176.54	399.44	399.44	2354.66	2354.66	1962.22	1962.22	E	1176.54	1176.54	humana medicare advantage	hmo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	7453.01	7453.01	humana medicare advantage	hmo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	7453.01	7453.01	humana medicare advantage	pos
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	7453.01	7453.01	humana medicare advantage	ppo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	7453.01	7453.01	humana medicare advantage	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	humana medicare advantage	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	humana medicare advantage	pos
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	humana medicare advantage	ppo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	humana medicare advantage	hmo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	1044.35	1044.35	humana medicare advantage	hmo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	1044.35	1044.35	humana medicare advantage	pos
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	1044.35	1044.35	humana medicare advantage	ppo
Insertion of guide wire with dilation of esophagus using an endoscope	cpt	43248	2442.65	2442.65	685.69	685.69	4299.44	4299.44	3582.87	3582.87	O	1044.35	1044.35	humana medicare advantage	hmo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	1958.83	1958.83	humana medicare advantage	hmo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	1958.83	1958.83	humana medicare advantage	pos
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	1958.83	1958.83	humana medicare advantage	ppo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	1958.83	1958.83	humana medicare advantage	hmo
vitamin b12 injection	cpt	J3420	2121.81	2121.81	2121.81	2121.81	21812.96	21812.96	18177.47	18177.47	E	2121.81	2121.81	humana medicare advantage	hmo
vitamin b12 injection	cpt	J3420	2121.81	2121.81	2121.81	2121.81	21812.96	21812.96	18177.47	18177.47	E	2121.81	2121.81	humana medicare advantage	pos
vitamin b12 injection	cpt	J3420	2121.81	2121.81	2121.81	2121.81	21812.96	21812.96	18177.47	18177.47	E	2121.81	2121.81	humana medicare advantage	ppo
vitamin b12 injection	cpt	J3420	2121.81	2121.81	2121.81	2121.81	21812.96	21812.96	18177.47	18177.47	E	2121.81	2121.81	humana medicare advantage	hmo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	2371.01	2371.01	humana medicare advantage	hmo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	2371.01	2371.01	humana medicare advantage	pos
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	2371.01	2371.01	humana medicare advantage	ppo
vitamin b12 injection	cpt	J3420	15987.99	15987.99	53.57	53.57	475.2	475.2	396	396	O	2371.01	2371.01	humana medicare advantage	hmo
Examination of chest using an endoscope with lymph node biopsy	cpt	39402	4282.09	4282.09	4213.58	4213.58	23534.24	23534.24	19611.87	19611.87	O	4282.09	4282.09	humana medicare advantage	hmo
Examination of chest using an endoscope with lymph node biopsy	cpt	39402	4282.09	4282.09	4213.58	4213.58	23534.24	23534.24	19611.87	19611.87	O	4282.09	4282.09	humana medicare advantage	pos
Examination of chest using an endoscope with lymph node biopsy	cpt	39402	4282.09	4282.09	4213.58	4213.58	23534.24	23534.24	19611.87	19611.87	O	4282.09	4282.09	humana medicare advantage	ppo
Examination of chest using an endoscope with lymph node biopsy	cpt	39402	4282.09	4282.09	4213.58	4213.58	23534.24	23534.24	19611.87	19611.87	O	4282.09	4282.09	humana medicare advantage	hmo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	4639.61	4639.61	humana medicare advantage	hmo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	4639.61	4639.61	humana medicare advantage	pos
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	4639.61	4639.61	humana medicare advantage	ppo
Injection of radioactive dye for X-ray identification of lymph node	cpt	38792	8915.14	8915.14	326.12	326.12	31558.91	31558.91	26299.09	26299.09	O	4639.61	4639.61	humana medicare advantage	hmo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	2636.04	2636.04	humana medicare advantage	hmo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	2636.04	2636.04	humana medicare advantage	pos
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	2636.04	2636.04	humana medicare advantage	ppo
"Biopsy or removal of lymph nodes of under the arm, open procedure"	cpt	38525	4565.38	4565.38	2636.04	2636.04	28090.33	28090.33	23408.61	23408.61	O	2636.04	2636.04	humana medicare advantage	hmo
"Biopsy or removal of lymph nodes of neck, open procedure"	cpt	38510	4565.38	4565.38	2640.88	2640.88	17878.4	17878.4	14898.67	14898.67	O	2683.82	2683.82	humana medicare advantage	hmo
"Biopsy or removal of lymph nodes of neck, open procedure"	cpt	38510	4565.38	4565.38	2640.88	2640.88	17878.4	17878.4	14898.67	14898.67	O	2683.82	2683.82	humana medicare advantage	pos
"Biopsy or removal of lymph nodes of neck, open procedure"	cpt	38510	4565.38	4565.38	2640.88	2640.88	17878.4	17878.4	14898.67	14898.67	O	2683.82	2683.82	humana medicare advantage	ppo
"Biopsy or removal of lymph nodes of neck, open procedure"	cpt	38510	4565.38	4565.38	2640.88	2640.88	17878.4	17878.4	14898.67	14898.67	O	2683.82	2683.82	humana medicare advantage	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	4187.14	4187.14	humana medicare advantage	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	4187.14	4187.14	humana medicare advantage	pos
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	4187.14	4187.14	humana medicare advantage	ppo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	4187.14	4187.14	humana medicare advantage	hmo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	4639.61	4639.61	humana medicare advantage	hmo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	4639.61	4639.61	humana medicare advantage	pos
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	4639.61	4639.61	humana medicare advantage	ppo
"Biopsy or removal of lymph nodes, open procedure"	cpt	38500	8915.14	8915.14	4565.38	4565.38	29275.99	29275.99	24396.66	24396.66	O	4639.61	4639.61	humana medicare advantage	hmo
Tying incision and/or removal of varicose vein clusters of leg	cpt	37785	982.25	982.25	982.25	982.25	1178.7	1178.7	982.25	982.25	E	982.25	982.25	humana medicare advantage	hmo
Tying incision and/or removal of varicose vein clusters of leg	cpt	37785	982.25	982.25	982.25	982.25	1178.7	1178.7	982.25	982.25	E	982.25	982.25	humana medicare advantage	pos
Tying incision and/or removal of varicose vein clusters of leg	cpt	37785	982.25	982.25	982.25	982.25	1178.7	1178.7	982.25	982.25	E	982.25	982.25	humana medicare advantage	ppo
Tying incision and/or removal of varicose vein clusters of leg	cpt	37785	982.25	982.25	982.25	982.25	1178.7	1178.7	982.25	982.25	E	982.25	982.25	humana medicare advantage	hmo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	2455.02	2455.02	humana medicare advantage	hmo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	2455.02	2455.02	humana medicare advantage	pos
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	2455.02	2455.02	humana medicare advantage	ppo
"Multiple incisions for removal of varicose veins of arm or leg, greater than 20 incisions"	cpt	37766	12086.89	12086.89	2455.02	2455.02	24402.41	24402.41	20335.34	20335.34	O	2455.02	2455.02	humana medicare advantage	hmo
"Multiple incisions for removal of varicose veins of arm or leg, 10-20 incisions"	cpt	37765	2455.02	2455.02	2455.02	2455.02	21291.67	21291.67	17743.06	17743.06	O	2455.02	2455.02	humana medicare advantage	hmo
"Multiple incisions for removal of varicose veins of arm or leg, 10-20 incisions"	cpt	37765	2455.02	2455.02	2455.02	2455.02	21291.67	21291.67	17743.06	17743.06	O	2455.02	2455.02	humana medicare advantage	pos
"Multiple incisions for removal of varicose veins of arm or leg, 10-20 incisions"	cpt	37765	2455.02	2455.02	2455.02	2455.02	21291.67	21291.67	17743.06	17743.06	O	2455.02	2455.02	humana medicare advantage	ppo
"Multiple incisions for removal of varicose veins of arm or leg, 10-20 incisions"	cpt	37765	2455.02	2455.02	2455.02	2455.02	21291.67	21291.67	17743.06	17743.06	O	2455.02	2455.02	humana medicare advantage	hmo
"Ultrasound evaluation of blood vessel during diagnosis or treatment, initial vessel"	cpt	37252	14120.9	14120.9	8777.72	8777.72	104458.68	104458.68	87048.9	87048.9	O	14120.9	14120.9	humana medicare advantage	hmo
"Ultrasound evaluation of blood vessel during diagnosis or treatment, initial vessel"	cpt	37252	14120.9	14120.9	8777.72	8777.72	104458.68	104458.68	87048.9	87048.9	O	14120.9	14120.9	humana medicare advantage	pos
"Ultrasound evaluation of blood vessel during diagnosis or treatment, initial vessel"	cpt	37252	14120.9	14120.9	8777.72	8777.72	104458.68	104458.68	87048.9	87048.9	O	14120.9	14120.9	humana medicare advantage	ppo
"Ultrasound evaluation of blood vessel during diagnosis or treatment, initial vessel"	cpt	37252	14120.9	14120.9	8777.72	8777.72	104458.68	104458.68	87048.9	87048.9	O	14120.9	14120.9	humana medicare advantage	hmo
"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37232	14120.9	14120.9	8646.05	8646.05	93086.88	93086.88	77572.4	77572.4	O	8646.05	8646.05	humana medicare advantage	hmo
"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37232	14120.9	14120.9	8646.05	8646.05	93086.88	93086.88	77572.4	77572.4	O	8646.05	8646.05	humana medicare advantage	pos
"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37232	14120.9	14120.9	8646.05	8646.05	93086.88	93086.88	77572.4	77572.4	O	8646.05	8646.05	humana medicare advantage	ppo
"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37232	14120.9	14120.9	8646.05	8646.05	93086.88	93086.88	77572.4	77572.4	O	8646.05	8646.05	humana medicare advantage	hmo
"Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37231	14120.9	14120.9	14120.9	14120.9	145342	145342	121118.33	121118.33	O	14120.9	14120.9	humana medicare advantage	hmo
"Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37231	14120.9	14120.9	14120.9	14120.9	145342	145342	121118.33	121118.33	O	14120.9	14120.9	humana medicare advantage	pos
"Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37231	14120.9	14120.9	14120.9	14120.9	145342	145342	121118.33	121118.33	O	14120.9	14120.9	humana medicare advantage	ppo
"Removal of plaque and insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37231	14120.9	14120.9	14120.9	14120.9	145342	145342	121118.33	121118.33	O	14120.9	14120.9	humana medicare advantage	hmo
"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37230	14120.9	14120.9	14007.94	14007.94	90677.59	90677.59	75564.66	75564.66	O	14007.94	14007.94	humana medicare advantage	hmo
"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37230	14120.9	14120.9	14007.94	14007.94	90677.59	90677.59	75564.66	75564.66	O	14007.94	14007.94	humana medicare advantage	pos
"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37230	14120.9	14120.9	14007.94	14007.94	90677.59	90677.59	75564.66	75564.66	O	14007.94	14007.94	humana medicare advantage	ppo
"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37230	14120.9	14120.9	14007.94	14007.94	90677.59	90677.59	75564.66	75564.66	O	14007.94	14007.94	humana medicare advantage	hmo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	11383.48	11383.48	humana medicare advantage	hmo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	11383.48	11383.48	humana medicare advantage	pos
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	11383.48	11383.48	humana medicare advantage	ppo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	11383.48	11383.48	humana medicare advantage	hmo
"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37226	14007.94	14007.94	8097.07	8097.07	92080.52	92080.52	76733.77	76733.77	O	14007.94	14007.94	humana medicare advantage	hmo
"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37226	14007.94	14007.94	8097.07	8097.07	92080.52	92080.52	76733.77	76733.77	O	14007.94	14007.94	humana medicare advantage	pos
"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37226	14007.94	14007.94	8097.07	8097.07	92080.52	92080.52	76733.77	76733.77	O	14007.94	14007.94	humana medicare advantage	ppo
"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37226	14007.94	14007.94	8097.07	8097.07	92080.52	92080.52	76733.77	76733.77	O	14007.94	14007.94	humana medicare advantage	hmo
"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37225	11449.31	11449.31	8704.03	8704.03	78604.32	78604.32	65503.6	65503.6	O	11449.31	11449.31	humana medicare advantage	hmo
"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37225	11449.31	11449.31	8704.03	8704.03	78604.32	78604.32	65503.6	65503.6	O	11449.31	11449.31	humana medicare advantage	pos
"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37225	11449.31	11449.31	8704.03	8704.03	78604.32	78604.32	65503.6	65503.6	O	11449.31	11449.31	humana medicare advantage	ppo
"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37225	11449.31	11449.31	8704.03	8704.03	78604.32	78604.32	65503.6	65503.6	O	11449.31	11449.31	humana medicare advantage	hmo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	7700.07	7700.07	humana medicare advantage	hmo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	7700.07	7700.07	humana medicare advantage	pos
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	7700.07	7700.07	humana medicare advantage	ppo
bevacizumab injection	cpt	J9035	8590.23	8590.23	3858.86	3858.86	21437.02	21437.02	17864.18	17864.18	O	7700.07	7700.07	humana medicare advantage	hmo
"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37224	8630.33	8630.33	4023.57	4023.57	44426.34	44426.34	37021.95	37021.95	O	6517.31	6517.31	humana medicare advantage	hmo
"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37224	8630.33	8630.33	4023.57	4023.57	44426.34	44426.34	37021.95	37021.95	O	6517.31	6517.31	humana medicare advantage	pos
"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37224	8630.33	8630.33	4023.57	4023.57	44426.34	44426.34	37021.95	37021.95	O	6517.31	6517.31	humana medicare advantage	ppo
"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37224	8630.33	8630.33	4023.57	4023.57	44426.34	44426.34	37021.95	37021.95	O	6517.31	6517.31	humana medicare advantage	hmo
"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37221	8777.72	8777.72	8185.32	8185.32	62575.42	62575.42	52146.18	52146.18	O	8603.97	8603.97	humana medicare advantage	hmo
"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37221	8777.72	8777.72	8185.32	8185.32	62575.42	62575.42	52146.18	52146.18	O	8603.97	8603.97	humana medicare advantage	pos
"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37221	8777.72	8777.72	8185.32	8185.32	62575.42	62575.42	52146.18	52146.18	O	8603.97	8603.97	humana medicare advantage	ppo
"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37221	8777.72	8777.72	8185.32	8185.32	62575.42	62575.42	52146.18	52146.18	O	8603.97	8603.97	humana medicare advantage	hmo
"inj., velcade 0.1 mg"	cpt	J9041	1206.33	1206.33	1184.61	1184.61	8626.8	8626.8	7189	7189	O	1204.76	1204.76	humana medicare advantage	hmo
"inj., velcade 0.1 mg"	cpt	J9041	1206.33	1206.33	1184.61	1184.61	8626.8	8626.8	7189	7189	O	1204.76	1204.76	humana medicare advantage	pos
"inj., velcade 0.1 mg"	cpt	J9041	1206.33	1206.33	1184.61	1184.61	8626.8	8626.8	7189	7189	O	1204.76	1204.76	humana medicare advantage	ppo
"inj., velcade 0.1 mg"	cpt	J9041	1206.33	1206.33	1184.61	1184.61	8626.8	8626.8	7189	7189	O	1204.76	1204.76	humana medicare advantage	hmo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8646.05	8646.05	humana medicare advantage	hmo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8646.05	8646.05	humana medicare advantage	pos
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8646.05	8646.05	humana medicare advantage	ppo
"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure"	cpt	37220	8646.05	8646.05	6509.45	6509.45	57926.81	57926.81	48272.34	48272.34	O	8646.05	8646.05	humana medicare advantage	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	7649.74	7649.74	humana medicare advantage	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	7649.74	7649.74	humana medicare advantage	pos
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	7649.74	7649.74	humana medicare advantage	ppo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	7649.74	7649.74	humana medicare advantage	hmo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	1444.99	1444.99	humana medicare advantage	hmo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	1444.99	1444.99	humana medicare advantage	pos
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	1444.99	1444.99	humana medicare advantage	ppo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	1444.99	1444.99	humana medicare advantage	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	224.22	224.22	humana medicare advantage	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	224.22	224.22	humana medicare advantage	pos
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	224.22	224.22	humana medicare advantage	ppo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	224.22	224.22	humana medicare advantage	hmo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	368.79	368.79	humana medicare advantage	hmo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	368.79	368.79	humana medicare advantage	pos
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	368.79	368.79	humana medicare advantage	ppo
docetaxel injection	cpt	J9171	23772.44	23772.44	368.79	368.79	32313.89	32313.89	26928.24	26928.24	O	368.79	368.79	humana medicare advantage	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	2015.29	2015.29	humana medicare advantage	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	2015.29	2015.29	humana medicare advantage	pos
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	2015.29	2015.29	humana medicare advantage	ppo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	2015.29	2015.29	629.32	629.32	10125.67	10125.67	8438.06	8438.06	E	2015.29	2015.29	humana medicare advantage	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	928.87	928.87	humana medicare advantage	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	928.87	928.87	humana medicare advantage	pos
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	928.87	928.87	humana medicare advantage	ppo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	928.87	928.87	humana medicare advantage	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	5253.4	5253.4	humana medicare advantage	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	5253.4	5253.4	humana medicare advantage	pos
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	5253.4	5253.4	humana medicare advantage	ppo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	5253.4	5253.4	humana medicare advantage	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	808.19	808.19	797.7	797.7	3121.24	3121.24	2601.03	2601.03	E	797.7	797.7	humana medicare advantage	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	808.19	808.19	797.7	797.7	3121.24	3121.24	2601.03	2601.03	E	797.7	797.7	humana medicare advantage	pos
Declotting infusion of implanted central venous access device or catheter	cpt	36593	808.19	808.19	797.7	797.7	3121.24	3121.24	2601.03	2601.03	E	797.7	797.7	humana medicare advantage	ppo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	808.19	808.19	797.7	797.7	3121.24	3121.24	2601.03	2601.03	E	797.7	797.7	humana medicare advantage	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7649.74	7649.74	humana medicare advantage	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7649.74	7649.74	humana medicare advantage	pos
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7649.74	7649.74	humana medicare advantage	ppo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7649.74	7649.74	humana medicare advantage	hmo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	928.87	928.87	humana medicare advantage	hmo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	928.87	928.87	humana medicare advantage	pos
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	928.87	928.87	humana medicare advantage	ppo
irinotecan injection	cpt	J9206	8573.35	8573.35	928.87	928.87	23692.8	23692.8	19744	19744	O	928.87	928.87	humana medicare advantage	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1914.89	1914.89	humana medicare advantage	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1914.89	1914.89	humana medicare advantage	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1914.89	1914.89	humana medicare advantage	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1914.89	1914.89	humana medicare advantage	hmo
Collection of blood specimen from a completely implantable venous access device	cpt	36591	10315.29	10315.29	96.59	96.59	697.24	697.24	581.03	581.03	O	96.59	96.59	humana medicare advantage	hmo
Collection of blood specimen from a completely implantable venous access device	cpt	36591	10315.29	10315.29	96.59	96.59	697.24	697.24	581.03	581.03	O	96.59	96.59	humana medicare advantage	pos
Collection of blood specimen from a completely implantable venous access device	cpt	36591	10315.29	10315.29	96.59	96.59	697.24	697.24	581.03	581.03	O	96.59	96.59	humana medicare advantage	ppo
Collection of blood specimen from a completely implantable venous access device	cpt	36591	10315.29	10315.29	96.59	96.59	697.24	697.24	581.03	581.03	O	96.59	96.59	humana medicare advantage	hmo
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	2455.02	2455.02	humana medicare advantage	hmo
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	2455.02	2455.02	humana medicare advantage	pos
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	2455.02	2455.02	humana medicare advantage	ppo
Removal of peripheral venous catheter for infusion	cpt	36590	2455.02	2455.02	509.53	509.53	12704.36	12704.36	10586.97	10586.97	O	2455.02	2455.02	humana medicare advantage	hmo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	451.73	451.73	humana medicare advantage	hmo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	451.73	451.73	humana medicare advantage	pos
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	451.73	451.73	humana medicare advantage	ppo
paclitaxel injection	cpt	J9267	2981.53	2981.53	429.12	429.12	4304.7	4304.7	3587.25	3587.25	O	451.73	451.73	humana medicare advantage	hmo
"Replacement of central venous catheter, tunneled without port or pump"	cpt	36581	2455.02	2455.02	2353.39	2353.39	19733.89	19733.89	16444.91	16444.91	O	2455.02	2455.02	humana medicare advantage	hmo
"Replacement of central venous catheter, tunneled without port or pump"	cpt	36581	2455.02	2455.02	2353.39	2353.39	19733.89	19733.89	16444.91	16444.91	O	2455.02	2455.02	humana medicare advantage	pos
"Replacement of central venous catheter, tunneled without port or pump"	cpt	36581	2455.02	2455.02	2353.39	2353.39	19733.89	19733.89	16444.91	16444.91	O	2455.02	2455.02	humana medicare advantage	ppo
"Replacement of central venous catheter, tunneled without port or pump"	cpt	36581	2455.02	2455.02	2353.39	2353.39	19733.89	19733.89	16444.91	16444.91	O	2455.02	2455.02	humana medicare advantage	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	7502.28	7502.28	humana medicare advantage	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	7502.28	7502.28	humana medicare advantage	pos
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	7502.28	7502.28	humana medicare advantage	ppo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	7502.28	7502.28	humana medicare advantage	hmo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	6636.16	6636.16	humana medicare advantage	hmo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	6636.16	6636.16	humana medicare advantage	pos
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	6636.16	6636.16	humana medicare advantage	ppo
"Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older"	cpt	36569	6636.16	6636.16	1333.15	1333.15	2981.17	2981.17	2484.31	2484.31	O	6636.16	6636.16	humana medicare advantage	hmo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	4996.45	4996.45	humana medicare advantage	hmo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	4996.45	4996.45	humana medicare advantage	pos
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	4996.45	4996.45	humana medicare advantage	ppo
"injection, nivolumab"	cpt	J9299	16388.92	16388.92	3788.28	3788.28	29876.89	29876.89	24897.41	24897.41	O	4996.45	4996.45	humana medicare advantage	hmo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	4579.24	4579.24	humana medicare advantage	hmo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	4579.24	4579.24	humana medicare advantage	pos
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	4579.24	4579.24	humana medicare advantage	ppo
inj. pemetrexed nos 10mg	cpt	J9305	17466.44	17466.44	4579.24	4579.24	68724.02	68724.02	57270.02	57270.02	O	4579.24	4579.24	humana medicare advantage	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	11362.44	11362.44	humana medicare advantage	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	11362.44	11362.44	humana medicare advantage	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	11362.44	11362.44	humana medicare advantage	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	11362.44	11362.44	humana medicare advantage	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2418.19	2418.19	humana medicare advantage	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2418.19	2418.19	humana medicare advantage	pos
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2418.19	2418.19	humana medicare advantage	ppo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2418.19	2418.19	humana medicare advantage	hmo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	6402.18	6402.18	humana medicare advantage	hmo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	6402.18	6402.18	humana medicare advantage	pos
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	6402.18	6402.18	humana medicare advantage	ppo
"inj, ado-trastuzumab emt 1mg"	cpt	J9354	16776.17	16776.17	6402.18	6402.18	46690.63	46690.63	38908.86	38908.86	O	6402.18	6402.18	humana medicare advantage	hmo
"Insertion of central venous catheter for infusion, patient 5 years or older, tunneled"	cpt	36558	2455.02	2455.02	2415.74	2415.74	20607.3	20607.3	17172.75	17172.75	O	2455.02	2455.02	humana medicare advantage	hmo
"Insertion of central venous catheter for infusion, patient 5 years or older, tunneled"	cpt	36558	2455.02	2455.02	2415.74	2415.74	20607.3	20607.3	17172.75	17172.75	O	2455.02	2455.02	humana medicare advantage	pos
"Insertion of central venous catheter for infusion, patient 5 years or older, tunneled"	cpt	36558	2455.02	2455.02	2415.74	2415.74	20607.3	20607.3	17172.75	17172.75	O	2455.02	2455.02	humana medicare advantage	ppo
"Insertion of central venous catheter for infusion, patient 5 years or older, tunneled"	cpt	36558	2455.02	2455.02	2415.74	2415.74	20607.3	20607.3	17172.75	17172.75	O	2455.02	2455.02	humana medicare advantage	hmo
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	humana medicare advantage	hmo
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	humana medicare advantage	pos
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	humana medicare advantage	ppo
"Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled"	cpt	36556	1719.81	1719.81	1444.99	1444.99	16238.96	16238.96	13532.47	13532.47	O	1444.99	1444.99	humana medicare advantage	hmo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	2455.02	2455.02	humana medicare advantage	hmo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	2455.02	2455.02	humana medicare advantage	pos
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	2455.02	2455.02	humana medicare advantage	ppo
"Destruction of insufficient vein of arm or leg, accessed through the skin"	cpt	36475	12086.89	12086.89	2415.74	2415.74	12086.68	12086.68	10072.23	10072.23	O	2455.02	2455.02	humana medicare advantage	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2939.47	2939.47	humana medicare advantage	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2939.47	2939.47	humana medicare advantage	pos
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2939.47	2939.47	humana medicare advantage	ppo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2939.47	2939.47	humana medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	978.45	978.45	humana medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	978.45	978.45	humana medicare advantage	pos
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	978.45	978.45	humana medicare advantage	ppo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	978.45	978.45	humana medicare advantage	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	283.05	283.05	humana medicare advantage	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	283.05	283.05	humana medicare advantage	pos
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	283.05	283.05	humana medicare advantage	ppo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	283.05	283.05	humana medicare advantage	hmo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	485.11	485.11	humana medicare advantage	hmo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	485.11	485.11	humana medicare advantage	pos
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	485.11	485.11	humana medicare advantage	ppo
non-pneum walk boot pre cst	cpt	L4386	529.29	529.29	258.55	258.55	2156.71	2156.71	1797.26	1797.26	O	485.11	485.11	humana medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	2052.21	2052.21	humana medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	2052.21	2052.21	humana medicare advantage	pos
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	2052.21	2052.21	humana medicare advantage	ppo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	2052.21	2052.21	humana medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	707.85	707.85	humana medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	707.85	707.85	humana medicare advantage	pos
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	707.85	707.85	humana medicare advantage	ppo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	707.85	707.85	humana medicare advantage	hmo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	1109.83	1109.83	humana medicare advantage	hmo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	1109.83	1109.83	humana medicare advantage	pos
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	1109.83	1109.83	humana medicare advantage	ppo
platelet pheres leukoreduced	cpt	P9035	2178.24	2178.24	1109.83	1109.83	5653.97	5653.97	4711.64	4711.64	O	1109.83	1109.83	humana medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	2052.21	2052.21	humana medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	2052.21	2052.21	humana medicare advantage	pos
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	2052.21	2052.21	humana medicare advantage	ppo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	2052.21	2052.21	humana medicare advantage	hmo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	1109.83	1109.83	humana medicare advantage	hmo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	1109.83	1109.83	humana medicare advantage	pos
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	1109.83	1109.83	humana medicare advantage	ppo
plate pheres leukoredu irrad	cpt	P9037	2332.93	2332.93	1109.83	1109.83	5247.16	5247.16	4372.63	4372.63	O	1109.83	1109.83	humana medicare advantage	hmo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	1055.25	1055.25	humana medicare advantage	hmo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	1055.25	1055.25	humana medicare advantage	pos
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	1055.25	1055.25	humana medicare advantage	ppo
rbc leukoreduced irradiated	cpt	P9040	2209.95	2209.95	606.52	606.52	3370.13	3370.13	2808.44	2808.44	O	1055.25	1055.25	humana medicare advantage	hmo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	560.06	560.06	humana medicare advantage	hmo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	560.06	560.06	humana medicare advantage	pos
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	560.06	560.06	humana medicare advantage	ppo
"ferumoxytol, non-esrd"	cpt	Q0138	801.75	801.75	556.49	556.49	2883.62	2883.62	2403.02	2403.02	O	560.06	560.06	humana medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	408.55	408.55	humana medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	408.55	408.55	humana medicare advantage	pos
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	408.55	408.55	humana medicare advantage	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	408.55	408.55	humana medicare advantage	hmo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	6636.16	6636.16	humana medicare advantage	hmo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	6636.16	6636.16	humana medicare advantage	pos
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	6636.16	6636.16	humana medicare advantage	ppo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	6636.16	6636.16	humana medicare advantage	hmo
strattice tm	cpt	Q4130	2569.42	2569.42	2569.42	2569.42	29280.64	29280.64	24400.53	24400.53	O	2569.42	2569.42	humana medicare advantage	hmo
strattice tm	cpt	Q4130	2569.42	2569.42	2569.42	2569.42	29280.64	29280.64	24400.53	24400.53	O	2569.42	2569.42	humana medicare advantage	pos
strattice tm	cpt	Q4130	2569.42	2569.42	2569.42	2569.42	29280.64	29280.64	24400.53	24400.53	O	2569.42	2569.42	humana medicare advantage	ppo
strattice tm	cpt	Q4130	2569.42	2569.42	2569.42	2569.42	29280.64	29280.64	24400.53	24400.53	O	2569.42	2569.42	humana medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	881.79	881.79	humana medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	881.79	881.79	humana medicare advantage	pos
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	881.79	881.79	humana medicare advantage	ppo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	881.79	881.79	humana medicare advantage	hmo
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	418.04	418.04	humana medicare advantage	hmo
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	418.04	418.04	humana medicare advantage	pos
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	418.04	418.04	humana medicare advantage	ppo
inj retacrit non-esrd use	cpt	Q5106	418.04	418.04	412.37	412.37	1567.1	1567.1	1305.92	1305.92	O	418.04	418.04	humana medicare advantage	hmo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4309.68	4309.68	humana medicare advantage	hmo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4309.68	4309.68	humana medicare advantage	pos
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4309.68	4309.68	humana medicare advantage	ppo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4309.68	4309.68	humana medicare advantage	hmo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10448.12	10448.12	humana medicare advantage	hmo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10448.12	10448.12	humana medicare advantage	pos
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10448.12	10448.12	humana medicare advantage	ppo
"inj., kanjinti, 10 mg"	cpt	Q5117	10872.3	10872.3	3654.19	3654.19	21191.38	21191.38	17659.48	17659.48	O	10448.12	10448.12	humana medicare advantage	hmo
"inj octafluoropropane mic,ml"	cpt	Q9956	426.62	426.62	426.62	426.62	1209	1209	1007.5	1007.5	O	426.62	426.62	humana medicare advantage	hmo
"inj octafluoropropane mic,ml"	cpt	Q9956	426.62	426.62	426.62	426.62	1209	1209	1007.5	1007.5	O	426.62	426.62	humana medicare advantage	pos
"inj octafluoropropane mic,ml"	cpt	Q9956	426.62	426.62	426.62	426.62	1209	1209	1007.5	1007.5	O	426.62	426.62	humana medicare advantage	ppo
"inj octafluoropropane mic,ml"	cpt	Q9956	426.62	426.62	426.62	426.62	1209	1209	1007.5	1007.5	O	426.62	426.62	humana medicare advantage	hmo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	2504.71	2504.71	humana medicare advantage	hmo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	2504.71	2504.71	humana medicare advantage	pos
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	2504.71	2504.71	humana medicare advantage	ppo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	2504.71	2504.71	humana medicare advantage	hmo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	586.65	586.65	humana medicare advantage	hmo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	586.65	586.65	humana medicare advantage	pos
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	586.65	586.65	humana medicare advantage	ppo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	586.65	586.65	humana medicare advantage	hmo
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	14120.9	14120.9	8777.72	8777.72	75967.02	75967.02	63305.85	63305.85	E	8777.72	8777.72	humana medicare advantage	hmo
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	14120.9	14120.9	8777.72	8777.72	75967.02	75967.02	63305.85	63305.85	E	8777.72	8777.72	humana medicare advantage	pos
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	14120.9	14120.9	8777.72	8777.72	75967.02	75967.02	63305.85	63305.85	E	8777.72	8777.72	humana medicare advantage	ppo
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	14120.9	14120.9	8777.72	8777.72	75967.02	75967.02	63305.85	63305.85	E	8777.72	8777.72	humana medicare advantage	hmo
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	8777.72	8777.72	1362.44	1362.44	45290.62	45290.62	37742.18	37742.18	O	8777.72	8777.72	humana medicare advantage	hmo
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	8777.72	8777.72	1362.44	1362.44	45290.62	45290.62	37742.18	37742.18	O	8777.72	8777.72	humana medicare advantage	pos
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	8777.72	8777.72	1362.44	1362.44	45290.62	45290.62	37742.18	37742.18	O	8777.72	8777.72	humana medicare advantage	ppo
"locm 200-299mg/ml iodine,1ml"	cpt	Q9966	8777.72	8777.72	1362.44	1362.44	45290.62	45290.62	37742.18	37742.18	O	8777.72	8777.72	humana medicare advantage	hmo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	4639.61	4639.61	humana medicare advantage	hmo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	4639.61	4639.61	humana medicare advantage	pos
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	4639.61	4639.61	humana medicare advantage	ppo
visualization adjunct	cpt	Q9968	4639.61	4639.61	3661.72	3661.72	30332.77	30332.77	25277.31	25277.31	O	4639.61	4639.61	humana medicare advantage	hmo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1130.05	1130.05	humana medicare advantage	hmo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1130.05	1130.05	humana medicare advantage	pos
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1130.05	1130.05	humana medicare advantage	ppo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1130.05	1130.05	humana medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	68.95	68.95	humana medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	68.95	68.95	humana medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	68.95	68.95	humana medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	68.95	68.95	humana medicare advantage	hmo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	4425.86	4425.86	humana medicare advantage	hmo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	4425.86	4425.86	humana medicare advantage	pos
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	4425.86	4425.86	humana medicare advantage	ppo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	4425.86	4425.86	humana medicare advantage	hmo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	1791.13	1791.13	humana medicare advantage	hmo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	1791.13	1791.13	humana medicare advantage	pos
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	1791.13	1791.13	humana medicare advantage	ppo
contact lens/es other type	cpt	V2599	4337.53	4337.53	1791.13	1791.13	19639.43	19639.43	16366.19	16366.19	O	1791.13	1791.13	humana medicare advantage	hmo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	1791.13	1791.13	humana medicare advantage	hmo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	1791.13	1791.13	humana medicare advantage	pos
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	1791.13	1791.13	humana medicare advantage	ppo
post chmbr intraocular lens	cpt	V2632	7851.31	7851.31	1639	1639	14828.47	14828.47	12357.06	12357.06	O	1791.13	1791.13	humana medicare advantage	hmo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1193.07	1193.07	humana medicare advantage	hmo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1193.07	1193.07	humana medicare advantage	pos
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1193.07	1193.07	humana medicare advantage	ppo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	1193.07	1193.07	humana medicare advantage	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1259.33	1259.33	humana medicare advantage	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1259.33	1259.33	humana medicare advantage	pos
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1259.33	1259.33	humana medicare advantage	ppo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	1259.33	1259.33	humana medicare advantage	hmo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3259.12	3259.12	humana medicare advantage	hmo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3259.12	3259.12	humana medicare advantage	pos
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3259.12	3259.12	humana medicare advantage	ppo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3259.12	3259.12	humana medicare advantage	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	2300.69	2300.69	humana medicare advantage	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	2300.69	2300.69	humana medicare advantage	pos
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	2300.69	2300.69	humana medicare advantage	ppo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	2300.69	2300.69	humana medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	humana medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	humana medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	humana medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	humana medicare advantage	hmo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	1457.29	1457.29	humana medicare advantage	hmo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	1457.29	1457.29	humana medicare advantage	pos
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	1457.29	1457.29	humana medicare advantage	ppo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	1457.29	1457.29	humana medicare advantage	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	408.55	408.55	humana medicare advantage	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	408.55	408.55	humana medicare advantage	pos
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	408.55	408.55	humana medicare advantage	ppo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	408.55	408.55	humana medicare advantage	hmo
"Insertion of catheter into abdominal pelvic or leg artery, each first order branch"	cpt	36245	2455.02	2455.02	125.31	125.31	25382.86	25382.86	21152.38	21152.38	O	2455.02	2455.02	humana medicare advantage	hmo
"Insertion of catheter into abdominal pelvic or leg artery, each first order branch"	cpt	36245	2455.02	2455.02	125.31	125.31	25382.86	25382.86	21152.38	21152.38	O	2455.02	2455.02	humana medicare advantage	pos
"Insertion of catheter into abdominal pelvic or leg artery, each first order branch"	cpt	36245	2455.02	2455.02	125.31	125.31	25382.86	25382.86	21152.38	21152.38	O	2455.02	2455.02	humana medicare advantage	ppo
"Insertion of catheter into abdominal pelvic or leg artery, each first order branch"	cpt	36245	2455.02	2455.02	125.31	125.31	25382.86	25382.86	21152.38	21152.38	O	2455.02	2455.02	humana medicare advantage	hmo
Repair of blood vessel of leg	cpt	35226	653.76	653.76	653.76	653.76	1443.6	1443.6	1203	1203	E	653.76	653.76	humana medicare advantage	hmo
Repair of blood vessel of leg	cpt	35226	653.76	653.76	653.76	653.76	1443.6	1443.6	1203	1203	E	653.76	653.76	humana medicare advantage	pos
Repair of blood vessel of leg	cpt	35226	653.76	653.76	653.76	653.76	1443.6	1443.6	1203	1203	E	653.76	653.76	humana medicare advantage	ppo
Repair of blood vessel of leg	cpt	35226	653.76	653.76	653.76	653.76	1443.6	1443.6	1203	1203	E	653.76	653.76	humana medicare advantage	hmo
Insertion or replacement of single or dual chamber pacing defibrillator leads	cpt	33249	28598.55	28598.55	26166.91	26166.91	111127.04	111127.04	92605.87	92605.87	O	28598.55	28598.55	humana medicare advantage	hmo
Insertion or replacement of single or dual chamber pacing defibrillator leads	cpt	33249	28598.55	28598.55	26166.91	26166.91	111127.04	111127.04	92605.87	92605.87	O	28598.55	28598.55	humana medicare advantage	pos
Insertion or replacement of single or dual chamber pacing defibrillator leads	cpt	33249	28598.55	28598.55	26166.91	26166.91	111127.04	111127.04	92605.87	92605.87	O	28598.55	28598.55	humana medicare advantage	ppo
Insertion or replacement of single or dual chamber pacing defibrillator leads	cpt	33249	28598.55	28598.55	26166.91	26166.91	111127.04	111127.04	92605.87	92605.87	O	28598.55	28598.55	humana medicare advantage	hmo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	4282.09	4282.09	humana medicare advantage	hmo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	4282.09	4282.09	humana medicare advantage	pos
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	4282.09	4282.09	humana medicare advantage	ppo
Sterile	revCode	272	14120.9	14120.9	4282.09	4282.09	56647.38	56647.38	47206.15	47206.15	O	4282.09	4282.09	humana medicare advantage	hmo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	10573.89	10573.89	humana medicare advantage	hmo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	10573.89	10573.89	humana medicare advantage	pos
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	10573.89	10573.89	humana medicare advantage	ppo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	10573.89	10573.89	humana medicare advantage	hmo
Removal and replacement of single lead permanent pacemaker pulse generator	cpt	33227	6769.76	6769.76	6769.76	6769.76	28995.43	28995.43	24162.86	24162.86	O	6769.76	6769.76	humana medicare advantage	hmo
Removal and replacement of single lead permanent pacemaker pulse generator	cpt	33227	6769.76	6769.76	6769.76	6769.76	28995.43	28995.43	24162.86	24162.86	O	6769.76	6769.76	humana medicare advantage	pos
Removal and replacement of single lead permanent pacemaker pulse generator	cpt	33227	6769.76	6769.76	6769.76	6769.76	28995.43	28995.43	24162.86	24162.86	O	6769.76	6769.76	humana medicare advantage	ppo
Removal and replacement of single lead permanent pacemaker pulse generator	cpt	33227	6769.76	6769.76	6769.76	6769.76	28995.43	28995.43	24162.86	24162.86	O	6769.76	6769.76	humana medicare advantage	hmo
"Insertion of needle into vein, patient 3 years or older"	cpt	36410	1952.13	1952.13	750.1	750.1	17715.2	17715.2	14762.67	14762.67	E	1952.13	1952.13	humana medicare advantage	hmo
"Insertion of needle into vein, patient 3 years or older"	cpt	36410	1952.13	1952.13	750.1	750.1	17715.2	17715.2	14762.67	14762.67	E	1952.13	1952.13	humana medicare advantage	pos
"Insertion of needle into vein, patient 3 years or older"	cpt	36410	1952.13	1952.13	750.1	750.1	17715.2	17715.2	14762.67	14762.67	E	1952.13	1952.13	humana medicare advantage	ppo
"Insertion of needle into vein, patient 3 years or older"	cpt	36410	1952.13	1952.13	750.1	750.1	17715.2	17715.2	14762.67	14762.67	E	1952.13	1952.13	humana medicare advantage	hmo
"Placement of temporary pacemaker leads, single chamber"	cpt	33210	6636.16	6636.16	6636.16	6636.16	23055.73	23055.73	19213.11	19213.11	O	6636.16	6636.16	humana medicare advantage	hmo
"Placement of temporary pacemaker leads, single chamber"	cpt	33210	6636.16	6636.16	6636.16	6636.16	23055.73	23055.73	19213.11	19213.11	O	6636.16	6636.16	humana medicare advantage	pos
"Placement of temporary pacemaker leads, single chamber"	cpt	33210	6636.16	6636.16	6636.16	6636.16	23055.73	23055.73	19213.11	19213.11	O	6636.16	6636.16	humana medicare advantage	ppo
"Placement of temporary pacemaker leads, single chamber"	cpt	33210	6636.16	6636.16	6636.16	6636.16	23055.73	23055.73	19213.11	19213.11	O	6636.16	6636.16	humana medicare advantage	hmo
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	9081.99	9081.99	40085.34	40085.34	33404.45	33404.45	O	9081.99	9081.99	humana medicare advantage	hmo
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	9081.99	9081.99	40085.34	40085.34	33404.45	33404.45	O	9081.99	9081.99	humana medicare advantage	pos
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	9081.99	9081.99	40085.34	40085.34	33404.45	33404.45	O	9081.99	9081.99	humana medicare advantage	ppo
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	9081.99	9081.99	40085.34	40085.34	33404.45	33404.45	O	9081.99	9081.99	humana medicare advantage	hmo
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	pos
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	ppo
Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes	cpt	33208	9081.99	9081.99	8959.3	8959.3	52117.37	52117.37	43431.14	43431.14	E	8959.3	8959.3	humana medicare advantage	hmo
"Needle biopsy of lung or chest tissue, accessed through the skin"	cpt	32405	1461.55	1461.55	1196.5	1196.5	10267.81	10267.81	8556.51	8556.51	O	1215.96	1215.96	humana medicare advantage	hmo
"Needle biopsy of lung or chest tissue, accessed through the skin"	cpt	32405	1461.55	1461.55	1196.5	1196.5	10267.81	10267.81	8556.51	8556.51	O	1215.96	1215.96	humana medicare advantage	pos
"Needle biopsy of lung or chest tissue, accessed through the skin"	cpt	32405	1461.55	1461.55	1196.5	1196.5	10267.81	10267.81	8556.51	8556.51	O	1215.96	1215.96	humana medicare advantage	ppo
"Needle biopsy of lung or chest tissue, accessed through the skin"	cpt	32405	1461.55	1461.55	1196.5	1196.5	10267.81	10267.81	8556.51	8556.51	O	1215.96	1215.96	humana medicare advantage	hmo
Insertion of catheter for suction of secretions	cpt	31720	2039.21	2039.21	194.68	194.68	1083.48	1083.48	902.9	902.9	E	2039.21	2039.21	humana medicare advantage	hmo
Insertion of catheter for suction of secretions	cpt	31720	2039.21	2039.21	194.68	194.68	1083.48	1083.48	902.9	902.9	E	2039.21	2039.21	humana medicare advantage	pos
Insertion of catheter for suction of secretions	cpt	31720	2039.21	2039.21	194.68	194.68	1083.48	1083.48	902.9	902.9	E	2039.21	2039.21	humana medicare advantage	ppo
Insertion of catheter for suction of secretions	cpt	31720	2039.21	2039.21	194.68	194.68	1083.48	1083.48	902.9	902.9	E	2039.21	2039.21	humana medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11527.74	11527.74	humana medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11527.74	11527.74	humana medicare advantage	pos
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11527.74	11527.74	humana medicare advantage	ppo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11527.74	11527.74	humana medicare advantage	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1466.26	1466.26	humana medicare advantage	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1466.26	1466.26	humana medicare advantage	pos
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1466.26	1466.26	humana medicare advantage	ppo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	1466.26	1466.26	1066.8	1066.8	11133.48	11133.48	9277.9	9277.9	O	1466.26	1466.26	humana medicare advantage	hmo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	23354.3	23354.3	humana medicare advantage	hmo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	23354.3	23354.3	humana medicare advantage	pos
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	23354.3	23354.3	humana medicare advantage	ppo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	23354.3	23354.3	humana medicare advantage	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	851.56	851.56	humana medicare advantage	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	851.56	851.56	humana medicare advantage	pos
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	851.56	851.56	humana medicare advantage	ppo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	851.56	851.56	humana medicare advantage	hmo
General	revCode	370	3748.71	3748.71	2455.02	2455.02	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	hmo
General	revCode	370	3748.71	3748.71	2455.02	2455.02	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	pos
General	revCode	370	3748.71	3748.71	2455.02	2455.02	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	ppo
General	revCode	370	3748.71	3748.71	2455.02	2455.02	36618.94	36618.94	30515.78	30515.78	E	3748.71	3748.71	humana medicare advantage	hmo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	2076.66	2076.66	humana medicare advantage	hmo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	2076.66	2076.66	humana medicare advantage	pos
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	2076.66	2076.66	humana medicare advantage	ppo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	2076.66	2076.66	humana medicare advantage	hmo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	1328.48	1328.48	humana medicare advantage	hmo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	1328.48	1328.48	humana medicare advantage	pos
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	1328.48	1328.48	humana medicare advantage	ppo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	1328.48	1328.48	humana medicare advantage	hmo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	2425.05	2425.05	humana medicare advantage	hmo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	2425.05	2425.05	humana medicare advantage	pos
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	2425.05	2425.05	humana medicare advantage	ppo
Repair of shoulder rotator cuff using an endoscope	cpt	29827	15196.01	15196.01	2425.05	2425.05	38203.72	38203.72	31836.43	31836.43	O	2425.05	2425.05	humana medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6299.79	6299.79	humana medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6299.79	6299.79	humana medicare advantage	pos
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6299.79	6299.79	humana medicare advantage	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6299.79	6299.79	humana medicare advantage	hmo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	2425.05	2425.05	humana medicare advantage	hmo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	2425.05	2425.05	humana medicare advantage	pos
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	2425.05	2425.05	humana medicare advantage	ppo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	2425.05	2425.05	humana medicare advantage	hmo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	2425.05	2425.05	humana medicare advantage	hmo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	2425.05	2425.05	humana medicare advantage	pos
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	2425.05	2425.05	humana medicare advantage	ppo
Removal of shoulder joint tissue using an endoscope	cpt	29822	5550.48	5550.48	2386.25	2386.25	27571.72	27571.72	22976.43	22976.43	O	2425.05	2425.05	humana medicare advantage	hmo
General	revCode	710	3748.71	3748.71	2435.38	2435.38	30308.78	30308.78	25257.32	25257.32	E	3748.71	3748.71	humana medicare advantage	hmo
General	revCode	710	3748.71	3748.71	2435.38	2435.38	30308.78	30308.78	25257.32	25257.32	E	3748.71	3748.71	humana medicare advantage	pos
General	revCode	710	3748.71	3748.71	2435.38	2435.38	30308.78	30308.78	25257.32	25257.32	E	3748.71	3748.71	humana medicare advantage	ppo
General	revCode	710	3748.71	3748.71	2435.38	2435.38	30308.78	30308.78	25257.32	25257.32	E	3748.71	3748.71	humana medicare advantage	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	2524.71	2524.71	humana medicare advantage	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	2524.71	2524.71	humana medicare advantage	pos
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	2524.71	2524.71	humana medicare advantage	ppo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	2524.71	2524.71	humana medicare advantage	hmo
Amputation of toe at joint between the forefoot and toes	cpt	28820	2386.25	2386.25	2298.06	2298.06	16258	16258	13548.33	13548.33	O	2382.45	2382.45	humana medicare advantage	hmo
Amputation of toe at joint between the forefoot and toes	cpt	28820	2386.25	2386.25	2298.06	2298.06	16258	16258	13548.33	13548.33	O	2382.45	2382.45	humana medicare advantage	pos
Amputation of toe at joint between the forefoot and toes	cpt	28820	2386.25	2386.25	2298.06	2298.06	16258	16258	13548.33	13548.33	O	2382.45	2382.45	humana medicare advantage	ppo
Amputation of toe at joint between the forefoot and toes	cpt	28820	2386.25	2386.25	2298.06	2298.06	16258	16258	13548.33	13548.33	O	2382.45	2382.45	humana medicare advantage	hmo
Amputation of toe and midfoot bone	cpt	28810	2425.05	2425.05	2386.25	2386.25	18552.49	18552.49	15460.41	15460.41	O	2425.05	2425.05	humana medicare advantage	hmo
Amputation of toe and midfoot bone	cpt	28810	2425.05	2425.05	2386.25	2386.25	18552.49	18552.49	15460.41	15460.41	O	2425.05	2425.05	humana medicare advantage	pos
Amputation of toe and midfoot bone	cpt	28810	2425.05	2425.05	2386.25	2386.25	18552.49	18552.49	15460.41	15460.41	O	2425.05	2425.05	humana medicare advantage	ppo
Amputation of toe and midfoot bone	cpt	28810	2425.05	2425.05	2386.25	2386.25	18552.49	18552.49	15460.41	15460.41	O	2425.05	2425.05	humana medicare advantage	hmo
Treatment room	revCode	761	1193.07	1193.07	1193.07	1193.07	14428.14	14428.14	12023.45	12023.45	E	1193.07	1193.07	humana medicare advantage	hmo
Treatment room	revCode	761	1193.07	1193.07	1193.07	1193.07	14428.14	14428.14	12023.45	12023.45	E	1193.07	1193.07	humana medicare advantage	pos
Treatment room	revCode	761	1193.07	1193.07	1193.07	1193.07	14428.14	14428.14	12023.45	12023.45	E	1193.07	1193.07	humana medicare advantage	ppo
Treatment room	revCode	761	1193.07	1193.07	1193.07	1193.07	14428.14	14428.14	12023.45	12023.45	E	1193.07	1193.07	humana medicare advantage	hmo
"Correction of bunion, with alignment correction of midfoot bone (metatarsal) towards toe areas"	cpt	28296	5299.29	5299.29	2425.05	2425.05	21810.48	21810.48	18175.4	18175.4	O	2425.05	2425.05	humana medicare advantage	hmo
"Correction of bunion, with alignment correction of midfoot bone (metatarsal) towards toe areas"	cpt	28296	5299.29	5299.29	2425.05	2425.05	21810.48	21810.48	18175.4	18175.4	O	2425.05	2425.05	humana medicare advantage	pos
"Correction of bunion, with alignment correction of midfoot bone (metatarsal) towards toe areas"	cpt	28296	5299.29	5299.29	2425.05	2425.05	21810.48	21810.48	18175.4	18175.4	O	2425.05	2425.05	humana medicare advantage	ppo
"Correction of bunion, with alignment correction of midfoot bone (metatarsal) towards toe areas"	cpt	28296	5299.29	5299.29	2425.05	2425.05	21810.48	21810.48	18175.4	18175.4	O	2425.05	2425.05	humana medicare advantage	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1952.13	1952.13	humana medicare advantage	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1952.13	1952.13	humana medicare advantage	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1952.13	1952.13	humana medicare advantage	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1952.13	1952.13	humana medicare advantage	hmo
"Incision to lengthen toe tendon, open procedure"	cpt	28232	2383.1	2383.1	2383.1	2383.1	19047.34	19047.34	15872.78	15872.78	O	2383.1	2383.1	humana medicare advantage	hmo
"Incision to lengthen toe tendon, open procedure"	cpt	28232	2383.1	2383.1	2383.1	2383.1	19047.34	19047.34	15872.78	15872.78	O	2383.1	2383.1	humana medicare advantage	pos
"Incision to lengthen toe tendon, open procedure"	cpt	28232	2383.1	2383.1	2383.1	2383.1	19047.34	19047.34	15872.78	15872.78	O	2383.1	2383.1	humana medicare advantage	ppo
"Incision to lengthen toe tendon, open procedure"	cpt	28232	2383.1	2383.1	2383.1	2383.1	19047.34	19047.34	15872.78	15872.78	O	2383.1	2383.1	humana medicare advantage	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	1503.55	1503.55	humana medicare advantage	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	1503.55	1503.55	humana medicare advantage	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	1503.55	1503.55	humana medicare advantage	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	1503.55	1503.55	humana medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	humana medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	humana medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	humana medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	1952.13	1952.13	humana medicare advantage	hmo
Partial removal of toe bone	cpt	28124	2383.75	2383.75	2248.64	2248.64	19187.63	19187.63	15989.69	15989.69	O	2383.75	2383.75	humana medicare advantage	hmo
Partial removal of toe bone	cpt	28124	2383.75	2383.75	2248.64	2248.64	19187.63	19187.63	15989.69	15989.69	O	2383.75	2383.75	humana medicare advantage	pos
Partial removal of toe bone	cpt	28124	2383.75	2383.75	2248.64	2248.64	19187.63	19187.63	15989.69	15989.69	O	2383.75	2383.75	humana medicare advantage	ppo
Partial removal of toe bone	cpt	28124	2383.75	2383.75	2248.64	2248.64	19187.63	19187.63	15989.69	15989.69	O	2383.75	2383.75	humana medicare advantage	hmo
Partial removal of foot or heel bone for bone infection in the midfoot area	cpt	28122	2425.05	2425.05	2425.05	2425.05	22013.7	22013.7	18344.75	18344.75	O	2425.05	2425.05	humana medicare advantage	hmo
Partial removal of foot or heel bone for bone infection in the midfoot area	cpt	28122	2425.05	2425.05	2425.05	2425.05	22013.7	22013.7	18344.75	18344.75	O	2425.05	2425.05	humana medicare advantage	pos
Partial removal of foot or heel bone for bone infection in the midfoot area	cpt	28122	2425.05	2425.05	2425.05	2425.05	22013.7	22013.7	18344.75	18344.75	O	2425.05	2425.05	humana medicare advantage	ppo
Partial removal of foot or heel bone for bone infection in the midfoot area	cpt	28122	2425.05	2425.05	2425.05	2425.05	22013.7	22013.7	18344.75	18344.75	O	2425.05	2425.05	humana medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	humana medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	humana medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	humana medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	humana medicare advantage	hmo
Removal of heel bone	cpt	28118	5299.29	5299.29	5299.29	5299.29	37086.2	37086.2	30905.17	30905.17	O	5299.29	5299.29	humana medicare advantage	hmo
Removal of heel bone	cpt	28118	5299.29	5299.29	5299.29	5299.29	37086.2	37086.2	30905.17	30905.17	O	5299.29	5299.29	humana medicare advantage	pos
Removal of heel bone	cpt	28118	5299.29	5299.29	5299.29	5299.29	37086.2	37086.2	30905.17	30905.17	O	5299.29	5299.29	humana medicare advantage	ppo
Removal of heel bone	cpt	28118	5299.29	5299.29	5299.29	5299.29	37086.2	37086.2	30905.17	30905.17	O	5299.29	5299.29	humana medicare advantage	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	11643.48	11643.48	humana medicare advantage	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	11643.48	11643.48	humana medicare advantage	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	11643.48	11643.48	humana medicare advantage	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	11643.48	11643.48	humana medicare advantage	hmo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	13282.95	13282.95	humana medicare advantage	hmo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	13282.95	13282.95	humana medicare advantage	pos
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	13282.95	13282.95	humana medicare advantage	ppo
Cervical spinal fusion	ms-drg	473	18636.78	18636.78	12339.04	12339.04	71424.26	71424.26	59520.22	59520.22	I	13282.95	13282.95	humana medicare advantage	hmo
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle	cpt	27822	5299.29	5299.29	5199.2	5199.2	42880.74	42880.74	35733.95	35733.95	O	5199.2	5199.2	humana medicare advantage	hmo
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle	cpt	27822	5299.29	5299.29	5199.2	5199.2	42880.74	42880.74	35733.95	35733.95	O	5199.2	5199.2	humana medicare advantage	pos
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle	cpt	27822	5299.29	5299.29	5199.2	5199.2	42880.74	42880.74	35733.95	35733.95	O	5199.2	5199.2	humana medicare advantage	ppo
Open treatment of all three prominences of the bones of the leg (tibia and fibula) in the region of the ankle	cpt	27822	5299.29	5299.29	5199.2	5199.2	42880.74	42880.74	35733.95	35733.95	O	5199.2	5199.2	humana medicare advantage	hmo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1191.11	1191.11	1178.5	1178.5	4865.9	4865.9	4054.92	4054.92	E	1178.5	1178.5	humana medicare advantage	hmo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1191.11	1191.11	1178.5	1178.5	4865.9	4865.9	4054.92	4054.92	E	1178.5	1178.5	humana medicare advantage	pos
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1191.11	1191.11	1178.5	1178.5	4865.9	4865.9	4054.92	4054.92	E	1178.5	1178.5	humana medicare advantage	ppo
Closed treatment of all three the portions of the bones of the leg (tibia and fibula) in the region of the ankle with manipulation	cpt	27818	1191.11	1191.11	1178.5	1178.5	4865.9	4865.9	4054.92	4054.92	E	1178.5	1178.5	humana medicare advantage	hmo
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation	cpt	27814	5299.29	5299.29	5299.29	5299.29	35942.2	35942.2	29951.83	29951.83	O	5299.29	5299.29	humana medicare advantage	hmo
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation	cpt	27814	5299.29	5299.29	5299.29	5299.29	35942.2	35942.2	29951.83	29951.83	O	5299.29	5299.29	humana medicare advantage	pos
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation	cpt	27814	5299.29	5299.29	5299.29	5299.29	35942.2	35942.2	29951.83	29951.83	O	5299.29	5299.29	humana medicare advantage	ppo
Open treatment of prominences of both bones of the leg (tibia and fibula) in the region of the ankle without hardware fixation	cpt	27814	5299.29	5299.29	5299.29	5299.29	35942.2	35942.2	29951.83	29951.83	O	5299.29	5299.29	humana medicare advantage	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4626.86	4626.86	humana medicare advantage	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4626.86	4626.86	humana medicare advantage	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4626.86	4626.86	humana medicare advantage	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	4626.86	4626.86	humana medicare advantage	hmo
major chest procedures with mcc	ms-drg	163	28721.37	28721.37	15759.84	15759.84	142219.09	142219.09	118515.91	118515.91	I	26509.5	26509.5	humana medicare advantage	hmo
major chest procedures with mcc	ms-drg	163	28721.37	28721.37	15759.84	15759.84	142219.09	142219.09	118515.91	118515.91	I	26509.5	26509.5	humana medicare advantage	pos
major chest procedures with mcc	ms-drg	163	28721.37	28721.37	15759.84	15759.84	142219.09	142219.09	118515.91	118515.91	I	26509.5	26509.5	humana medicare advantage	ppo
major chest procedures with mcc	ms-drg	163	28721.37	28721.37	15759.84	15759.84	142219.09	142219.09	118515.91	118515.91	I	26509.5	26509.5	humana medicare advantage	hmo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	15185.68	15185.68	humana medicare advantage	hmo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	15185.68	15185.68	humana medicare advantage	pos
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	15185.68	15185.68	humana medicare advantage	ppo
major chest procedures with cc	ms-drg	164	25248.79	25248.79	14423.44	14423.44	88686.06	88686.06	73905.05	73905.05	I	15185.68	15185.68	humana medicare advantage	hmo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	11400.92	11400.92	humana medicare advantage	hmo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	11400.92	11400.92	humana medicare advantage	pos
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	11400.92	11400.92	humana medicare advantage	ppo
major chest procedures without cc/mcc	ms-drg	165	22244.9	22244.9	8174.76	8174.76	84098.41	84098.41	70082.01	70082.01	I	11400.92	11400.92	humana medicare advantage	hmo
Removal of ankle implant	cpt	27704	581.83	581.83	581.83	581.83	28247.05	28247.05	23539.21	23539.21	O	581.83	581.83	humana medicare advantage	hmo
Removal of ankle implant	cpt	27704	581.83	581.83	581.83	581.83	28247.05	28247.05	23539.21	23539.21	O	581.83	581.83	humana medicare advantage	pos
Removal of ankle implant	cpt	27704	581.83	581.83	581.83	581.83	28247.05	28247.05	23539.21	23539.21	O	581.83	581.83	humana medicare advantage	ppo
Removal of ankle implant	cpt	27704	581.83	581.83	581.83	581.83	28247.05	28247.05	23539.21	23539.21	O	581.83	581.83	humana medicare advantage	hmo
Lengthening of calf muscle	cpt	27687	3544.14	3544.14	2425.05	2425.05	29642.78	29642.78	24702.32	24702.32	O	2425.05	2425.05	humana medicare advantage	hmo
Lengthening of calf muscle	cpt	27687	3544.14	3544.14	2425.05	2425.05	29642.78	29642.78	24702.32	24702.32	O	2425.05	2425.05	humana medicare advantage	pos
Lengthening of calf muscle	cpt	27687	3544.14	3544.14	2425.05	2425.05	29642.78	29642.78	24702.32	24702.32	O	2425.05	2425.05	humana medicare advantage	ppo
Lengthening of calf muscle	cpt	27687	3544.14	3544.14	2425.05	2425.05	29642.78	29642.78	24702.32	24702.32	O	2425.05	2425.05	humana medicare advantage	hmo
"Repair of ruptured Achilles tendon, open or through skin procedure"	cpt	27650	5299.29	5299.29	5299.29	5299.29	38357.64	38357.64	31964.7	31964.7	O	5299.29	5299.29	humana medicare advantage	hmo
"Repair of ruptured Achilles tendon, open or through skin procedure"	cpt	27650	5299.29	5299.29	5299.29	5299.29	38357.64	38357.64	31964.7	31964.7	O	5299.29	5299.29	humana medicare advantage	pos
"Repair of ruptured Achilles tendon, open or through skin procedure"	cpt	27650	5299.29	5299.29	5299.29	5299.29	38357.64	38357.64	31964.7	31964.7	O	5299.29	5299.29	humana medicare advantage	ppo
"Repair of ruptured Achilles tendon, open or through skin procedure"	cpt	27650	5299.29	5299.29	5299.29	5299.29	38357.64	38357.64	31964.7	31964.7	O	5299.29	5299.29	humana medicare advantage	hmo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	11621.07	11621.07	humana medicare advantage	hmo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	11621.07	11621.07	humana medicare advantage	pos
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	11621.07	11621.07	humana medicare advantage	ppo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	11621.07	11621.07	humana medicare advantage	hmo
Alignment of knee joint under anesthesia	cpt	27570	1200.71	1200.71	1138.71	1138.71	12245.21	12245.21	10204.34	10204.34	O	1200.71	1200.71	humana medicare advantage	hmo
Alignment of knee joint under anesthesia	cpt	27570	1200.71	1200.71	1138.71	1138.71	12245.21	12245.21	10204.34	10204.34	O	1200.71	1200.71	humana medicare advantage	pos
Alignment of knee joint under anesthesia	cpt	27570	1200.71	1200.71	1138.71	1138.71	12245.21	12245.21	10204.34	10204.34	O	1200.71	1200.71	humana medicare advantage	ppo
Alignment of knee joint under anesthesia	cpt	27570	1200.71	1200.71	1138.71	1138.71	12245.21	12245.21	10204.34	10204.34	O	1200.71	1200.71	humana medicare advantage	hmo
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	8004.74	8004.74	humana medicare advantage	hmo
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	8004.74	8004.74	humana medicare advantage	pos
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	8004.74	8004.74	humana medicare advantage	ppo
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	8004.74	8004.74	humana medicare advantage	hmo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	6073.51	6073.51	humana medicare advantage	hmo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	6073.51	6073.51	humana medicare advantage	pos
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	6073.51	6073.51	humana medicare advantage	ppo
simple pneumonia and pleurisy with cc	ms-drg	194	9778.82	9778.82	3554.32	3554.32	20194.99	20194.99	16829.16	16829.16	I	6073.51	6073.51	humana medicare advantage	hmo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	4917.44	4917.44	humana medicare advantage	hmo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	4917.44	4917.44	humana medicare advantage	pos
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	4917.44	4917.44	humana medicare advantage	ppo
simple pneumonia and pleurisy without cc/mcc	ms-drg	195	8418.87	8418.87	2370.55	2370.55	17403.08	17403.08	14502.57	14502.57	I	4917.44	4917.44	humana medicare advantage	hmo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	1200.71	1200.71	humana medicare advantage	hmo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	1200.71	1200.71	humana medicare advantage	pos
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	1200.71	1200.71	humana medicare advantage	ppo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	1200.71	1200.71	humana medicare advantage	hmo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	17256.44	17256.44	humana medicare advantage	hmo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	17256.44	17256.44	humana medicare advantage	pos
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	17256.44	17256.44	humana medicare advantage	ppo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	17256.44	17256.44	humana medicare advantage	hmo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	15147.62	15147.62	humana medicare advantage	hmo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	15147.62	15147.62	humana medicare advantage	pos
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	15147.62	15147.62	humana medicare advantage	ppo
respiratory system diagnosis with ventilator support <=96 hours	ms-drg	208	26637.75	26637.75	10337.94	10337.94	70235.36	70235.36	58529.47	58529.47	I	15147.62	15147.62	humana medicare advantage	hmo
other heart assist system implant	ms-drg	215	75544.03	75544.03	73725.61	73725.61	218033.38	218033.38	181694.48	181694.48	I	73725.61	73725.61	humana medicare advantage	hmo
other heart assist system implant	ms-drg	215	75544.03	75544.03	73725.61	73725.61	218033.38	218033.38	181694.48	181694.48	I	73725.61	73725.61	humana medicare advantage	pos
other heart assist system implant	ms-drg	215	75544.03	75544.03	73725.61	73725.61	218033.38	218033.38	181694.48	181694.48	I	73725.61	73725.61	humana medicare advantage	ppo
other heart assist system implant	ms-drg	215	75544.03	75544.03	73725.61	73725.61	218033.38	218033.38	181694.48	181694.48	I	73725.61	73725.61	humana medicare advantage	hmo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	626.2	626.2	humana medicare advantage	hmo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	626.2	626.2	humana medicare advantage	pos
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	626.2	626.2	humana medicare advantage	ppo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	626.2	626.2	humana medicare advantage	hmo
"Drainage of finger abscess, uncomplicated"	cpt	26010	352.64	352.64	229.65	229.65	1309.74	1309.74	1091.45	1091.45	E	268.15	268.15	humana medicare advantage	hmo
"Drainage of finger abscess, uncomplicated"	cpt	26010	352.64	352.64	229.65	229.65	1309.74	1309.74	1091.45	1091.45	E	268.15	268.15	humana medicare advantage	pos
"Drainage of finger abscess, uncomplicated"	cpt	26010	352.64	352.64	229.65	229.65	1309.74	1309.74	1091.45	1091.45	E	268.15	268.15	humana medicare advantage	ppo
"Drainage of finger abscess, uncomplicated"	cpt	26010	352.64	352.64	229.65	229.65	1309.74	1309.74	1091.45	1091.45	E	268.15	268.15	humana medicare advantage	hmo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	28792.96	28792.96	humana medicare advantage	hmo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	28792.96	28792.96	humana medicare advantage	pos
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	28792.96	28792.96	humana medicare advantage	ppo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	28792.96	28792.96	humana medicare advantage	hmo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	23475.39	23475.39	humana medicare advantage	hmo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	23475.39	23475.39	humana medicare advantage	pos
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	23475.39	23475.39	humana medicare advantage	ppo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	23475.39	23475.39	humana medicare advantage	hmo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	19025.98	19025.98	humana medicare advantage	hmo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	19025.98	19025.98	humana medicare advantage	pos
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	19025.98	19025.98	humana medicare advantage	ppo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	19025.98	19025.98	humana medicare advantage	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12067.36	12067.36	humana medicare advantage	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12067.36	12067.36	humana medicare advantage	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12067.36	12067.36	humana medicare advantage	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12067.36	12067.36	humana medicare advantage	hmo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	15245.66	15245.66	humana medicare advantage	hmo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	15245.66	15245.66	humana medicare advantage	pos
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	15245.66	15245.66	humana medicare advantage	ppo
percutaneous cardiovascular procedures without coronary artery stent with mcc	ms-drg	250	26746.13	26746.13	15245.66	15245.66	91705.07	91705.07	76420.89	76420.89	I	15245.66	15245.66	humana medicare advantage	hmo
other vascular procedures with mcc	ms-drg	252	20085.02	20085.02	17890.5	17890.5	99426.43	99426.43	82855.36	82855.36	I	17890.5	17890.5	humana medicare advantage	hmo
other vascular procedures with mcc	ms-drg	252	20085.02	20085.02	17890.5	17890.5	99426.43	99426.43	82855.36	82855.36	I	17890.5	17890.5	humana medicare advantage	pos
other vascular procedures with mcc	ms-drg	252	20085.02	20085.02	17890.5	17890.5	99426.43	99426.43	82855.36	82855.36	I	17890.5	17890.5	humana medicare advantage	ppo
other vascular procedures with mcc	ms-drg	252	20085.02	20085.02	17890.5	17890.5	99426.43	99426.43	82855.36	82855.36	I	17890.5	17890.5	humana medicare advantage	hmo
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	15837.47	15837.47	humana medicare advantage	hmo
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	15837.47	15837.47	humana medicare advantage	pos
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	15837.47	15837.47	humana medicare advantage	ppo
other vascular procedures with cc	ms-drg	253	29514.43	29514.43	14757.06	14757.06	79211.92	79211.92	66009.93	66009.93	I	15837.47	15837.47	humana medicare advantage	hmo
other vascular procedures without cc/mcc	ms-drg	254	13485.52	13485.52	10936.61	10936.61	37141.75	37141.75	30951.46	30951.46	I	11408.37	11408.37	humana medicare advantage	hmo
other vascular procedures without cc/mcc	ms-drg	254	13485.52	13485.52	10936.61	10936.61	37141.75	37141.75	30951.46	30951.46	I	11408.37	11408.37	humana medicare advantage	pos
other vascular procedures without cc/mcc	ms-drg	254	13485.52	13485.52	10936.61	10936.61	37141.75	37141.75	30951.46	30951.46	I	11408.37	11408.37	humana medicare advantage	ppo
other vascular procedures without cc/mcc	ms-drg	254	13485.52	13485.52	10936.61	10936.61	37141.75	37141.75	30951.46	30951.46	I	11408.37	11408.37	humana medicare advantage	hmo
aortic and heart assist procedures except pulsation balloon with mcc	ms-drg	268	39553.36	39553.36	703.02	703.02	154446.77	154446.77	128705.64	128705.64	I	703.02	703.02	humana medicare advantage	hmo
aortic and heart assist procedures except pulsation balloon with mcc	ms-drg	268	39553.36	39553.36	703.02	703.02	154446.77	154446.77	128705.64	128705.64	I	703.02	703.02	humana medicare advantage	pos
aortic and heart assist procedures except pulsation balloon with mcc	ms-drg	268	39553.36	39553.36	703.02	703.02	154446.77	154446.77	128705.64	128705.64	I	703.02	703.02	humana medicare advantage	ppo
aortic and heart assist procedures except pulsation balloon with mcc	ms-drg	268	39553.36	39553.36	703.02	703.02	154446.77	154446.77	128705.64	128705.64	I	703.02	703.02	humana medicare advantage	hmo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	12983.39	12983.39	humana medicare advantage	hmo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	12983.39	12983.39	humana medicare advantage	pos
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	12983.39	12983.39	humana medicare advantage	ppo
aortic and heart assist procedures except pulsation balloon without mcc	ms-drg	269	43254.05	43254.05	12983.39	12983.39	111818.45	111818.45	93182.04	93182.04	I	12983.39	12983.39	humana medicare advantage	hmo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	19105.86	19105.86	humana medicare advantage	hmo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	19105.86	19105.86	humana medicare advantage	pos
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	19105.86	19105.86	humana medicare advantage	ppo
other major cardiovascular procedures with cc	ms-drg	271	34817.44	34817.44	19105.86	19105.86	134179.22	134179.22	111816.02	111816.02	I	19105.86	19105.86	humana medicare advantage	hmo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	13335.64	13335.64	humana medicare advantage	hmo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	13335.64	13335.64	humana medicare advantage	pos
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	13335.64	13335.64	humana medicare advantage	ppo
"circulatory disorders except ami, with cardiac catheterization with mcc"	ms-drg	286	23670.85	23670.85	12375.58	12375.58	57221.47	57221.47	47684.56	47684.56	I	13335.64	13335.64	humana medicare advantage	hmo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	941.39	941.39	humana medicare advantage	hmo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	941.39	941.39	humana medicare advantage	pos
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	941.39	941.39	humana medicare advantage	ppo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	941.39	941.39	humana medicare advantage	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8423.14	8423.14	humana medicare advantage	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8423.14	8423.14	humana medicare advantage	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8423.14	8423.14	humana medicare advantage	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8423.14	8423.14	humana medicare advantage	hmo
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7607.38	7607.38	humana medicare advantage	hmo
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7607.38	7607.38	humana medicare advantage	pos
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7607.38	7607.38	humana medicare advantage	ppo
cardiac arrhythmia and conduction disorders with mcc	ms-drg	308	7858.02	7858.02	6156.23	6156.23	35585.35	35585.35	29654.46	29654.46	I	7607.38	7607.38	humana medicare advantage	hmo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	10573.89	10573.89	humana medicare advantage	hmo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	10573.89	10573.89	humana medicare advantage	pos
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	10573.89	10573.89	humana medicare advantage	ppo
"Insertion of posterior spinal instrumentation at base of neck for stabilization, 1 interspace"	cpt	22840	10625.2	10625.2	71.67	71.67	100078.81	100078.81	83399.01	83399.01	O	10573.89	10573.89	humana medicare advantage	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4910.45	4910.45	humana medicare advantage	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4910.45	4910.45	humana medicare advantage	pos
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4910.45	4910.45	humana medicare advantage	ppo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4910.45	4910.45	humana medicare advantage	hmo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3881.13	3881.13	humana medicare advantage	hmo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3881.13	3881.13	humana medicare advantage	pos
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3881.13	3881.13	humana medicare advantage	ppo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	3881.13	3881.13	humana medicare advantage	hmo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5682.31	5682.31	humana medicare advantage	hmo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5682.31	5682.31	humana medicare advantage	pos
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5682.31	5682.31	humana medicare advantage	ppo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5682.31	5682.31	humana medicare advantage	hmo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	10573.89	10573.89	humana medicare advantage	hmo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	10573.89	10573.89	humana medicare advantage	pos
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	10573.89	10573.89	humana medicare advantage	ppo
"Fusion of spine bones, posterior or posterolateral approach"	cpt	22614	10625.2	10625.2	6298.42	6298.42	107170.56	107170.56	89308.8	89308.8	O	10573.89	10573.89	humana medicare advantage	hmo
"Fusion of lower spine bones, posterior or posterolateral approach"	cpt	22612	10625.2	10625.2	71.67	71.67	98531.21	98531.21	82109.34	82109.34	O	10573.89	10573.89	humana medicare advantage	hmo
"Fusion of lower spine bones, posterior or posterolateral approach"	cpt	22612	10625.2	10625.2	71.67	71.67	98531.21	98531.21	82109.34	82109.34	O	10573.89	10573.89	humana medicare advantage	pos
"Fusion of lower spine bones, posterior or posterolateral approach"	cpt	22612	10625.2	10625.2	71.67	71.67	98531.21	98531.21	82109.34	82109.34	O	10573.89	10573.89	humana medicare advantage	ppo
"Fusion of lower spine bones, posterior or posterolateral approach"	cpt	22612	10625.2	10625.2	71.67	71.67	98531.21	98531.21	82109.34	82109.34	O	10573.89	10573.89	humana medicare advantage	hmo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	28508.13	28508.13	humana medicare advantage	hmo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	28508.13	28508.13	humana medicare advantage	pos
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	28508.13	28508.13	humana medicare advantage	ppo
major small and large bowel procedures with mcc	ms-drg	329	36464.38	36464.38	24057.11	24057.11	121868.66	121868.66	101557.22	101557.22	I	28508.13	28508.13	humana medicare advantage	hmo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	14581.38	14581.38	humana medicare advantage	hmo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	14581.38	14581.38	humana medicare advantage	pos
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	14581.38	14581.38	humana medicare advantage	ppo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	14581.38	14581.38	humana medicare advantage	hmo
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance	cpt	22515	10542.6	10542.6	5180.14	5180.14	62407.9	62407.9	52006.58	52006.58	O	10542.6	10542.6	humana medicare advantage	hmo
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance	cpt	22515	10542.6	10542.6	5180.14	5180.14	62407.9	62407.9	52006.58	52006.58	O	10542.6	10542.6	humana medicare advantage	pos
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance	cpt	22515	10542.6	10542.6	5180.14	5180.14	62407.9	62407.9	52006.58	52006.58	O	10542.6	10542.6	humana medicare advantage	ppo
Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance	cpt	22515	10542.6	10542.6	5180.14	5180.14	62407.9	62407.9	52006.58	52006.58	O	10542.6	10542.6	humana medicare advantage	hmo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	10550.05	10550.05	humana medicare advantage	hmo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	10550.05	10550.05	humana medicare advantage	pos
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	10550.05	10550.05	humana medicare advantage	ppo
major small and large bowel procedures without cc/mcc	ms-drg	331	11874.88	11874.88	7725.86	7725.86	56955.92	56955.92	47463.27	47463.27	I	10550.05	10550.05	humana medicare advantage	hmo
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance	cpt	22514	5299.29	5299.29	0.36	0.36	37771.36	37771.36	31476.13	31476.13	O	5093.22	5093.22	humana medicare advantage	hmo
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance	cpt	22514	5299.29	5299.29	0.36	0.36	37771.36	37771.36	31476.13	31476.13	O	5093.22	5093.22	humana medicare advantage	pos
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance	cpt	22514	5299.29	5299.29	0.36	0.36	37771.36	37771.36	31476.13	31476.13	O	5093.22	5093.22	humana medicare advantage	ppo
Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance	cpt	22514	5299.29	5299.29	0.36	0.36	37771.36	37771.36	31476.13	31476.13	O	5093.22	5093.22	humana medicare advantage	hmo
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending	cpt	22513	10542.6	10542.6	5256.9	5256.9	32081.46	32081.46	26734.55	26734.55	O	10542.6	10542.6	humana medicare advantage	hmo
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending	cpt	22513	10542.6	10542.6	5256.9	5256.9	32081.46	32081.46	26734.55	26734.55	O	10542.6	10542.6	humana medicare advantage	pos
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending	cpt	22513	10542.6	10542.6	5256.9	5256.9	32081.46	32081.46	26734.55	26734.55	O	10542.6	10542.6	humana medicare advantage	ppo
Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance in the thoracic to correct forward bending	cpt	22513	10542.6	10542.6	5256.9	5256.9	32081.46	32081.46	26734.55	26734.55	O	10542.6	10542.6	humana medicare advantage	hmo
Harvest of bone from same spine incision for graft	cpt	20936	10573.89	10573.89	10359.91	10359.91	90858.1	90858.1	75715.08	75715.08	O	10573.89	10573.89	humana medicare advantage	hmo
Harvest of bone from same spine incision for graft	cpt	20936	10573.89	10573.89	10359.91	10359.91	90858.1	90858.1	75715.08	75715.08	O	10573.89	10573.89	humana medicare advantage	pos
Harvest of bone from same spine incision for graft	cpt	20936	10573.89	10573.89	10359.91	10359.91	90858.1	90858.1	75715.08	75715.08	O	10573.89	10573.89	humana medicare advantage	ppo
Harvest of bone from same spine incision for graft	cpt	20936	10573.89	10573.89	10359.91	10359.91	90858.1	90858.1	75715.08	75715.08	O	10573.89	10573.89	humana medicare advantage	hmo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	10856.49	10856.49	humana medicare advantage	hmo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	10856.49	10856.49	humana medicare advantage	pos
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	10856.49	10856.49	humana medicare advantage	ppo
hernia procedures except inguinal and femoral with cc	ms-drg	354	19392.75	19392.75	10856.49	10856.49	65200.49	65200.49	54333.74	54333.74	I	10856.49	10856.49	humana medicare advantage	hmo
major esophageal disorders with mcc	ms-drg	368	12011.24	12011.24	11493.96	11493.96	41590.37	41590.37	34658.64	34658.64	I	11887.75	11887.75	humana medicare advantage	hmo
major esophageal disorders with mcc	ms-drg	368	12011.24	12011.24	11493.96	11493.96	41590.37	41590.37	34658.64	34658.64	I	11887.75	11887.75	humana medicare advantage	pos
major esophageal disorders with mcc	ms-drg	368	12011.24	12011.24	11493.96	11493.96	41590.37	41590.37	34658.64	34658.64	I	11887.75	11887.75	humana medicare advantage	ppo
major esophageal disorders with mcc	ms-drg	368	12011.24	12011.24	11493.96	11493.96	41590.37	41590.37	34658.64	34658.64	I	11887.75	11887.75	humana medicare advantage	hmo
major gastrointestinal disorders and peritoneal infections with mcc	ms-drg	371	10891.7	10891.7	7901.82	7901.82	58870.42	58870.42	49058.68	49058.68	I	10067.22	10067.22	humana medicare advantage	hmo
major gastrointestinal disorders and peritoneal infections with mcc	ms-drg	371	10891.7	10891.7	7901.82	7901.82	58870.42	58870.42	49058.68	49058.68	I	10067.22	10067.22	humana medicare advantage	pos
major gastrointestinal disorders and peritoneal infections with mcc	ms-drg	371	10891.7	10891.7	7901.82	7901.82	58870.42	58870.42	49058.68	49058.68	I	10067.22	10067.22	humana medicare advantage	ppo
major gastrointestinal disorders and peritoneal infections with mcc	ms-drg	371	10891.7	10891.7	7901.82	7901.82	58870.42	58870.42	49058.68	49058.68	I	10067.22	10067.22	humana medicare advantage	hmo
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery	cpt	20930	10573.89	10573.89	5215.79	5215.79	74066.99	74066.99	61722.49	61722.49	O	10573.89	10573.89	humana medicare advantage	hmo
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery	cpt	20930	10573.89	10573.89	5215.79	5215.79	74066.99	74066.99	61722.49	61722.49	O	10573.89	10573.89	humana medicare advantage	pos
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery	cpt	20930	10573.89	10573.89	5215.79	5215.79	74066.99	74066.99	61722.49	61722.49	O	10573.89	10573.89	humana medicare advantage	ppo
Fragmented donor bone graft or placement of material to promote bone growth for spine surgery	cpt	20930	10573.89	10573.89	5215.79	5215.79	74066.99	74066.99	61722.49	61722.49	O	10573.89	10573.89	humana medicare advantage	hmo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6617.66	6617.66	humana medicare advantage	hmo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6617.66	6617.66	humana medicare advantage	pos
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6617.66	6617.66	humana medicare advantage	ppo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6617.66	6617.66	humana medicare advantage	hmo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	231.9	231.9	humana medicare advantage	hmo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	231.9	231.9	humana medicare advantage	pos
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	231.9	231.9	humana medicare advantage	ppo
Aspiration and/or injection of large joint or joint capsule	cpt	20610	877.03	877.03	231.9	231.9	742.56	742.56	618.8	618.8	O	231.9	231.9	humana medicare advantage	hmo
complicated peptic ulcer with cc	ms-drg	381	7221.97	7221.97	6149.37	6149.37	25309.24	25309.24	21091.03	21091.03	I	7221.97	7221.97	humana medicare advantage	hmo
complicated peptic ulcer with cc	ms-drg	381	7221.97	7221.97	6149.37	6149.37	25309.24	25309.24	21091.03	21091.03	I	7221.97	7221.97	humana medicare advantage	pos
complicated peptic ulcer with cc	ms-drg	381	7221.97	7221.97	6149.37	6149.37	25309.24	25309.24	21091.03	21091.03	I	7221.97	7221.97	humana medicare advantage	ppo
complicated peptic ulcer with cc	ms-drg	381	7221.97	7221.97	6149.37	6149.37	25309.24	25309.24	21091.03	21091.03	I	7221.97	7221.97	humana medicare advantage	hmo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	6051.58	6051.58	humana medicare advantage	hmo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	6051.58	6051.58	humana medicare advantage	pos
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	6051.58	6051.58	humana medicare advantage	ppo
inflammatory bowel disease with cc	ms-drg	386	11750.65	11750.65	4738.54	4738.54	36145.84	36145.84	30121.53	30121.53	I	6051.58	6051.58	humana medicare advantage	hmo
Aspiration and/or injection of medium joint or joint capsule	cpt	20605	660.04	660.04	660.04	660.04	3448.16	3448.16	2873.47	2873.47	E	660.04	660.04	humana medicare advantage	hmo
Aspiration and/or injection of medium joint or joint capsule	cpt	20605	660.04	660.04	660.04	660.04	3448.16	3448.16	2873.47	2873.47	E	660.04	660.04	humana medicare advantage	pos
Aspiration and/or injection of medium joint or joint capsule	cpt	20605	660.04	660.04	660.04	660.04	3448.16	3448.16	2873.47	2873.47	E	660.04	660.04	humana medicare advantage	ppo
Aspiration and/or injection of medium joint or joint capsule	cpt	20605	660.04	660.04	660.04	660.04	3448.16	3448.16	2873.47	2873.47	E	660.04	660.04	humana medicare advantage	hmo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5432.62	5432.62	humana medicare advantage	hmo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5432.62	5432.62	humana medicare advantage	pos
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5432.62	5432.62	humana medicare advantage	ppo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5432.62	5432.62	humana medicare advantage	hmo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	6441.45	6441.45	humana medicare advantage	hmo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	6441.45	6441.45	humana medicare advantage	pos
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	6441.45	6441.45	humana medicare advantage	ppo
other digestive system diagnoses with cc	ms-drg	394	8388.74	8388.74	4580.56	4580.56	30617.81	30617.81	25514.84	25514.84	I	6441.45	6441.45	humana medicare advantage	hmo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4639.61	4639.61	humana medicare advantage	hmo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4639.61	4639.61	humana medicare advantage	pos
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4639.61	4639.61	humana medicare advantage	ppo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4639.61	4639.61	humana medicare advantage	hmo
malignancy of hepatobiliary system or pancreas with mcc	ms-drg	435	10769.03	10769.03	5409.97	5409.97	33564.19	33564.19	27970.16	27970.16	I	10715.69	10715.69	humana medicare advantage	hmo
malignancy of hepatobiliary system or pancreas with mcc	ms-drg	435	10769.03	10769.03	5409.97	5409.97	33564.19	33564.19	27970.16	27970.16	I	10715.69	10715.69	humana medicare advantage	pos
malignancy of hepatobiliary system or pancreas with mcc	ms-drg	435	10769.03	10769.03	5409.97	5409.97	33564.19	33564.19	27970.16	27970.16	I	10715.69	10715.69	humana medicare advantage	ppo
malignancy of hepatobiliary system or pancreas with mcc	ms-drg	435	10769.03	10769.03	5409.97	5409.97	33564.19	33564.19	27970.16	27970.16	I	10715.69	10715.69	humana medicare advantage	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	1345.13	1345.13	humana medicare advantage	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	1345.13	1345.13	humana medicare advantage	pos
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	1345.13	1345.13	humana medicare advantage	ppo
"Biopsy of breast accessed through the skin with ultrasound guidance, additional lesion"	cpt	19084	4003.45	4003.45	1196.5	1196.5	12652.85	12652.85	10544.04	10544.04	O	1345.13	1345.13	humana medicare advantage	hmo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	6497.96	6497.96	humana medicare advantage	hmo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	6497.96	6497.96	humana medicare advantage	pos
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	6497.96	6497.96	humana medicare advantage	ppo
disorders of pancreas except malignancy with mcc	ms-drg	438	25700.17	25700.17	6497.96	6497.96	50989.15	50989.15	42490.96	42490.96	I	6497.96	6497.96	humana medicare advantage	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1345.13	1345.13	humana medicare advantage	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1345.13	1345.13	humana medicare advantage	pos
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1345.13	1345.13	humana medicare advantage	ppo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	1345.13	1345.13	humana medicare advantage	hmo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with cc"	ms-drg	442	6432.48	6432.48	2765.26	2765.26	15198.22	15198.22	12665.18	12665.18	I	6414.99	6414.99	humana medicare advantage	hmo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with cc"	ms-drg	442	6432.48	6432.48	2765.26	2765.26	15198.22	15198.22	12665.18	12665.18	I	6414.99	6414.99	humana medicare advantage	pos
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with cc"	ms-drg	442	6432.48	6432.48	2765.26	2765.26	15198.22	15198.22	12665.18	12665.18	I	6414.99	6414.99	humana medicare advantage	ppo
"disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with cc"	ms-drg	442	6432.48	6432.48	2765.26	2765.26	15198.22	15198.22	12665.18	12665.18	I	6414.99	6414.99	humana medicare advantage	hmo
"Biopsy of breast accessed through the skin with stereotactic guidance, first lesion"	cpt	19081	1215.96	1215.96	1215.96	1215.96	11913.47	11913.47	9927.89	9927.89	O	1215.96	1215.96	humana medicare advantage	hmo
"Biopsy of breast accessed through the skin with stereotactic guidance, first lesion"	cpt	19081	1215.96	1215.96	1215.96	1215.96	11913.47	11913.47	9927.89	9927.89	O	1215.96	1215.96	humana medicare advantage	pos
"Biopsy of breast accessed through the skin with stereotactic guidance, first lesion"	cpt	19081	1215.96	1215.96	1215.96	1215.96	11913.47	11913.47	9927.89	9927.89	O	1215.96	1215.96	humana medicare advantage	ppo
"Biopsy of breast accessed through the skin with stereotactic guidance, first lesion"	cpt	19081	1215.96	1215.96	1215.96	1215.96	11913.47	11913.47	9927.89	9927.89	O	1215.96	1215.96	humana medicare advantage	hmo
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc	ms-drg	464	17839.18	17839.18	10570	10570	76750.34	76750.34	63958.62	63958.62	I	10570	10570	humana medicare advantage	hmo
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc	ms-drg	464	17839.18	17839.18	10570	10570	76750.34	76750.34	63958.62	63958.62	I	10570	10570	humana medicare advantage	pos
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc	ms-drg	464	17839.18	17839.18	10570	10570	76750.34	76750.34	63958.62	63958.62	I	10570	10570	humana medicare advantage	ppo
wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders with cc	ms-drg	464	17839.18	17839.18	10570	10570	76750.34	76750.34	63958.62	63958.62	I	10570	10570	humana medicare advantage	hmo
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	20754.42	20754.42	humana medicare advantage	hmo
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	20754.42	20754.42	humana medicare advantage	pos
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	20754.42	20754.42	humana medicare advantage	ppo
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	20754.42	20754.42	humana medicare advantage	hmo
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	29284.18	29284.18	humana medicare advantage	hmo
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	29284.18	29284.18	humana medicare advantage	pos
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	29284.18	29284.18	humana medicare advantage	ppo
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	29284.18	29284.18	humana medicare advantage	hmo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	21300.97	21300.97	humana medicare advantage	hmo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	21300.97	21300.97	humana medicare advantage	pos
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	21300.97	21300.97	humana medicare advantage	ppo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	21300.97	21300.97	humana medicare advantage	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	12770.33	12770.33	humana medicare advantage	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	12770.33	12770.33	humana medicare advantage	pos
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	12770.33	12770.33	humana medicare advantage	ppo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	12770.33	12770.33	humana medicare advantage	hmo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	540.4	540.4	humana medicare advantage	hmo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	540.4	540.4	humana medicare advantage	pos
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	540.4	540.4	humana medicare advantage	ppo
Aspiration of breast cyst	cpt	19000	4127.82	4127.82	540.4	540.4	2462.56	2462.56	2052.13	2052.13	O	540.4	540.4	humana medicare advantage	hmo
"Skin, mucus membrane and beneath the skin procedure"	cpt	17999	3760.63	3760.63	1206.23	1206.23	23434.01	23434.01	19528.34	19528.34	O	1215.96	1215.96	humana medicare advantage	hmo
"Skin, mucus membrane and beneath the skin procedure"	cpt	17999	3760.63	3760.63	1206.23	1206.23	23434.01	23434.01	19528.34	19528.34	O	1215.96	1215.96	humana medicare advantage	pos
"Skin, mucus membrane and beneath the skin procedure"	cpt	17999	3760.63	3760.63	1206.23	1206.23	23434.01	23434.01	19528.34	19528.34	O	1215.96	1215.96	humana medicare advantage	ppo
"Skin, mucus membrane and beneath the skin procedure"	cpt	17999	3760.63	3760.63	1206.23	1206.23	23434.01	23434.01	19528.34	19528.34	O	1215.96	1215.96	humana medicare advantage	hmo
major joint or limb reattachment procedures of upper extremities	ms-drg	483	14813.24	14813.24	14629.54	14629.54	91939.14	91939.14	76615.95	76615.95	I	14629.54	14629.54	humana medicare advantage	hmo
major joint or limb reattachment procedures of upper extremities	ms-drg	483	14813.24	14813.24	14629.54	14629.54	91939.14	91939.14	76615.95	76615.95	I	14629.54	14629.54	humana medicare advantage	pos
major joint or limb reattachment procedures of upper extremities	ms-drg	483	14813.24	14813.24	14629.54	14629.54	91939.14	91939.14	76615.95	76615.95	I	14629.54	14629.54	humana medicare advantage	ppo
major joint or limb reattachment procedures of upper extremities	ms-drg	483	14813.24	14813.24	14629.54	14629.54	91939.14	91939.14	76615.95	76615.95	I	14629.54	14629.54	humana medicare advantage	hmo
Muscle flap wound repair at trunk	cpt	15734	7309.85	7309.85	7309.85	7309.85	30295.2	30295.2	25246	25246	O	7309.85	7309.85	humana medicare advantage	hmo
Muscle flap wound repair at trunk	cpt	15734	7309.85	7309.85	7309.85	7309.85	30295.2	30295.2	25246	25246	O	7309.85	7309.85	humana medicare advantage	pos
Muscle flap wound repair at trunk	cpt	15734	7309.85	7309.85	7309.85	7309.85	30295.2	30295.2	25246	25246	O	7309.85	7309.85	humana medicare advantage	ppo
Muscle flap wound repair at trunk	cpt	15734	7309.85	7309.85	7309.85	7309.85	30295.2	30295.2	25246	25246	O	7309.85	7309.85	humana medicare advantage	hmo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	8532.4	8532.4	humana medicare advantage	hmo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	8532.4	8532.4	humana medicare advantage	pos
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	8532.4	8532.4	humana medicare advantage	ppo
back and neck procedures except spinal fusion without cc/mcc	ms-drg	520	12494.82	12494.82	6675.11	6675.11	38066.74	38066.74	31722.28	31722.28	I	8532.4	8532.4	humana medicare advantage	hmo
hip replacement with principal diagnosis of hip fracture without mcc	ms-drg	522	13434.58	13434.58	13309.54	13309.54	86336.41	86336.41	71947.01	71947.01	I	13309.54	13309.54	humana medicare advantage	hmo
hip replacement with principal diagnosis of hip fracture without mcc	ms-drg	522	13434.58	13434.58	13309.54	13309.54	86336.41	86336.41	71947.01	71947.01	I	13309.54	13309.54	humana medicare advantage	pos
hip replacement with principal diagnosis of hip fracture without mcc	ms-drg	522	13434.58	13434.58	13309.54	13309.54	86336.41	86336.41	71947.01	71947.01	I	13309.54	13309.54	humana medicare advantage	ppo
hip replacement with principal diagnosis of hip fracture without mcc	ms-drg	522	13434.58	13434.58	13309.54	13309.54	86336.41	86336.41	71947.01	71947.01	I	13309.54	13309.54	humana medicare advantage	hmo
connective tissue disorders with mcc	ms-drg	545	15159.26	15159.26	14109.06	14109.06	97336.54	97336.54	81113.78	81113.78	I	15159.26	15159.26	humana medicare advantage	hmo
connective tissue disorders with mcc	ms-drg	545	15159.26	15159.26	14109.06	14109.06	97336.54	97336.54	81113.78	81113.78	I	15159.26	15159.26	humana medicare advantage	pos
connective tissue disorders with mcc	ms-drg	545	15159.26	15159.26	14109.06	14109.06	97336.54	97336.54	81113.78	81113.78	I	15159.26	15159.26	humana medicare advantage	ppo
connective tissue disorders with mcc	ms-drg	545	15159.26	15159.26	14109.06	14109.06	97336.54	97336.54	81113.78	81113.78	I	15159.26	15159.26	humana medicare advantage	hmo
medical back problems with mcc	ms-drg	551	10158.98	10158.98	6280.8	6280.8	39910.76	39910.76	33258.97	33258.97	I	9936.8	9936.8	humana medicare advantage	hmo
medical back problems with mcc	ms-drg	551	10158.98	10158.98	6280.8	6280.8	39910.76	39910.76	33258.97	33258.97	I	9936.8	9936.8	humana medicare advantage	pos
medical back problems with mcc	ms-drg	551	10158.98	10158.98	6280.8	6280.8	39910.76	39910.76	33258.97	33258.97	I	9936.8	9936.8	humana medicare advantage	ppo
medical back problems with mcc	ms-drg	551	10158.98	10158.98	6280.8	6280.8	39910.76	39910.76	33258.97	33258.97	I	9936.8	9936.8	humana medicare advantage	hmo
"fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc"	ms-drg	563	5760.45	5760.45	4113.82	4113.82	19610.36	19610.36	16341.97	16341.97	I	5305.67	5305.67	humana medicare advantage	hmo
"fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc"	ms-drg	563	5760.45	5760.45	4113.82	4113.82	19610.36	19610.36	16341.97	16341.97	I	5305.67	5305.67	humana medicare advantage	pos
"fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc"	ms-drg	563	5760.45	5760.45	4113.82	4113.82	19610.36	19610.36	16341.97	16341.97	I	5305.67	5305.67	humana medicare advantage	ppo
"fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc"	ms-drg	563	5760.45	5760.45	4113.82	4113.82	19610.36	19610.36	16341.97	16341.97	I	5305.67	5305.67	humana medicare advantage	hmo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	10217.88	10217.88	humana medicare advantage	hmo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	10217.88	10217.88	humana medicare advantage	pos
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	10217.88	10217.88	humana medicare advantage	ppo
"other skin, subcutaneous tissue and breast procedures with cc"	ms-drg	580	13853.94	13853.94	2320.4	2320.4	60281.84	60281.84	50234.87	50234.87	I	10217.88	10217.88	humana medicare advantage	hmo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	517.64	517.64	197.85	197.85	1425.3	1425.3	1187.75	1187.75	E	473.8	473.8	humana medicare advantage	hmo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	517.64	517.64	197.85	197.85	1425.3	1425.3	1187.75	1187.75	E	473.8	473.8	humana medicare advantage	pos
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	517.64	517.64	197.85	197.85	1425.3	1425.3	1187.75	1187.75	E	473.8	473.8	humana medicare advantage	ppo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	517.64	517.64	197.85	197.85	1425.3	1425.3	1187.75	1187.75	E	473.8	473.8	humana medicare advantage	hmo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	9125.6	9125.6	humana medicare advantage	hmo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	9125.6	9125.6	humana medicare advantage	pos
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	9125.6	9125.6	humana medicare advantage	ppo
cellulitis with mcc	ms-drg	602	16664.06	16664.06	5542.21	5542.21	52542.07	52542.07	43785.06	43785.06	I	9125.6	9125.6	humana medicare advantage	hmo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	315.35	315.35	humana medicare advantage	hmo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	315.35	315.35	humana medicare advantage	pos
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	315.35	315.35	humana medicare advantage	ppo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	315.35	315.35	humana medicare advantage	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	461.23	461.23	humana medicare advantage	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	461.23	461.23	humana medicare advantage	pos
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	461.23	461.23	humana medicare advantage	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	461.23	461.23	humana medicare advantage	hmo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	11696.3	11696.3	humana medicare advantage	hmo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	11696.3	11696.3	humana medicare advantage	pos
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	11696.3	11696.3	humana medicare advantage	ppo
"amputation of lower limb for endocrine, nutritional and metabolic disorders with cc"	ms-drg	617	19091.29	19091.29	10377.05	10377.05	53486.18	53486.18	44571.82	44571.82	I	11696.3	11696.3	humana medicare advantage	hmo
"skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	622	22420.04	22420.04	22420.04	22420.04	69318.7	69318.7	57765.58	57765.58	I	22420.04	22420.04	humana medicare advantage	hmo
"skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	622	22420.04	22420.04	22420.04	22420.04	69318.7	69318.7	57765.58	57765.58	I	22420.04	22420.04	humana medicare advantage	pos
"skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	622	22420.04	22420.04	22420.04	22420.04	69318.7	69318.7	57765.58	57765.58	I	22420.04	22420.04	humana medicare advantage	ppo
"skin grafts and wound debridement for endocrine, nutritional and metabolic disorders with mcc"	ms-drg	622	22420.04	22420.04	22420.04	22420.04	69318.7	69318.7	57765.58	57765.58	I	22420.04	22420.04	humana medicare advantage	hmo
"other endocrine, nutritional and metabolic o.r. procedures with cc"	ms-drg	629	14310.16	14310.16	9468.97	9468.97	58346.14	58346.14	48621.78	48621.78	I	9468.97	9468.97	humana medicare advantage	hmo
"other endocrine, nutritional and metabolic o.r. procedures with cc"	ms-drg	629	14310.16	14310.16	9468.97	9468.97	58346.14	58346.14	48621.78	48621.78	I	9468.97	9468.97	humana medicare advantage	pos
"other endocrine, nutritional and metabolic o.r. procedures with cc"	ms-drg	629	14310.16	14310.16	9468.97	9468.97	58346.14	58346.14	48621.78	48621.78	I	9468.97	9468.97	humana medicare advantage	ppo
"other endocrine, nutritional and metabolic o.r. procedures with cc"	ms-drg	629	14310.16	14310.16	9468.97	9468.97	58346.14	58346.14	48621.78	48621.78	I	9468.97	9468.97	humana medicare advantage	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	8835.1	8835.1	humana medicare advantage	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	8835.1	8835.1	humana medicare advantage	pos
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	8835.1	8835.1	humana medicare advantage	ppo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	8835.1	8835.1	humana medicare advantage	hmo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6055.18	6055.18	humana medicare advantage	hmo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6055.18	6055.18	humana medicare advantage	pos
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6055.18	6055.18	humana medicare advantage	ppo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	6055.18	6055.18	humana medicare advantage	hmo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	410.93	410.93	humana medicare advantage	hmo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	410.93	410.93	humana medicare advantage	pos
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	410.93	410.93	humana medicare advantage	ppo
"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs"	cpt	12001	1130.86	1130.86	197.85	197.85	1247.68	1247.68	1039.73	1039.73	E	410.93	410.93	humana medicare advantage	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7438.56	7438.56	humana medicare advantage	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7438.56	7438.56	humana medicare advantage	pos
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7438.56	7438.56	humana medicare advantage	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7438.56	7438.56	humana medicare advantage	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5227.82	5227.82	humana medicare advantage	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5227.82	5227.82	humana medicare advantage	pos
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5227.82	5227.82	humana medicare advantage	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	5227.82	5227.82	humana medicare advantage	hmo
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	6214.46	6214.46	humana medicare advantage	hmo
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	6214.46	6214.46	humana medicare advantage	pos
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	6214.46	6214.46	humana medicare advantage	ppo
endocrine disorders with cc	ms-drg	644	19059.25	19059.25	6214.46	6214.46	25664.1	25664.1	21386.75	21386.75	I	6214.46	6214.46	humana medicare advantage	hmo
transurethral procedures with cc	ms-drg	669	9728.02	9728.02	9728.02	9728.02	81339.89	81339.89	67783.24	67783.24	I	9728.02	9728.02	humana medicare advantage	hmo
transurethral procedures with cc	ms-drg	669	9728.02	9728.02	9728.02	9728.02	81339.89	81339.89	67783.24	67783.24	I	9728.02	9728.02	humana medicare advantage	pos
transurethral procedures with cc	ms-drg	669	9728.02	9728.02	9728.02	9728.02	81339.89	81339.89	67783.24	67783.24	I	9728.02	9728.02	humana medicare advantage	ppo
transurethral procedures with cc	ms-drg	669	9728.02	9728.02	9728.02	9728.02	81339.89	81339.89	67783.24	67783.24	I	9728.02	9728.02	humana medicare advantage	hmo
"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11624	2890.67	2890.67	1215.96	1215.96	19505.98	19505.98	16254.98	16254.98	O	1215.96	1215.96	humana medicare advantage	hmo
"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11624	2890.67	2890.67	1215.96	1215.96	19505.98	19505.98	16254.98	16254.98	O	1215.96	1215.96	humana medicare advantage	pos
"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11624	2890.67	2890.67	1215.96	1215.96	19505.98	19505.98	16254.98	16254.98	O	1215.96	1215.96	humana medicare advantage	ppo
"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11624	2890.67	2890.67	1215.96	1215.96	19505.98	19505.98	16254.98	16254.98	O	1215.96	1215.96	humana medicare advantage	hmo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	8894.22	8894.22	humana medicare advantage	hmo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	8894.22	8894.22	humana medicare advantage	pos
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	8894.22	8894.22	humana medicare advantage	ppo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	8894.22	8894.22	humana medicare advantage	hmo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	1215.96	1215.96	humana medicare advantage	hmo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	1215.96	1215.96	humana medicare advantage	pos
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	1215.96	1215.96	humana medicare advantage	ppo
"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs"	cpt	11606	5337.57	5337.57	1215.96	1215.96	16745.52	16745.52	13954.6	13954.6	O	1215.96	1215.96	humana medicare advantage	hmo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6211.69	6211.69	humana medicare advantage	hmo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6211.69	6211.69	humana medicare advantage	pos
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6211.69	6211.69	humana medicare advantage	ppo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6211.69	6211.69	humana medicare advantage	hmo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	2628.54	2628.54	humana medicare advantage	hmo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	2628.54	2628.54	humana medicare advantage	pos
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	2628.54	2628.54	humana medicare advantage	ppo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	2628.54	2628.54	humana medicare advantage	hmo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	2054.26	2054.26	humana medicare advantage	hmo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	2054.26	2054.26	humana medicare advantage	pos
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	2054.26	2054.26	humana medicare advantage	ppo
"Removal of growth (4.0 centimeters) of the trunk, arms, or legs"	cpt	11406	4476.04	4476.04	1215.96	1215.96	17348.3	17348.3	14456.92	14456.92	O	2054.26	2054.26	humana medicare advantage	hmo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2054.26	2054.26	humana medicare advantage	hmo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2054.26	2054.26	humana medicare advantage	pos
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2054.26	2054.26	humana medicare advantage	ppo
"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs"	cpt	11404	2173.47	2173.47	2054.26	2054.26	16481.42	16481.42	13734.52	13734.52	O	2054.26	2054.26	humana medicare advantage	hmo
"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs"	cpt	11403	2054.26	2054.26	868.45	868.45	15294.19	15294.19	12745.16	12745.16	O	2054.26	2054.26	humana medicare advantage	hmo
"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs"	cpt	11403	2054.26	2054.26	868.45	868.45	15294.19	15294.19	12745.16	12745.16	O	2054.26	2054.26	humana medicare advantage	pos
"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs"	cpt	11403	2054.26	2054.26	868.45	868.45	15294.19	15294.19	12745.16	12745.16	O	2054.26	2054.26	humana medicare advantage	ppo
"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs"	cpt	11403	2054.26	2054.26	868.45	868.45	15294.19	15294.19	12745.16	12745.16	O	2054.26	2054.26	humana medicare advantage	hmo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1192.54	1192.54	humana medicare advantage	hmo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1192.54	1192.54	humana medicare advantage	pos
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1192.54	1192.54	humana medicare advantage	ppo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	1192.54	1192.54	humana medicare advantage	hmo
Removal of skin and/or muscle first 20 sq cm or less	cpt	11043	440.3	440.3	433.26	433.26	2436.26	2436.26	2030.22	2030.22	O	440.3	440.3	humana medicare advantage	hmo
Removal of skin and/or muscle first 20 sq cm or less	cpt	11043	440.3	440.3	433.26	433.26	2436.26	2436.26	2030.22	2030.22	O	440.3	440.3	humana medicare advantage	pos
Removal of skin and/or muscle first 20 sq cm or less	cpt	11043	440.3	440.3	433.26	433.26	2436.26	2436.26	2030.22	2030.22	O	440.3	440.3	humana medicare advantage	ppo
Removal of skin and/or muscle first 20 sq cm or less	cpt	11043	440.3	440.3	433.26	433.26	2436.26	2436.26	2030.22	2030.22	O	440.3	440.3	humana medicare advantage	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	humana medicare advantage	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	humana medicare advantage	pos
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	humana medicare advantage	ppo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	283.05	283.05	humana medicare advantage	hmo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	6599.64	6599.64	humana medicare advantage	hmo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	6599.64	6599.64	humana medicare advantage	pos
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	6599.64	6599.64	humana medicare advantage	ppo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	6599.64	6599.64	humana medicare advantage	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	humana medicare advantage	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	humana medicare advantage	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	humana medicare advantage	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	283.05	283.05	humana medicare advantage	hmo
acute leukemia without major o.r. procedures with mcc	ms-drg	834	23517.21	23517.21	17804.61	17804.61	58562.51	58562.51	48802.09	48802.09	I	23517.21	23517.21	humana medicare advantage	hmo
acute leukemia without major o.r. procedures with mcc	ms-drg	834	23517.21	23517.21	17804.61	17804.61	58562.51	58562.51	48802.09	48802.09	I	23517.21	23517.21	humana medicare advantage	pos
acute leukemia without major o.r. procedures with mcc	ms-drg	834	23517.21	23517.21	17804.61	17804.61	58562.51	58562.51	48802.09	48802.09	I	23517.21	23517.21	humana medicare advantage	ppo
acute leukemia without major o.r. procedures with mcc	ms-drg	834	23517.21	23517.21	17804.61	17804.61	58562.51	58562.51	48802.09	48802.09	I	23517.21	23517.21	humana medicare advantage	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	29630.17	29630.17	humana medicare advantage	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	29630.17	29630.17	humana medicare advantage	pos
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	29630.17	29630.17	humana medicare advantage	ppo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	29630.17	29630.17	humana medicare advantage	hmo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	470.54	470.54	humana medicare advantage	hmo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	470.54	470.54	humana medicare advantage	pos
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	470.54	470.54	humana medicare advantage	ppo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	470.54	470.54	humana medicare advantage	hmo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	13097.4	13097.4	humana medicare advantage	hmo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	13097.4	13097.4	humana medicare advantage	pos
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	13097.4	13097.4	humana medicare advantage	ppo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	13097.4	13097.4	humana medicare advantage	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	11580.12	11580.12	humana medicare advantage	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	11580.12	11580.12	humana medicare advantage	pos
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	11580.12	11580.12	humana medicare advantage	ppo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	11580.12	11580.12	humana medicare advantage	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	537.95	537.95	humana medicare advantage	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	537.95	537.95	humana medicare advantage	pos
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	537.95	537.95	humana medicare advantage	ppo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	537.95	537.95	humana medicare advantage	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	36773.4	36773.4	humana medicare advantage	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	36773.4	36773.4	humana medicare advantage	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	36773.4	36773.4	humana medicare advantage	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	36773.4	36773.4	humana medicare advantage	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11460.87	11460.87	humana medicare advantage	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11460.87	11460.87	humana medicare advantage	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11460.87	11460.87	humana medicare advantage	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	11460.87	11460.87	humana medicare advantage	hmo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	326.12	326.12	humana medicare advantage	hmo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	326.12	326.12	humana medicare advantage	pos
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	326.12	326.12	humana medicare advantage	ppo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	326.12	326.12	humana medicare advantage	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6441.29	6441.29	humana medicare advantage	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6441.29	6441.29	humana medicare advantage	pos
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6441.29	6441.29	humana medicare advantage	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	6441.29	6441.29	humana medicare advantage	hmo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	99.29	99.29	humana medicare advantage	hmo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	99.29	99.29	humana medicare advantage	pos
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	99.29	99.29	humana medicare advantage	ppo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	99.29	99.29	humana medicare advantage	hmo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	4969.46	4969.46	humana medicare advantage	hmo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	4969.46	4969.46	humana medicare advantage	pos
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	4969.46	4969.46	humana medicare advantage	ppo
depressive neuroses	ms-drg	881	5854.77	5854.77	1743.69	1743.69	17531.84	17531.84	14609.87	14609.87	I	4969.46	4969.46	humana medicare advantage	hmo
neuroses except depressive	ms-drg	882	2988	2988	1738.02	1738.02	14677.57	14677.57	12231.31	12231.31	I	2988	2988	humana medicare advantage	hmo
neuroses except depressive	ms-drg	882	2988	2988	1738.02	1738.02	14677.57	14677.57	12231.31	12231.31	I	2988	2988	humana medicare advantage	pos
neuroses except depressive	ms-drg	882	2988	2988	1738.02	1738.02	14677.57	14677.57	12231.31	12231.31	I	2988	2988	humana medicare advantage	ppo
neuroses except depressive	ms-drg	882	2988	2988	1738.02	1738.02	14677.57	14677.57	12231.31	12231.31	I	2988	2988	humana medicare advantage	hmo
X-ray of shoulder blade	cpt	73010	97.3	97.3	15.56	15.56	256.8	256.8	214	214	O	97.3	97.3	humana medicare advantage	hmo
X-ray of shoulder blade	cpt	73010	97.3	97.3	15.56	15.56	256.8	256.8	214	214	O	97.3	97.3	humana medicare advantage	pos
X-ray of shoulder blade	cpt	73010	97.3	97.3	15.56	15.56	256.8	256.8	214	214	O	97.3	97.3	humana medicare advantage	ppo
X-ray of shoulder blade	cpt	73010	97.3	97.3	15.56	15.56	256.8	256.8	214	214	O	97.3	97.3	humana medicare advantage	hmo
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	6808.2	6808.2	humana medicare advantage	hmo
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	6808.2	6808.2	humana medicare advantage	pos
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	6808.2	6808.2	humana medicare advantage	ppo
psychoses	ms-drg	885	8042.08	8042.08	1842.42	1842.42	18156.65	18156.65	15130.54	15130.54	I	6808.2	6808.2	humana medicare advantage	hmo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	hmo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	pos
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	ppo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	99.29	99.29	humana medicare advantage	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4477.46	4477.46	humana medicare advantage	hmo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4477.46	4477.46	humana medicare advantage	pos
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4477.46	4477.46	humana medicare advantage	ppo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4477.46	4477.46	humana medicare advantage	hmo
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	210.13	210.13	humana medicare advantage	hmo
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	210.13	210.13	humana medicare advantage	pos
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	210.13	210.13	humana medicare advantage	ppo
CT scan of face	cpt	70486	639.16	639.16	81.2	81.2	1366.13	1366.13	1138.44	1138.44	E	210.13	210.13	humana medicare advantage	hmo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	12452.88	12452.88	humana medicare advantage	hmo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	12452.88	12452.88	humana medicare advantage	pos
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	12452.88	12452.88	humana medicare advantage	ppo
other o.r. procedures for injuries with cc	ms-drg	908	16148.43	16148.43	6226.41	6226.41	54024	54024	45020	45020	I	12452.88	12452.88	humana medicare advantage	hmo
allergic reactions without mcc	ms-drg	916	4747.61	4747.61	1686.46	1686.46	34418.34	34418.34	28681.95	28681.95	I	4645	4645	humana medicare advantage	hmo
allergic reactions without mcc	ms-drg	916	4747.61	4747.61	1686.46	1686.46	34418.34	34418.34	28681.95	28681.95	I	4645	4645	humana medicare advantage	pos
allergic reactions without mcc	ms-drg	916	4747.61	4747.61	1686.46	1686.46	34418.34	34418.34	28681.95	28681.95	I	4645	4645	humana medicare advantage	ppo
allergic reactions without mcc	ms-drg	916	4747.61	4747.61	1686.46	1686.46	34418.34	34418.34	28681.95	28681.95	I	4645	4645	humana medicare advantage	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	14.7	14.7	humana medicare advantage	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	14.7	14.7	humana medicare advantage	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	14.7	14.7	humana medicare advantage	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	14.7	14.7	humana medicare advantage	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	9.3	9.3	humana medicare advantage	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	9.3	9.3	humana medicare advantage	pos
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	9.3	9.3	humana medicare advantage	ppo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	9.3	9.3	humana medicare advantage	hmo
Gastrin (GI tract hormone) level	cpt	82941	17.63	17.63	17.46	17.46	128.47	128.47	107.06	107.06	O	17.63	17.63	humana medicare advantage	hmo
Gastrin (GI tract hormone) level	cpt	82941	17.63	17.63	17.46	17.46	128.47	128.47	107.06	107.06	O	17.63	17.63	humana medicare advantage	pos
Gastrin (GI tract hormone) level	cpt	82941	17.63	17.63	17.46	17.46	128.47	128.47	107.06	107.06	O	17.63	17.63	humana medicare advantage	ppo
Gastrin (GI tract hormone) level	cpt	82941	17.63	17.63	17.46	17.46	128.47	128.47	107.06	107.06	O	17.63	17.63	humana medicare advantage	hmo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	3.93	3.93	humana medicare advantage	hmo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	3.93	3.93	humana medicare advantage	pos
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	3.93	3.93	humana medicare advantage	ppo
Glucose (sugar) level on body fluid	cpt	82945	78.89	78.89	3.5	3.5	117.12	117.12	97.6	97.6	O	3.93	3.93	humana medicare advantage	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	13.63	13.63	humana medicare advantage	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	13.63	13.63	humana medicare advantage	pos
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	13.63	13.63	humana medicare advantage	ppo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	13.63	13.63	humana medicare advantage	hmo
Blood glucose (sugar) level	cpt	82947	3.93	3.93	3.85	3.85	117.12	117.12	97.6	97.6	E	3.93	3.93	humana medicare advantage	hmo
Blood glucose (sugar) level	cpt	82947	3.93	3.93	3.85	3.85	117.12	117.12	97.6	97.6	E	3.93	3.93	humana medicare advantage	pos
Blood glucose (sugar) level	cpt	82947	3.93	3.93	3.85	3.85	117.12	117.12	97.6	97.6	E	3.93	3.93	humana medicare advantage	ppo
Blood glucose (sugar) level	cpt	82947	3.93	3.93	3.85	3.85	117.12	117.12	97.6	97.6	E	3.93	3.93	humana medicare advantage	hmo
"Stool fat or lipids analysis, qualitative"	cpt	82705	5.1	5.1	5.1	5.1	16.98	16.98	14.15	14.15	O	5.1	5.1	humana medicare advantage	hmo
"Stool fat or lipids analysis, qualitative"	cpt	82705	5.1	5.1	5.1	5.1	16.98	16.98	14.15	14.15	O	5.1	5.1	humana medicare advantage	pos
"Stool fat or lipids analysis, qualitative"	cpt	82705	5.1	5.1	5.1	5.1	16.98	16.98	14.15	14.15	O	5.1	5.1	humana medicare advantage	ppo
"Stool fat or lipids analysis, qualitative"	cpt	82705	5.1	5.1	5.1	5.1	16.98	16.98	14.15	14.15	O	5.1	5.1	humana medicare advantage	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	12.87	12.87	humana medicare advantage	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	12.87	12.87	humana medicare advantage	pos
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	12.87	12.87	humana medicare advantage	ppo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	12.87	12.87	humana medicare advantage	hmo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	18.79	18.79	humana medicare advantage	hmo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	18.79	18.79	humana medicare advantage	pos
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	18.79	18.79	humana medicare advantage	ppo
Erythropoietin (protein) level	cpt	82668	50.06	50.06	16.99	16.99	160.27	160.27	133.56	133.56	O	18.79	18.79	humana medicare advantage	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	320.9	320.9	tricare	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	320.9	320.9	tricare	pos
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	275.05	275.05	tricare	ppo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	275.05	275.05	tricare	pos
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	167.1	167.1	tricare	ppo
Fetal fibronectin (protein) analysis	cpt	82731	348.55	348.55	57.29	57.29	609.54	609.54	507.95	507.95	O	167.1	167.1	tricare	pos
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	tricare	ppo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	21.84	21.84	tricare	pos
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	176.99	176.99	tricare	ppo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	176.99	176.99	tricare	pos
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	229.19	229.19	tricare	ppo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	229.19	229.19	tricare	pos
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	953.05	953.05	uhc medicare advantage	ppo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	953.05	953.05	uhc medicare advantage	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3312.01	3312.01	united health care	ppo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3312.01	3312.01	united health care	pos
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3312.01	3312.01	united health care	hmo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3312.01	3312.01	united health care	epo
"Walking training to 1 or more areas, each 15 minutes"	cpt	97116	3531.48	3531.48	421.02	421.02	5376.74	5376.74	4480.62	4480.62	O	3312.01	3312.01	united health care	hmo
Ultrasound of scrotum	cpt	76870	365.07	365.07	61.82	61.82	569.86	569.86	474.88	474.88	E	365.07	365.07	united health care	ppo
Ultrasound of scrotum	cpt	76870	365.07	365.07	61.82	61.82	569.86	569.86	474.88	474.88	E	365.07	365.07	united health care	pos
Ultrasound of scrotum	cpt	76870	365.07	365.07	61.82	61.82	569.86	569.86	474.88	474.88	E	365.07	365.07	united health care	hmo
Ultrasound of scrotum	cpt	76870	365.07	365.07	61.82	61.82	569.86	569.86	474.88	474.88	E	365.07	365.07	united health care	epo
Ultrasound of scrotum	cpt	76870	365.07	365.07	61.82	61.82	569.86	569.86	474.88	474.88	E	365.07	365.07	united health care	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1415.24	1415.24	united health care	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1415.24	1415.24	united health care	pos
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1415.24	1415.24	united health care	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1415.24	1415.24	united health care	epo
"Injections of lower or sacral spine facet joint using imaging guidance, single level"	cpt	64493	3530.58	3530.58	657.1	657.1	4789.46	4789.46	3991.22	3991.22	O	1415.24	1415.24	united health care	hmo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	5714.16	5714.16	united health care	ppo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	5714.16	5714.16	united health care	pos
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	5714.16	5714.16	united health care	hmo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	5714.16	5714.16	united health care	epo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	5714.16	5714.16	united health care	hmo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	3812.03	3812.03	united health care	ppo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	3812.03	3812.03	united health care	pos
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	3812.03	3812.03	united health care	hmo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	3812.03	3812.03	united health care	epo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	3812.03	3812.03	united health care	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	2189.43	2189.43	united health care	ppo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	2189.43	2189.43	united health care	pos
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	2189.43	2189.43	united health care	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	2189.43	2189.43	united health care	epo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, each additional level"	cpt	64484	2189.43	2189.43	657.1	657.1	13287.97	13287.97	11073.31	11073.31	O	2189.43	2189.43	united health care	hmo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	3420.82	3420.82	united health care	ppo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	3420.82	3420.82	united health care	pos
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	3420.82	3420.82	united health care	hmo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	3420.82	3420.82	united health care	epo
"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes"	cpt	97112	3420.82	3420.82	195.16	195.16	4791.22	4791.22	3992.68	3992.68	O	3420.82	3420.82	united health care	hmo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	2686.91	2686.91	united health care	ppo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	2686.91	2686.91	united health care	pos
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	2686.91	2686.91	united health care	hmo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	2686.91	2686.91	united health care	epo
"Application of ultrasound to 1 or more areas, each 15 minutes"	cpt	97035	2686.91	2686.91	496.33	496.33	4441.82	4441.82	3701.52	3701.52	O	2686.91	2686.91	united health care	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	2686.91	2686.91	united health care	ppo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	2686.91	2686.91	united health care	pos
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	2686.91	2686.91	united health care	hmo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	2686.91	2686.91	united health care	epo
Application of hot wax bath to 1 or more areas	cpt	97018	2686.91	2686.91	335.64	335.64	3236.4	3236.4	2697	2697	O	2686.91	2686.91	united health care	hmo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2712.74	2712.74	united health care	ppo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2712.74	2712.74	united health care	pos
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2712.74	2712.74	united health care	hmo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2712.74	2712.74	united health care	epo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2712.74	2712.74	united health care	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	epo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	10344.21	10344.21	united health care	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	10344.21	10344.21	united health care	pos
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	10344.21	10344.21	united health care	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	10344.21	10344.21	united health care	epo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	10344.21	10344.21	united health care	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	7348.19	7348.19	united health care	ppo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	7348.19	7348.19	united health care	pos
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	7348.19	7348.19	united health care	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	7348.19	7348.19	united health care	epo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	7348.19	7348.19	united health care	hmo
adrenalin epinephrine inject	cpt	J0171	2087.31	2087.31	439.13	439.13	3485.48	3485.48	2904.57	2904.57	E	2087.31	2087.31	united health care	ppo
adrenalin epinephrine inject	cpt	J0171	2087.31	2087.31	439.13	439.13	3485.48	3485.48	2904.57	2904.57	E	2087.31	2087.31	united health care	pos
adrenalin epinephrine inject	cpt	J0171	2087.31	2087.31	439.13	439.13	3485.48	3485.48	2904.57	2904.57	E	2087.31	2087.31	united health care	hmo
adrenalin epinephrine inject	cpt	J0171	2087.31	2087.31	439.13	439.13	3485.48	3485.48	2904.57	2904.57	E	2087.31	2087.31	united health care	epo
adrenalin epinephrine inject	cpt	J0171	2087.31	2087.31	439.13	439.13	3485.48	3485.48	2904.57	2904.57	E	2087.31	2087.31	united health care	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	218.7	218.7	21.25	21.25	333.26	333.26	277.72	277.72	E	218.7	218.7	united health care	ppo
"X-ray of femur, minimum 2 views"	cpt	73552	218.7	218.7	21.25	21.25	333.26	333.26	277.72	277.72	E	218.7	218.7	united health care	pos
"X-ray of femur, minimum 2 views"	cpt	73552	218.7	218.7	21.25	21.25	333.26	333.26	277.72	277.72	E	218.7	218.7	united health care	hmo
"X-ray of femur, minimum 2 views"	cpt	73552	218.7	218.7	21.25	21.25	333.26	333.26	277.72	277.72	E	218.7	218.7	united health care	epo
"X-ray of femur, minimum 2 views"	cpt	73552	218.7	218.7	21.25	21.25	333.26	333.26	277.72	277.72	E	218.7	218.7	united health care	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	11663.48	11663.48	united health care	ppo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	11663.48	11663.48	united health care	pos
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	11663.48	11663.48	united health care	hmo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	11663.48	11663.48	united health care	epo
Infusion of chemotherapy into a vein	cpt	96415	11663.48	11663.48	1629.98	1629.98	20223.6	20223.6	16853	16853	O	11663.48	11663.48	united health care	hmo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	12553.76	12553.76	united health care	ppo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	12553.76	12553.76	united health care	pos
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	12553.76	12553.76	united health care	hmo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	12553.76	12553.76	united health care	epo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	12553.76	12553.76	united health care	hmo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	20798.67	20798.67	united health care	ppo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	20798.67	20798.67	united health care	pos
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	20798.67	20798.67	united health care	hmo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	20798.67	20798.67	united health care	epo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	20798.67	20798.67	united health care	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	pos
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	epo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	7348.19	7348.19	united health care	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	7348.19	7348.19	united health care	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	7348.19	7348.19	united health care	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	7348.19	7348.19	united health care	epo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	7348.19	7348.19	united health care	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	5454.5	5454.5	united health care	ppo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	5454.5	5454.5	united health care	pos
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	5454.5	5454.5	united health care	hmo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	5454.5	5454.5	united health care	epo
Infusion of different chemotherapy drug or substance into a vein	cpt	96411	7924.91	7924.91	938.77	938.77	19924.8	19924.8	16604	16604	O	5454.5	5454.5	united health care	hmo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16466.26	16466.26	united health care	ppo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16466.26	16466.26	united health care	pos
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16466.26	16466.26	united health care	hmo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16466.26	16466.26	united health care	epo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16466.26	16466.26	united health care	hmo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	23111.69	23111.69	united health care	ppo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	23111.69	23111.69	united health care	pos
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	23111.69	23111.69	united health care	hmo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	23111.69	23111.69	united health care	epo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	23111.69	23111.69	united health care	hmo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	10295.72	10295.72	united health care	ppo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	10295.72	10295.72	united health care	pos
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	10295.72	10295.72	united health care	hmo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	10295.72	10295.72	united health care	epo
Infusion of chemotherapy into a vein using push technique	cpt	96409	16191.52	16191.52	2537.15	2537.15	19304.16	19304.16	16086.8	16086.8	O	10295.72	10295.72	united health care	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	160.27	160.27	united health care	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	160.27	160.27	united health care	pos
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	160.27	160.27	united health care	hmo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	160.27	160.27	united health care	epo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	160.27	160.27	united health care	hmo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	674.85	674.85	united health care	ppo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	674.85	674.85	united health care	pos
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	674.85	674.85	united health care	hmo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	674.85	674.85	united health care	epo
Injection of substance into spinal canal of upper or middle back using imaging guidance	cpt	62321	1180.35	1180.35	544.86	544.86	2358.05	2358.05	1965.04	1965.04	O	674.85	674.85	united health care	hmo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	13417.93	13417.93	united health care	ppo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	13417.93	13417.93	united health care	pos
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	13417.93	13417.93	united health care	hmo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	13417.93	13417.93	united health care	epo
hydralazine hcl injection	cpt	J0360	13417.93	13417.93	3688.73	3688.73	26090.35	26090.35	21741.96	21741.96	O	13417.93	13417.93	united health care	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	240.09	240.09	united health care	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	240.09	240.09	united health care	pos
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	240.09	240.09	united health care	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	240.09	240.09	united health care	epo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	240.09	240.09	united health care	hmo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	11802.59	11802.59	united health care	ppo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	11802.59	11802.59	united health care	pos
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	11802.59	11802.59	united health care	hmo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	11802.59	11802.59	united health care	epo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	11802.59	11802.59	united health care	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2772.2	2772.2	united health care	ppo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2772.2	2772.2	united health care	pos
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2772.2	2772.2	united health care	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2772.2	2772.2	united health care	epo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	2772.2	2772.2	united health care	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	15419.2	15419.2	united health care	ppo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	15419.2	15419.2	united health care	pos
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	15419.2	15419.2	united health care	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	15419.2	15419.2	united health care	epo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	15419.2	15419.2	united health care	hmo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	16793.03	16793.03	united health care	ppo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	16793.03	16793.03	united health care	pos
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	16793.03	16793.03	united health care	hmo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	16793.03	16793.03	united health care	epo
hip and femur procedures except major joint with mcc	ms-drg	480	21300.97	21300.97	16007.64	16007.64	86719.46	86719.46	72266.22	72266.22	I	16793.03	16793.03	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	6390.02	6390.02	united health care	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	6390.02	6390.02	united health care	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	6390.02	6390.02	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	6390.02	6390.02	united health care	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	6390.02	6390.02	732.02	732.02	13759.18	13759.18	11465.98	11465.98	O	6390.02	6390.02	united health care	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	240.09	240.09	united health care	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	240.09	240.09	united health care	pos
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	240.09	240.09	united health care	hmo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	240.09	240.09	united health care	epo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	240.09	240.09	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	3792.31	3792.31	united health care	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	3792.31	3792.31	united health care	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	3792.31	3792.31	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	3792.31	3792.31	united health care	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	3792.31	3792.31	united health care	hmo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	ppo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	pos
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	hmo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	epo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	118.85	118.85	united health care	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	118.85	118.85	united health care	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	118.85	118.85	united health care	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	118.85	118.85	united health care	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	118.85	118.85	11.09	11.09	179.4	179.4	149.5	149.5	O	118.85	118.85	united health care	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	9805.54	9805.54	united health care	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	9805.54	9805.54	united health care	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	9805.54	9805.54	united health care	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	9805.54	9805.54	united health care	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	9805.54	9805.54	united health care	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12121.4	12121.4	united health care	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12121.4	12121.4	united health care	pos
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12121.4	12121.4	united health care	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12121.4	12121.4	united health care	epo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12121.4	12121.4	united health care	hmo
cefepime hcl for injection	cpt	J0692	3786.73	3786.73	162.77	162.77	11648.23	11648.23	9706.86	9706.86	O	3786.73	3786.73	united health care	ppo
cefepime hcl for injection	cpt	J0692	3786.73	3786.73	162.77	162.77	11648.23	11648.23	9706.86	9706.86	O	3786.73	3786.73	united health care	pos
cefepime hcl for injection	cpt	J0692	3786.73	3786.73	162.77	162.77	11648.23	11648.23	9706.86	9706.86	O	3786.73	3786.73	united health care	hmo
cefepime hcl for injection	cpt	J0692	3786.73	3786.73	162.77	162.77	11648.23	11648.23	9706.86	9706.86	O	3786.73	3786.73	united health care	epo
cefepime hcl for injection	cpt	J0692	3786.73	3786.73	162.77	162.77	11648.23	11648.23	9706.86	9706.86	O	3786.73	3786.73	united health care	hmo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2110.35	2110.35	united health care	ppo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2110.35	2110.35	united health care	pos
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2110.35	2110.35	united health care	hmo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2110.35	2110.35	united health care	epo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2110.35	2110.35	united health care	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3931.6	3931.6	united health care	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3931.6	3931.6	united health care	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3931.6	3931.6	united health care	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3931.6	3931.6	united health care	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	3931.6	3931.6	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	26702.62	26702.62	united health care	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	26702.62	26702.62	united health care	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	26702.62	26702.62	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	26702.62	26702.62	united health care	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	26702.62	26702.62	united health care	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	736.82	736.82	united health care	ppo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	736.82	736.82	united health care	pos
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	736.82	736.82	united health care	hmo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	736.82	736.82	united health care	epo
Fetal non-stress test	cpt	59025	1379.36	1379.36	65.61	65.61	1203.36	1203.36	1002.8	1002.8	O	736.82	736.82	united health care	hmo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	4713.74	4713.74	united health care	ppo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	4713.74	4713.74	united health care	pos
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	4713.74	4713.74	united health care	hmo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	4713.74	4713.74	united health care	epo
ceftriaxone sodium injection	cpt	J0696	4713.74	4713.74	162.77	162.77	2380	2380	1983.33	1983.33	O	4713.74	4713.74	united health care	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	pos
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	epo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	hmo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	398.27	398.27	united health care	ppo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	398.27	398.27	united health care	pos
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	398.27	398.27	united health care	hmo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	398.27	398.27	united health care	epo
betamethasone acet&sod phosp	cpt	J0702	1079.07	1079.07	127.03	127.03	1680.08	1680.08	1400.07	1400.07	O	398.27	398.27	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	3514.38	3514.38	united health care	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	3514.38	3514.38	united health care	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	3514.38	3514.38	united health care	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	3514.38	3514.38	united health care	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	3514.38	3514.38	united health care	hmo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	23111.69	23111.69	united health care	ppo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	23111.69	23111.69	united health care	pos
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	23111.69	23111.69	united health care	hmo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	23111.69	23111.69	united health care	epo
ciprofloxacin iv	cpt	J0744	23111.69	23111.69	3185.06	3185.06	23933.76	23933.76	19944.8	19944.8	O	23111.69	23111.69	united health care	hmo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	13137.87	13137.87	united health care	ppo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	13137.87	13137.87	united health care	pos
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	13137.87	13137.87	united health care	hmo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	13137.87	13137.87	united health care	epo
Destruction or removal of ovary or pelvic growths using an endoscope	cpt	58662	13137.87	13137.87	4158.06	4158.06	21020.59	21020.59	17517.16	17517.16	O	13137.87	13137.87	united health care	hmo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	3450.24	3450.24	united health care	ppo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	3450.24	3450.24	united health care	pos
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	3450.24	3450.24	united health care	hmo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	3450.24	3450.24	united health care	epo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	3450.24	3450.24	united health care	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	3844.63	3844.63	united health care	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	3844.63	3844.63	united health care	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	3844.63	3844.63	united health care	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	3844.63	3844.63	united health care	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	3844.63	3844.63	united health care	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	232.89	232.89	united health care	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	232.89	232.89	united health care	pos
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	232.89	232.89	united health care	hmo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	232.89	232.89	united health care	epo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	232.89	232.89	united health care	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1053.51	1053.51	united health care	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1053.51	1053.51	united health care	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1053.51	1053.51	united health care	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1053.51	1053.51	united health care	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	1053.51	1053.51	united health care	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	5612.54	5612.54	united health care	ppo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	5612.54	5612.54	united health care	pos
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	5612.54	5612.54	united health care	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	5612.54	5612.54	united health care	epo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	5612.54	5612.54	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	2712.74	2712.74	united health care	ppo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	2712.74	2712.74	united health care	pos
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	2712.74	2712.74	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	2712.74	2712.74	united health care	epo
"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion"	cpt	96368	2712.74	2712.74	729.65	729.65	7933.61	7933.61	6611.34	6611.34	E	2712.74	2712.74	united health care	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	258.78	258.78	united health care	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	258.78	258.78	united health care	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	258.78	258.78	united health care	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	258.78	258.78	united health care	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	258.78	258.78	united health care	hmo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1477.69	1477.69	united health care	ppo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1477.69	1477.69	united health care	pos
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1477.69	1477.69	united health care	hmo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1477.69	1477.69	united health care	epo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	1477.69	1477.69	united health care	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	5454.5	5454.5	united health care	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	5454.5	5454.5	united health care	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	5454.5	5454.5	united health care	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	5454.5	5454.5	united health care	epo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	5454.5	5454.5	united health care	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	E	654.29	654.29	united health care	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	E	654.29	654.29	united health care	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	E	654.29	654.29	united health care	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	E	654.29	654.29	united health care	epo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	E	654.29	654.29	united health care	hmo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	643.64	643.64	united health care	ppo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	643.64	643.64	united health care	pos
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	643.64	643.64	united health care	hmo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	643.64	643.64	united health care	epo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	643.64	643.64	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	9075.75	9075.75	united health care	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	9075.75	9075.75	united health care	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	9075.75	9075.75	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	9075.75	9075.75	united health care	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	9075.75	9075.75	588.86	588.86	11626.8	11626.8	9689	9689	O	9075.75	9075.75	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2311.63	2311.63	united health care	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2311.63	2311.63	united health care	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2311.63	2311.63	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2311.63	2311.63	united health care	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2311.63	2311.63	united health care	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	7348.19	7348.19	united health care	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	7348.19	7348.19	united health care	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	7348.19	7348.19	united health care	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	7348.19	7348.19	united health care	epo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	7348.19	7348.19	united health care	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	221.81	221.81	united health care	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	221.81	221.81	united health care	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	221.81	221.81	united health care	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	221.81	221.81	united health care	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	221.81	221.81	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	3914.61	3914.61	united health care	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	3914.61	3914.61	united health care	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	3914.61	3914.61	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	3914.61	3914.61	united health care	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	3914.61	3914.61	united health care	hmo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	4307.49	4307.49	united health care	ppo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	4307.49	4307.49	united health care	pos
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	4307.49	4307.49	united health care	hmo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	4307.49	4307.49	united health care	epo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	4307.49	4307.49	united health care	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	17413.33	17413.33	united health care	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	17413.33	17413.33	united health care	pos
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	17413.33	17413.33	united health care	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	17413.33	17413.33	united health care	epo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	17413.33	17413.33	united health care	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	118.85	118.85	united health care	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	118.85	118.85	united health care	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	118.85	118.85	united health care	hmo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	118.85	118.85	united health care	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	118.85	118.85	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	2575.12	2575.12	united health care	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	2575.12	2575.12	united health care	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	2575.12	2575.12	united health care	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	2575.12	2575.12	united health care	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	2575.12	2575.12	united health care	hmo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2880.39	2880.39	united health care	ppo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2880.39	2880.39	united health care	pos
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2880.39	2880.39	united health care	hmo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2880.39	2880.39	united health care	epo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	2880.39	2880.39	united health care	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	3931.6	3931.6	united health care	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	3931.6	3931.6	united health care	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	3931.6	3931.6	united health care	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	3931.6	3931.6	united health care	epo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	3931.6	3931.6	united health care	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	9075.75	9075.75	united health care	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	9075.75	9075.75	united health care	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	9075.75	9075.75	united health care	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	9075.75	9075.75	united health care	epo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	9075.75	9075.75	325.54	325.54	3045.7	3045.7	2538.08	2538.08	O	9075.75	9075.75	united health care	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	17916.14	17916.14	united health care	ppo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	17916.14	17916.14	united health care	pos
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	17916.14	17916.14	united health care	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	17916.14	17916.14	united health care	epo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	17916.14	17916.14	united health care	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	3013.18	3013.18	united health care	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	3013.18	3013.18	united health care	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	3013.18	3013.18	united health care	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	3013.18	3013.18	united health care	epo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	3013.18	3013.18	united health care	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1095.51	1095.51	united health care	ppo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1095.51	1095.51	united health care	pos
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1095.51	1095.51	united health care	hmo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1095.51	1095.51	united health care	epo
"Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort"	cpt	95806	1095.51	1095.51	60.64	60.64	1752.82	1752.82	1460.68	1460.68	O	1095.51	1095.51	united health care	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2967.25	2967.25	united health care	ppo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2967.25	2967.25	united health care	pos
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2967.25	2967.25	united health care	hmo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2967.25	2967.25	united health care	epo
Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube	cpt	95811	2967.25	2967.25	431.05	431.05	3990.23	3990.23	3325.19	3325.19	O	2967.25	2967.25	united health care	hmo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	6390.02	6390.02	united health care	ppo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	6390.02	6390.02	united health care	pos
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	6390.02	6390.02	united health care	hmo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	6390.02	6390.02	united health care	epo
Pulmonary service or operation	cpt	94799	10624.49	10624.49	271.85	271.85	36530.58	36530.58	30442.15	30442.15	O	6390.02	6390.02	united health care	hmo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	368.09	368.09	united health care	ppo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	368.09	368.09	united health care	pos
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	368.09	368.09	united health care	hmo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	368.09	368.09	united health care	epo
inj filgrastim excl biosimil	cpt	J1442	13361.26	13361.26	368.09	368.09	6381.84	6381.84	5318.2	5318.2	O	368.09	368.09	united health care	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	1090.37	1090.37	united health care	ppo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	1090.37	1090.37	united health care	pos
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	1090.37	1090.37	united health care	hmo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	1090.37	1090.37	united health care	epo
Measurement of lung diffusing capacity	cpt	94729	1090.37	1090.37	171.01	171.01	1600.01	1600.01	1333.34	1333.34	O	1090.37	1090.37	united health care	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	1090.38	1090.38	united health care	ppo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	1090.38	1090.38	united health care	pos
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	1090.38	1090.38	united health care	hmo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	1090.38	1090.38	united health care	epo
Determination of lung volumes using plethysmography	cpt	94726	1090.38	1090.38	159.8	159.8	1600.01	1600.01	1333.34	1333.34	O	1090.38	1090.38	united health care	hmo
"Partial thickness skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)"	cpt	15120	11689.03	11689.03	2683.82	2683.82	19013.27	19013.27	15844.39	15844.39	O	11689.03	11689.03	united health care	ppo
"Partial thickness skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)"	cpt	15120	11689.03	11689.03	2683.82	2683.82	19013.27	19013.27	15844.39	15844.39	O	11689.03	11689.03	united health care	pos
"Partial thickness skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)"	cpt	15120	11689.03	11689.03	2683.82	2683.82	19013.27	19013.27	15844.39	15844.39	O	11689.03	11689.03	united health care	hmo
"Partial thickness skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)"	cpt	15120	11689.03	11689.03	2683.82	2683.82	19013.27	19013.27	15844.39	15844.39	O	11689.03	11689.03	united health care	epo
"Partial thickness skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)"	cpt	15120	11689.03	11689.03	2683.82	2683.82	19013.27	19013.27	15844.39	15844.39	O	11689.03	11689.03	united health care	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5454.5	5454.5	united health care	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5454.5	5454.5	united health care	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5454.5	5454.5	united health care	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5454.5	5454.5	united health care	epo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	5454.5	5454.5	united health care	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	4691.13	4691.13	united health care	ppo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	4691.13	4691.13	united health care	pos
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	4691.13	4691.13	united health care	hmo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	4691.13	4691.13	united health care	epo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	4691.13	4691.13	678.84	678.84	2811.67	2811.67	2343.06	2343.06	O	4691.13	4691.13	united health care	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	6390.02	6390.02	united health care	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	6390.02	6390.02	united health care	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	6390.02	6390.02	united health care	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	6390.02	6390.02	united health care	epo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	6390.02	6390.02	762.39	762.39	13269.26	13269.26	11057.72	11057.72	O	6390.02	6390.02	united health care	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1098.38	1098.38	united health care	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1098.38	1098.38	united health care	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1098.38	1098.38	united health care	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1098.38	1098.38	united health care	epo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1098.38	1098.38	united health care	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	1090.38	1090.38	united health care	ppo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	1090.38	1090.38	united health care	pos
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	1090.38	1090.38	united health care	hmo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	1090.38	1090.38	united health care	epo
"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration"	cpt	94060	1090.38	1090.38	203.44	203.44	1633.93	1633.93	1361.61	1361.61	O	1090.38	1090.38	united health care	hmo
"lower extremity and humerus procedures except hip, foot and femur without cc/mcc"	ms-drg	494	33138.65	33138.65	7298.14	7298.14	52502.23	52502.23	43751.86	43751.86	I	33138.65	33138.65	united health care	ppo
"lower extremity and humerus procedures except hip, foot and femur without cc/mcc"	ms-drg	494	33138.65	33138.65	7298.14	7298.14	52502.23	52502.23	43751.86	43751.86	I	33138.65	33138.65	united health care	pos
"lower extremity and humerus procedures except hip, foot and femur without cc/mcc"	ms-drg	494	33138.65	33138.65	7298.14	7298.14	52502.23	52502.23	43751.86	43751.86	I	33138.65	33138.65	united health care	hmo
"lower extremity and humerus procedures except hip, foot and femur without cc/mcc"	ms-drg	494	33138.65	33138.65	7298.14	7298.14	52502.23	52502.23	43751.86	43751.86	I	33138.65	33138.65	united health care	epo
"lower extremity and humerus procedures except hip, foot and femur without cc/mcc"	ms-drg	494	33138.65	33138.65	7298.14	7298.14	52502.23	52502.23	43751.86	43751.86	I	33138.65	33138.65	united health care	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	181.26	181.26	united health care	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	181.26	181.26	united health care	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	181.26	181.26	united health care	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	181.26	181.26	united health care	epo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	181.26	181.26	united health care	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	73.37	73.37	united health care	ppo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	73.37	73.37	united health care	pos
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	73.37	73.37	united health care	hmo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	73.37	73.37	united health care	epo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	73.37	73.37	united health care	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	515.96	515.96	united health care	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	515.96	515.96	united health care	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	515.96	515.96	united health care	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	515.96	515.96	united health care	epo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	515.96	515.96	united health care	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	epo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	137.73	137.73	united health care	hmo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	260.76	260.76	22.27	22.27	417.22	417.22	347.68	347.68	E	260.76	260.76	united health care	ppo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	260.76	260.76	22.27	22.27	417.22	417.22	347.68	347.68	E	260.76	260.76	united health care	pos
"X-ray of abdomen, minimum of 3 views"	cpt	74021	260.76	260.76	22.27	22.27	417.22	417.22	347.68	347.68	E	260.76	260.76	united health care	hmo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	260.76	260.76	22.27	22.27	417.22	417.22	347.68	347.68	E	260.76	260.76	united health care	epo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	260.76	260.76	22.27	22.27	417.22	417.22	347.68	347.68	E	260.76	260.76	united health care	hmo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	23096.99	23096.99	united health care	ppo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	23096.99	23096.99	united health care	pos
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	23096.99	23096.99	united health care	hmo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	23096.99	23096.99	united health care	epo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	23096.99	23096.99	united health care	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	16160.85	16160.85	united health care	ppo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	16160.85	16160.85	united health care	pos
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	16160.85	16160.85	united health care	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	16160.85	16160.85	united health care	epo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	16160.85	16160.85	united health care	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	685.6	685.6	united health care	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	685.6	685.6	united health care	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	685.6	685.6	united health care	hmo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	685.6	685.6	united health care	epo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	685.6	685.6	united health care	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	6677.69	6677.69	united health care	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	6677.69	6677.69	united health care	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	6677.69	6677.69	united health care	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	6677.69	6677.69	united health care	epo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	6677.69	6677.69	united health care	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	773.81	773.81	united health care	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	773.81	773.81	united health care	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	773.81	773.81	united health care	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	773.81	773.81	united health care	epo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	773.81	773.81	united health care	hmo
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	431.57	431.57	97.7	97.7	657.62	657.62	548.02	548.02	O	431.57	431.57	united health care	ppo
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	431.57	431.57	97.7	97.7	657.62	657.62	548.02	548.02	O	431.57	431.57	united health care	pos
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	431.57	431.57	97.7	97.7	657.62	657.62	548.02	548.02	O	431.57	431.57	united health care	hmo
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	431.57	431.57	97.7	97.7	657.62	657.62	548.02	548.02	O	431.57	431.57	united health care	epo
Ultrasound study of arteries and arterial grafts of one arm or limited	cpt	93931	431.57	431.57	97.7	97.7	657.62	657.62	548.02	548.02	O	431.57	431.57	united health care	hmo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	E	349.8	349.8	united health care	ppo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	E	349.8	349.8	united health care	pos
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	E	349.8	349.8	united health care	hmo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	E	349.8	349.8	united health care	epo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	E	349.8	349.8	united health care	hmo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	4691.13	4691.13	united health care	ppo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	4691.13	4691.13	united health care	pos
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	4691.13	4691.13	united health care	hmo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	4691.13	4691.13	united health care	epo
inj enoxaparin sodium	cpt	J1650	7453.01	7453.01	2904.35	2904.35	27768.92	27768.92	23140.77	23140.77	O	4691.13	4691.13	united health care	hmo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	349.8	349.8	united health care	ppo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	349.8	349.8	united health care	pos
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	349.8	349.8	united health care	hmo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	349.8	349.8	united health care	epo
Complete X-ray study of abdomen with single X-ray of chest	cpt	74022	349.8	349.8	25.58	25.58	559.68	559.68	466.4	466.4	O	349.8	349.8	united health care	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	411.02	411.02	united health care	ppo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	411.02	411.02	united health care	pos
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	411.02	411.02	united health care	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	411.02	411.02	united health care	epo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.02	411.02	93.85	93.85	657.62	657.62	548.02	548.02	O	411.02	411.02	united health care	hmo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1476.71	1476.71	united health care	ppo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1476.71	1476.71	united health care	pos
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1476.71	1476.71	united health care	hmo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1476.71	1476.71	united health care	epo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	1476.71	1476.71	united health care	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	411.01	411.01	united health care	ppo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	411.01	411.01	united health care	pos
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	411.01	411.01	united health care	hmo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	411.01	411.01	united health care	epo
Ultrasound study of arteries and arterial grafts of one leg or limited	cpt	93926	411.01	411.01	93.1	93.1	690.5	690.5	575.42	575.42	E	411.01	411.01	united health care	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	3855.93	3855.93	united health care	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	3855.93	3855.93	united health care	pos
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	3855.93	3855.93	united health care	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	3855.93	3855.93	united health care	epo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	3855.93	3855.93	united health care	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	epo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	479.39	479.39	united health care	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	479.39	479.39	united health care	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	479.39	479.39	united health care	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	479.39	479.39	united health care	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	479.39	479.39	united health care	hmo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1563.96	1563.96	united health care	ppo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1563.96	1563.96	united health care	pos
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1563.96	1563.96	united health care	hmo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1563.96	1563.96	united health care	epo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1563.96	1563.96	united health care	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	3786.73	3786.73	united health care	ppo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	3786.73	3786.73	united health care	pos
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	3786.73	3786.73	united health care	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	3786.73	3786.73	united health care	epo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	3786.73	3786.73	united health care	hmo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	1118.22	1118.22	united health care	ppo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	1118.22	1118.22	united health care	pos
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	1118.22	1118.22	united health care	hmo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	1118.22	1118.22	united health care	epo
CT scan abdomen with contrast	cpt	74160	1118.22	1118.22	147.45	147.45	2148.41	2148.41	1790.34	1790.34	O	1118.22	1118.22	united health care	hmo
leuprolide acetate /3.75 mg	cpt	J1950	2839.81	2839.81	2839.81	2839.81	4327.34	4327.34	3606.12	3606.12	O	2839.81	2839.81	united health care	ppo
leuprolide acetate /3.75 mg	cpt	J1950	2839.81	2839.81	2839.81	2839.81	4327.34	4327.34	3606.12	3606.12	O	2839.81	2839.81	united health care	pos
leuprolide acetate /3.75 mg	cpt	J1950	2839.81	2839.81	2839.81	2839.81	4327.34	4327.34	3606.12	3606.12	O	2839.81	2839.81	united health care	hmo
leuprolide acetate /3.75 mg	cpt	J1950	2839.81	2839.81	2839.81	2839.81	4327.34	4327.34	3606.12	3606.12	O	2839.81	2839.81	united health care	epo
leuprolide acetate /3.75 mg	cpt	J1950	2839.81	2839.81	2839.81	2839.81	4327.34	4327.34	3606.12	3606.12	O	2839.81	2839.81	united health care	hmo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	3173.26	3173.26	united health care	ppo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	3173.26	3173.26	united health care	pos
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	3173.26	3173.26	united health care	hmo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	3173.26	3173.26	united health care	epo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	3173.26	3173.26	united health care	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	503.35	503.35	united health care	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	503.35	503.35	united health care	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	503.35	503.35	united health care	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	503.35	503.35	united health care	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	503.35	503.35	90	90	767.02	767.02	639.18	639.18	E	503.35	503.35	united health care	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1708.46	1708.46	united health care	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1708.46	1708.46	united health care	pos
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1708.46	1708.46	united health care	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1708.46	1708.46	united health care	epo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	1708.46	1708.46	united health care	hmo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	6110.48	6110.48	united health care	ppo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	6110.48	6110.48	united health care	pos
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	6110.48	6110.48	united health care	hmo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	6110.48	6110.48	united health care	epo
"Needle biopsy of kidney, accessed through the skin"	cpt	50200	6110.48	6110.48	1116.61	1116.61	9226.97	9226.97	7689.14	7689.14	O	6110.48	6110.48	united health care	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1708.45	1708.45	united health care	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1708.45	1708.45	united health care	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1708.45	1708.45	united health care	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1708.45	1708.45	united health care	epo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1708.45	1708.45	united health care	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	16100.16	16100.16	united health care	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	16100.16	16100.16	united health care	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	16100.16	16100.16	united health care	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	16100.16	16100.16	united health care	epo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	16100.16	16100.16	united health care	hmo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	3662.54	3662.54	united health care	ppo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	3662.54	3662.54	united health care	pos
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	3662.54	3662.54	united health care	hmo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	3662.54	3662.54	united health care	epo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	3662.54	3662.54	united health care	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	19046.96	19046.96	united health care	ppo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	19046.96	19046.96	united health care	pos
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	19046.96	19046.96	united health care	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	19046.96	19046.96	united health care	epo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	19046.96	19046.96	united health care	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	23096.99	23096.99	united health care	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	23096.99	23096.99	united health care	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	23096.99	23096.99	united health care	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	23096.99	23096.99	united health care	epo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	23096.99	23096.99	1461.03	1461.03	44986.61	44986.61	37488.84	37488.84	E	23096.99	23096.99	united health care	hmo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	10827.93	10827.93	united health care	ppo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	10827.93	10827.93	united health care	pos
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	10827.93	10827.93	united health care	hmo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	10827.93	10827.93	united health care	epo
mannitol injection	cpt	J2150	10827.93	10827.93	832.09	832.09	26665.03	26665.03	22220.86	22220.86	O	10827.93	10827.93	united health care	hmo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	279.84	279.84	united health care	ppo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	279.84	279.84	united health care	pos
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	279.84	279.84	united health care	hmo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	279.84	279.84	united health care	epo
Follow-up or limited ultrasound examination of heart	cpt	93308	279.84	279.84	188.57	188.57	447.74	447.74	373.12	373.12	O	279.84	279.84	united health care	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1269.62	1269.62	united health care	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1269.62	1269.62	united health care	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1269.62	1269.62	united health care	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1269.62	1269.62	united health care	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1269.62	1269.62	united health care	hmo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	23096.99	23096.99	united health care	ppo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	23096.99	23096.99	united health care	pos
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	23096.99	23096.99	united health care	hmo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	23096.99	23096.99	united health care	epo
inj midazolam hydrochloride	cpt	J2250	23096.99	23096.99	2179.77	2179.77	32244.66	32244.66	26870.55	26870.55	E	23096.99	23096.99	united health care	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	6073.23	6073.23	united health care	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	6073.23	6073.23	united health care	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	6073.23	6073.23	united health care	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	6073.23	6073.23	united health care	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	6073.23	6073.23	united health care	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	15146.83	15146.83	united health care	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	15146.83	15146.83	united health care	pos
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	15146.83	15146.83	united health care	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	15146.83	15146.83	united health care	epo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	15146.83	15146.83	united health care	hmo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	ppo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	pos
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	hmo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	epo
Blood glucose (sugar) level after receiving dose of glucose	cpt	82950	26.24	26.24	4.23	4.23	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	215.45	215.45	united health care	ppo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	215.45	215.45	united health care	pos
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	215.45	215.45	united health care	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	215.45	215.45	united health care	epo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	215.45	215.45	united health care	hmo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	3792.31	3792.31	united health care	ppo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	3792.31	3792.31	united health care	pos
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	3792.31	3792.31	united health care	hmo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	3792.31	3792.31	united health care	epo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	3792.31	3792.31	united health care	hmo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	116.07	116.07	united health care	ppo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	116.07	116.07	united health care	pos
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	116.07	116.07	united health care	hmo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	116.07	116.07	united health care	epo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	116.07	116.07	united health care	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	ppo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	pos
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	hmo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	epo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	6865.24	6865.24	united health care	ppo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	6865.24	6865.24	united health care	pos
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	6865.24	6865.24	united health care	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	6865.24	6865.24	united health care	epo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	6865.24	6865.24	united health care	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	ppo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	pos
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	hmo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	epo
"Heart rhythm analysis, interpretation and report of 48-hour EKG"	cpt	93226	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	ppo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	pos
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	hmo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	epo
Heart rhythm tracing of 48-hour EKG	cpt	93225	355.6	355.6	52.96	52.96	541.87	541.87	451.56	451.56	O	355.6	355.6	united health care	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	5285.79	5285.79	united health care	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	5285.79	5285.79	united health care	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	5285.79	5285.79	united health care	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	5285.79	5285.79	united health care	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	5285.79	5285.79	united health care	hmo
"octreotide inj, non-depot"	cpt	J2354	6865.24	6865.24	1357.6	1357.6	10984.32	10984.32	9153.6	9153.6	O	6865.24	6865.24	united health care	ppo
"octreotide inj, non-depot"	cpt	J2354	6865.24	6865.24	1357.6	1357.6	10984.32	10984.32	9153.6	9153.6	O	6865.24	6865.24	united health care	pos
"octreotide inj, non-depot"	cpt	J2354	6865.24	6865.24	1357.6	1357.6	10984.32	10984.32	9153.6	9153.6	O	6865.24	6865.24	united health care	hmo
"octreotide inj, non-depot"	cpt	J2354	6865.24	6865.24	1357.6	1357.6	10984.32	10984.32	9153.6	9153.6	O	6865.24	6865.24	united health care	epo
"octreotide inj, non-depot"	cpt	J2354	6865.24	6865.24	1357.6	1357.6	10984.32	10984.32	9153.6	9153.6	O	6865.24	6865.24	united health care	hmo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1538.8	1538.8	united health care	ppo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1538.8	1538.8	united health care	pos
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1538.8	1538.8	united health care	hmo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1538.8	1538.8	united health care	epo
Drainage of fluid from abdominal cavity using imaging guidance	cpt	49083	1538.8	1538.8	659.31	659.31	2626.91	2626.91	2189.09	2189.09	O	1538.8	1538.8	united health care	hmo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	716.17	716.17	united health care	ppo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	716.17	716.17	united health care	pos
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	716.17	716.17	united health care	hmo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	716.17	716.17	united health care	epo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	716.17	716.17	united health care	hmo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	326.14	326.14	united health care	ppo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	326.14	326.14	united health care	pos
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	326.14	326.14	united health care	hmo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	326.14	326.14	united health care	epo
X-ray of upper digestive tract with single contrast	cpt	74240	326.14	326.14	73.98	73.98	521.82	521.82	434.85	434.85	O	326.14	326.14	united health care	hmo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	875.18	875.18	united health care	ppo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	875.18	875.18	united health care	pos
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	875.18	875.18	united health care	hmo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	875.18	875.18	united health care	epo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	875.18	875.18	united health care	hmo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	30.13	30.13	united health care	ppo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	30.13	30.13	united health care	pos
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	30.13	30.13	united health care	hmo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	30.13	30.13	united health care	epo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	30.13	30.13	united health care	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	23111.69	23111.69	united health care	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	23111.69	23111.69	united health care	pos
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	23111.69	23111.69	united health care	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	23111.69	23111.69	united health care	epo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	23111.69	23111.69	united health care	hmo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	16237.85	16237.85	united health care	ppo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	16237.85	16237.85	united health care	pos
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	16237.85	16237.85	united health care	hmo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	16237.85	16237.85	united health care	epo
Removal of gallbladder with X-ray study of bile ducts using endoscope	cpt	47563	16237.85	16237.85	3942.46	3942.46	25980.56	25980.56	21650.47	21650.47	O	16237.85	16237.85	united health care	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	10082.72	10082.72	united health care	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	10082.72	10082.72	united health care	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	10082.72	10082.72	united health care	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	10082.72	10082.72	united health care	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	10082.72	10082.72	united health care	hmo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	3972.76	3972.76	united health care	ppo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	3972.76	3972.76	united health care	pos
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	3972.76	3972.76	united health care	hmo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	3972.76	3972.76	united health care	epo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	3972.76	3972.76	united health care	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	5389.93	5389.93	united health care	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	5389.93	5389.93	united health care	pos
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	5389.93	5389.93	united health care	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	5389.93	5389.93	united health care	epo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	5389.93	5389.93	united health care	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	326.2	326.2	united health care	ppo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	326.2	326.2	united health care	pos
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	326.2	326.2	united health care	hmo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	326.2	326.2	united health care	epo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	326.2	326.2	united health care	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.66	11.66	united health care	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.66	11.66	united health care	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.66	11.66	united health care	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.66	11.66	united health care	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	11.66	11.66	united health care	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	9805.54	9805.54	united health care	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	9805.54	9805.54	united health care	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	9805.54	9805.54	united health care	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	9805.54	9805.54	united health care	epo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	9805.54	9805.54	united health care	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1195.52	1195.52	united health care	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1195.52	1195.52	united health care	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1195.52	1195.52	united health care	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1195.52	1195.52	united health care	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1195.52	1195.52	united health care	hmo
Tying of multiple internal hemorrhoid groups	cpt	46946	17972.06	17972.06	2076.66	2076.66	15925.92	15925.92	13271.6	13271.6	O	17972.06	17972.06	united health care	ppo
Tying of multiple internal hemorrhoid groups	cpt	46946	17972.06	17972.06	2076.66	2076.66	15925.92	15925.92	13271.6	13271.6	O	17972.06	17972.06	united health care	pos
Tying of multiple internal hemorrhoid groups	cpt	46946	17972.06	17972.06	2076.66	2076.66	15925.92	15925.92	13271.6	13271.6	O	17972.06	17972.06	united health care	hmo
Tying of multiple internal hemorrhoid groups	cpt	46946	17972.06	17972.06	2076.66	2076.66	15925.92	15925.92	13271.6	13271.6	O	17972.06	17972.06	united health care	epo
Tying of multiple internal hemorrhoid groups	cpt	46946	17972.06	17972.06	2076.66	2076.66	15925.92	15925.92	13271.6	13271.6	O	17972.06	17972.06	united health care	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	2181.77	2181.77	united health care	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	2181.77	2181.77	united health care	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	2181.77	2181.77	united health care	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	2181.77	2181.77	united health care	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	2181.77	2181.77	united health care	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	10344.21	10344.21	united health care	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	10344.21	10344.21	united health care	pos
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	10344.21	10344.21	united health care	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	10344.21	10344.21	united health care	epo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	10344.21	10344.21	united health care	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	430.09	430.09	united health care	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	430.09	430.09	united health care	pos
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	430.09	430.09	united health care	hmo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	430.09	430.09	united health care	epo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	430.09	430.09	united health care	hmo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	13430.9	13430.9	united health care	ppo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	13430.9	13430.9	united health care	pos
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	13430.9	13430.9	united health care	hmo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	13430.9	13430.9	united health care	epo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	13430.9	13430.9	united health care	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	331.52	331.52	united health care	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	331.52	331.52	united health care	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	331.52	331.52	united health care	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	331.52	331.52	united health care	epo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	331.52	331.52	united health care	hmo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	6390.02	6390.02	united health care	ppo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	6390.02	6390.02	united health care	pos
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	6390.02	6390.02	united health care	hmo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	6390.02	6390.02	united health care	epo
"Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free"	cpt	90686	11116.59	11116.59	50.63	50.63	721.56	721.56	601.3	601.3	O	6390.02	6390.02	united health care	hmo
Vaccine for rabies injection into skin	cpt	90676	4295.94	4295.94	229.65	229.65	1669.33	1669.33	1391.11	1391.11	E	4295.94	4295.94	united health care	ppo
Vaccine for rabies injection into skin	cpt	90676	4295.94	4295.94	229.65	229.65	1669.33	1669.33	1391.11	1391.11	E	4295.94	4295.94	united health care	pos
Vaccine for rabies injection into skin	cpt	90676	4295.94	4295.94	229.65	229.65	1669.33	1669.33	1391.11	1391.11	E	4295.94	4295.94	united health care	hmo
Vaccine for rabies injection into skin	cpt	90676	4295.94	4295.94	229.65	229.65	1669.33	1669.33	1391.11	1391.11	E	4295.94	4295.94	united health care	epo
Vaccine for rabies injection into skin	cpt	90676	4295.94	4295.94	229.65	229.65	1669.33	1669.33	1391.11	1391.11	E	4295.94	4295.94	united health care	hmo
Administration of vaccine	cpt	90472	4295.94	4295.94	368.14	368.14	10250.63	10250.63	8542.19	8542.19	E	4295.94	4295.94	united health care	ppo
Administration of vaccine	cpt	90472	4295.94	4295.94	368.14	368.14	10250.63	10250.63	8542.19	8542.19	E	4295.94	4295.94	united health care	pos
Administration of vaccine	cpt	90472	4295.94	4295.94	368.14	368.14	10250.63	10250.63	8542.19	8542.19	E	4295.94	4295.94	united health care	hmo
Administration of vaccine	cpt	90472	4295.94	4295.94	368.14	368.14	10250.63	10250.63	8542.19	8542.19	E	4295.94	4295.94	united health care	epo
Administration of vaccine	cpt	90472	4295.94	4295.94	368.14	368.14	10250.63	10250.63	8542.19	8542.19	E	4295.94	4295.94	united health care	hmo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	3972.76	3972.76	united health care	ppo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	3972.76	3972.76	united health care	pos
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	3972.76	3972.76	united health care	hmo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	3972.76	3972.76	united health care	epo
metoclopramide hcl injection	cpt	J2765	21270.9	21270.9	544.16	544.16	4067.09	4067.09	3389.24	3389.24	E	3972.76	3972.76	united health care	hmo
Removal of external hemorrhoids by rubber banding	cpt	46221	17972.06	17972.06	676.71	676.71	5123.33	5123.33	4269.44	4269.44	O	17972.06	17972.06	united health care	ppo
Removal of external hemorrhoids by rubber banding	cpt	46221	17972.06	17972.06	676.71	676.71	5123.33	5123.33	4269.44	4269.44	O	17972.06	17972.06	united health care	pos
Removal of external hemorrhoids by rubber banding	cpt	46221	17972.06	17972.06	676.71	676.71	5123.33	5123.33	4269.44	4269.44	O	17972.06	17972.06	united health care	hmo
Removal of external hemorrhoids by rubber banding	cpt	46221	17972.06	17972.06	676.71	676.71	5123.33	5123.33	4269.44	4269.44	O	17972.06	17972.06	united health care	epo
Removal of external hemorrhoids by rubber banding	cpt	46221	17972.06	17972.06	676.71	676.71	5123.33	5123.33	4269.44	4269.44	O	17972.06	17972.06	united health care	hmo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	722.18	722.18	united health care	ppo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	722.18	722.18	united health care	pos
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	722.18	722.18	united health care	hmo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	722.18	722.18	united health care	epo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	722.18	722.18	united health care	hmo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	733.62	733.62	united health care	ppo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	733.62	733.62	united health care	pos
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	733.62	733.62	united health care	hmo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	733.62	733.62	united health care	epo
Incision of external hemorrhoid with blood clot (thrombosed hemorrhoid)	cpt	46083	733.62	733.62	405.94	405.94	1173.78	1173.78	978.15	978.15	E	733.62	733.62	united health care	hmo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	10082.72	10082.72	united health care	ppo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	10082.72	10082.72	united health care	pos
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	10082.72	10082.72	united health care	hmo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	10082.72	10082.72	united health care	epo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	10082.72	10082.72	united health care	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	5481.82	5481.82	united health care	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	5481.82	5481.82	united health care	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	5481.82	5481.82	united health care	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	5481.82	5481.82	united health care	epo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	5481.82	5481.82	united health care	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	205.91	205.91	united health care	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	205.91	205.91	united health care	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	205.91	205.91	united health care	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	205.91	205.91	united health care	epo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	205.91	205.91	united health care	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	united health care	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	united health care	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	united health care	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	united health care	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	35.45	35.45	united health care	hmo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	283.02	283.02	united health care	ppo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	283.02	283.02	united health care	pos
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	283.02	283.02	united health care	hmo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	283.02	283.02	united health care	epo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	283.02	283.02	united health care	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	478.59	478.59	united health care	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	478.59	478.59	united health care	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	478.59	478.59	united health care	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	478.59	478.59	united health care	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	E	478.59	478.59	united health care	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	80.93	80.93	united health care	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	80.93	80.93	united health care	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	80.93	80.93	united health care	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	80.93	80.93	united health care	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	107.9	107.9	8.02	8.02	129.48	129.48	107.9	107.9	E	80.93	80.93	united health care	hmo
methylprednisolone injection	cpt	J2920	8072.2	8072.2	5421.18	5421.18	15330.14	15330.14	12775.12	12775.12	O	5540.58	5540.58	united health care	ppo
methylprednisolone injection	cpt	J2920	8072.2	8072.2	5421.18	5421.18	15330.14	15330.14	12775.12	12775.12	O	5540.58	5540.58	united health care	pos
methylprednisolone injection	cpt	J2920	8072.2	8072.2	5421.18	5421.18	15330.14	15330.14	12775.12	12775.12	O	5540.58	5540.58	united health care	hmo
methylprednisolone injection	cpt	J2920	8072.2	8072.2	5421.18	5421.18	15330.14	15330.14	12775.12	12775.12	O	5540.58	5540.58	united health care	epo
methylprednisolone injection	cpt	J2920	8072.2	8072.2	5421.18	5421.18	15330.14	15330.14	12775.12	12775.12	O	5540.58	5540.58	united health care	hmo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	2087.31	2087.31	united health care	ppo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	2087.31	2087.31	united health care	pos
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	2087.31	2087.31	united health care	hmo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	2087.31	2087.31	united health care	epo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	2087.31	2087.31	united health care	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	478.59	478.59	united health care	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	478.59	478.59	united health care	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	478.59	478.59	united health care	hmo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	478.59	478.59	united health care	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	478.59	478.59	united health care	hmo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	170.13	170.13	united health care	ppo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	170.13	170.13	united health care	pos
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	170.13	170.13	united health care	hmo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	170.13	170.13	united health care	epo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	170.13	170.13	united health care	hmo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	3426.89	3426.89	united health care	ppo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	3426.89	3426.89	united health care	pos
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	3426.89	3426.89	united health care	hmo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	3426.89	3426.89	united health care	epo
methylprednisolone injection	cpt	J2930	4388.57	4388.57	196.53	196.53	5089.15	5089.15	4240.96	4240.96	O	3426.89	3426.89	united health care	hmo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	57.24	57.24	united health care	ppo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	57.24	57.24	united health care	pos
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	57.24	57.24	united health care	hmo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	57.24	57.24	united health care	epo
Hemoglobin A1C level	cpt	83036	57.24	57.24	8.64	8.64	91.58	91.58	76.32	76.32	E	57.24	57.24	united health care	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	8558.99	8558.99	united health care	ppo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	8558.99	8558.99	united health care	pos
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	8558.99	8558.99	united health care	hmo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	8558.99	8558.99	united health care	epo
alteplase recombinant	cpt	J2997	14238.66	14238.66	2009.92	2009.92	23969.68	23969.68	19974.73	19974.73	O	8558.99	8558.99	united health care	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	143.1	143.1	united health care	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	143.1	143.1	united health care	pos
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	143.1	143.1	united health care	hmo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	143.1	143.1	united health care	epo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	143.1	143.1	united health care	hmo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	4010.86	4010.86	united health care	ppo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	4010.86	4010.86	united health care	pos
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	4010.86	4010.86	united health care	hmo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	4010.86	4010.86	united health care	epo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	4010.86	4010.86	united health care	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	12553.76	12553.76	united health care	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	12553.76	12553.76	united health care	pos
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	12553.76	12553.76	united health care	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	12553.76	12553.76	united health care	epo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	12553.76	12553.76	united health care	hmo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	33.39	33.39	united health care	ppo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	33.39	33.39	united health care	pos
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	33.39	33.39	united health care	hmo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	33.39	33.39	united health care	epo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	33.39	33.39	united health care	hmo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	23111.69	23111.69	united health care	ppo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	23111.69	23111.69	united health care	pos
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	23111.69	23111.69	united health care	hmo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	23111.69	23111.69	united health care	epo
Repair of muscle at esophagus and stomach using an endoscope	cpt	43280	23111.69	23111.69	6846.83	6846.83	37921.39	37921.39	31601.16	31601.16	O	23111.69	23111.69	united health care	hmo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	275.47	275.47	united health care	ppo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	275.47	275.47	united health care	pos
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	275.47	275.47	united health care	hmo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	275.47	275.47	united health care	epo
"Ultrasound behind abdominal cavity, limited"	cpt	76775	275.47	275.47	99.29	99.29	419.76	419.76	349.8	349.8	O	275.47	275.47	united health care	hmo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	ppo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	pos
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	hmo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	epo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	hmo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	968.91	968.91	united health care	ppo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	968.91	968.91	united health care	pos
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	968.91	968.91	united health care	hmo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	968.91	968.91	united health care	epo
"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12004	968.91	968.91	300.35	300.35	1868.68	1868.68	1557.23	1557.23	E	968.91	968.91	united health care	hmo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	40.46	40.46	united health care	ppo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	40.46	40.46	united health care	pos
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	40.46	40.46	united health care	hmo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	40.46	40.46	united health care	epo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	40.46	40.46	united health care	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	255.2	255.2	61.35	61.35	408.31	408.31	340.26	340.26	E	255.2	255.2	united health care	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	255.2	255.2	61.35	61.35	408.31	408.31	340.26	340.26	E	255.2	255.2	united health care	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	255.2	255.2	61.35	61.35	408.31	408.31	340.26	340.26	E	255.2	255.2	united health care	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	255.2	255.2	61.35	61.35	408.31	408.31	340.26	340.26	E	255.2	255.2	united health care	epo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	255.2	255.2	61.35	61.35	408.31	408.31	340.26	340.26	E	255.2	255.2	united health care	hmo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7750.85	7750.85	united health care	ppo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7750.85	7750.85	united health care	pos
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7750.85	7750.85	united health care	hmo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7750.85	7750.85	united health care	epo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7750.85	7750.85	united health care	hmo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	280.64	280.64	united health care	ppo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	280.64	280.64	united health care	pos
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	280.64	280.64	united health care	hmo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	280.64	280.64	united health care	epo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	280.64	280.64	united health care	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	65.52	65.52	united health care	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	65.52	65.52	united health care	pos
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	65.52	65.52	united health care	hmo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	65.52	65.52	united health care	epo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	65.52	65.52	united health care	hmo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	13407.23	13407.23	united health care	ppo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	13407.23	13407.23	united health care	pos
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	13407.23	13407.23	united health care	hmo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	13407.23	13407.23	united health care	epo
cellulitis without mcc	ms-drg	603	13407.23	13407.23	3088.85	3088.85	23262.28	23262.28	19385.23	19385.23	I	13407.23	13407.23	united health care	hmo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	3628.75	3628.75	united health care	ppo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	3628.75	3628.75	united health care	pos
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	3628.75	3628.75	united health care	hmo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	3628.75	3628.75	united health care	epo
thiamine hcl 100 mg	cpt	J3411	3628.75	3628.75	508.17	508.17	5986.43	5986.43	4988.69	4988.69	E	3628.75	3628.75	united health care	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	80.97	80.97	united health care	ppo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	80.97	80.97	united health care	pos
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	80.97	80.97	united health care	hmo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	80.97	80.97	united health care	epo
"Blood glucose (sugar) tolerance test, 3 specimens"	cpt	82951	80.97	80.97	11.45	11.45	126.82	126.82	105.68	105.68	O	80.97	80.97	united health care	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	255.2	255.2	united health care	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	255.2	255.2	united health care	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	255.2	255.2	united health care	hmo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	255.2	255.2	united health care	epo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	255.2	255.2	united health care	hmo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	6677.69	6677.69	united health care	ppo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	6677.69	6677.69	united health care	pos
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	6677.69	6677.69	united health care	hmo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	6677.69	6677.69	united health care	epo
inj magnesium sulfate	cpt	J3475	6677.69	6677.69	796.68	796.68	11780.23	11780.23	9816.86	9816.86	E	6677.69	6677.69	united health care	hmo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	ppo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	pos
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	epo
"Ultrasound of pregnant uterus, 1 or more fetus(es)"	cpt	76815	411.81	411.81	84.57	84.57	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	701.13	701.13	344.09	344.09	1121.8	1121.8	934.83	934.83	E	701.13	701.13	united health care	ppo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	701.13	701.13	344.09	344.09	1121.8	1121.8	934.83	934.83	E	701.13	701.13	united health care	pos
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	701.13	701.13	344.09	344.09	1121.8	1121.8	934.83	934.83	E	701.13	701.13	united health care	hmo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	701.13	701.13	344.09	344.09	1121.8	1121.8	934.83	934.83	E	701.13	701.13	united health care	epo
"Drainage of abscess, cyst, or blood accumulation of dental bone"	cpt	41800	701.13	701.13	344.09	344.09	1121.8	1121.8	934.83	934.83	E	701.13	701.13	united health care	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	10827.93	10827.93	united health care	ppo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	10827.93	10827.93	united health care	pos
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	10827.93	10827.93	united health care	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	10827.93	10827.93	united health care	epo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	10827.93	10827.93	united health care	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	united health care	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	united health care	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	united health care	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	united health care	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	77.12	77.12	united health care	hmo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	10827.93	10827.93	united health care	ppo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	10827.93	10827.93	united health care	pos
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	10827.93	10827.93	united health care	hmo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	10827.93	10827.93	united health care	epo
inj potassium chloride	cpt	J3480	10827.93	10827.93	832.09	832.09	17141.53	17141.53	14284.61	14284.61	O	10827.93	10827.93	united health care	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	77.12	77.12	united health care	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	77.12	77.12	united health care	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	77.12	77.12	united health care	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	77.12	77.12	united health care	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	17.83	17.83	123.38	123.38	102.82	102.82	E	77.12	77.12	united health care	hmo
"Stool analysis for blood, by peroxidase activity"	cpt	82272	16.86	16.86	3.76	3.76	25.69	25.69	21.41	21.41	E	16.86	16.86	united health care	ppo
"Stool analysis for blood, by peroxidase activity"	cpt	82272	16.86	16.86	3.76	3.76	25.69	25.69	21.41	21.41	E	16.86	16.86	united health care	pos
"Stool analysis for blood, by peroxidase activity"	cpt	82272	16.86	16.86	3.76	3.76	25.69	25.69	21.41	21.41	E	16.86	16.86	united health care	hmo
"Stool analysis for blood, by peroxidase activity"	cpt	82272	16.86	16.86	3.76	3.76	25.69	25.69	21.41	21.41	E	16.86	16.86	united health care	epo
"Stool analysis for blood, by peroxidase activity"	cpt	82272	16.86	16.86	3.76	3.76	25.69	25.69	21.41	21.41	E	16.86	16.86	united health care	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	100.97	100.97	united health care	ppo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	100.97	100.97	united health care	pos
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	100.97	100.97	united health care	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	100.97	100.97	united health care	epo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	31.21	31.21	161.54	161.54	134.62	134.62	O	100.97	100.97	united health care	hmo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5055.3	5055.3	united health care	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5055.3	5055.3	united health care	pos
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5055.3	5055.3	united health care	hmo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5055.3	5055.3	united health care	epo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	5055.3	5055.3	united health care	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	100.97	100.97	united health care	ppo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	100.97	100.97	united health care	pos
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	100.97	100.97	united health care	hmo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	100.97	100.97	united health care	epo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	100.97	100.97	united health care	hmo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	ppo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	pos
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	epo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	9075.75	9075.75	united health care	ppo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	9075.75	9075.75	united health care	pos
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	9075.75	9075.75	united health care	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	9075.75	9075.75	united health care	epo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	9075.75	9075.75	united health care	hmo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	13467.02	13467.02	united health care	ppo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	13467.02	13467.02	united health care	pos
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	13467.02	13467.02	united health care	hmo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	13467.02	13467.02	united health care	epo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	13467.02	13467.02	united health care	hmo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	61.22	61.22	united health care	ppo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	61.22	61.22	united health care	pos
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	61.22	61.22	united health care	hmo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	61.22	61.22	united health care	epo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	61.22	61.22	united health care	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	870.77	870.77	united health care	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	870.77	870.77	united health care	pos
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	870.77	870.77	united health care	hmo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	870.77	870.77	united health care	epo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	870.77	870.77	united health care	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	6865.24	6865.24	united health care	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	6865.24	6865.24	united health care	pos
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	6865.24	6865.24	united health care	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	6865.24	6865.24	united health care	epo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	6865.24	6865.24	united health care	hmo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	89.04	89.04	united health care	ppo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	89.04	89.04	united health care	pos
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	89.04	89.04	united health care	hmo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	89.04	89.04	united health care	epo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	89.04	89.04	united health care	hmo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	ppo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	pos
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	epo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	91.43	91.43	united health care	ppo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	91.43	91.43	united health care	pos
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	91.43	91.43	united health care	hmo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	91.43	91.43	united health care	epo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	91.43	91.43	united health care	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	28.7	28.7	united health care	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	28.7	28.7	united health care	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	28.7	28.7	united health care	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	28.7	28.7	united health care	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	28.7	28.7	united health care	hmo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	219.42	219.42	219.42	219.42	351.07	351.07	292.56	292.56	O	219.42	219.42	united health care	ppo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	219.42	219.42	219.42	219.42	351.07	351.07	292.56	292.56	O	219.42	219.42	united health care	pos
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	219.42	219.42	219.42	219.42	351.07	351.07	292.56	292.56	O	219.42	219.42	united health care	hmo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	219.42	219.42	219.42	219.42	351.07	351.07	292.56	292.56	O	219.42	219.42	united health care	epo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	219.42	219.42	219.42	219.42	351.07	351.07	292.56	292.56	O	219.42	219.42	united health care	hmo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	158.63	158.63	126.87	126.87	351.07	351.07	292.56	292.56	E	158.63	158.63	united health care	ppo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	158.63	158.63	126.87	126.87	351.07	351.07	292.56	292.56	E	158.63	158.63	united health care	pos
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	158.63	158.63	126.87	126.87	351.07	351.07	292.56	292.56	E	158.63	158.63	united health care	hmo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	158.63	158.63	126.87	126.87	351.07	351.07	292.56	292.56	E	158.63	158.63	united health care	epo
"Detection test by nucleic acid for multiple types of respiratory virus, multiple types or subtypes, 3-5 targets"	cpt	87631	158.63	158.63	126.87	126.87	351.07	351.07	292.56	292.56	E	158.63	158.63	united health care	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	97.48	97.48	united health care	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	97.48	97.48	united health care	pos
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	97.48	97.48	united health care	hmo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	97.48	97.48	united health care	epo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	97.48	97.48	united health care	hmo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	4642.21	4642.21	united health care	ppo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	4642.21	4642.21	united health care	pos
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	4642.21	4642.21	united health care	hmo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	4642.21	4642.21	united health care	epo
ringers lactate infusion	cpt	J7120	21270.9	21270.9	612.63	612.63	7456.24	7456.24	6213.53	6213.53	E	4642.21	4642.21	united health care	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	1477.69	1477.69	united health care	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	1477.69	1477.69	united health care	pos
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	1477.69	1477.69	united health care	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	1477.69	1477.69	united health care	epo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	1477.69	1477.69	united health care	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	47.7	47.7	united health care	ppo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	47.7	47.7	united health care	pos
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	47.7	47.7	united health care	hmo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	47.7	47.7	united health care	epo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	47.7	47.7	united health care	hmo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	ppo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	pos
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	epo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	411.81	411.81	united health care	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	hmo
5% dextrose in lac ringers	cpt	J7121	6073.23	6073.23	478.56	478.56	3035.82	3035.82	2529.85	2529.85	E	6073.23	6073.23	united health care	ppo
5% dextrose in lac ringers	cpt	J7121	6073.23	6073.23	478.56	478.56	3035.82	3035.82	2529.85	2529.85	E	6073.23	6073.23	united health care	pos
5% dextrose in lac ringers	cpt	J7121	6073.23	6073.23	478.56	478.56	3035.82	3035.82	2529.85	2529.85	E	6073.23	6073.23	united health care	hmo
5% dextrose in lac ringers	cpt	J7121	6073.23	6073.23	478.56	478.56	3035.82	3035.82	2529.85	2529.85	E	6073.23	6073.23	united health care	epo
5% dextrose in lac ringers	cpt	J7121	6073.23	6073.23	478.56	478.56	3035.82	3035.82	2529.85	2529.85	E	6073.23	6073.23	united health care	hmo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	842.46	842.46	united health care	ppo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	842.46	842.46	united health care	pos
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	842.46	842.46	united health care	hmo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	842.46	842.46	united health care	epo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	842.46	842.46	united health care	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	hmo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	hmo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	6390.02	6390.02	united health care	ppo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	6390.02	6390.02	united health care	pos
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	6390.02	6390.02	united health care	hmo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	6390.02	6390.02	united health care	epo
prednisone ir or dr oral 1mg	cpt	J7512	6390.02	6390.02	436.31	436.31	5379.08	5379.08	4482.57	4482.57	O	6390.02	6390.02	united health care	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	14763.73	14763.73	united health care	ppo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	14763.73	14763.73	united health care	pos
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	14763.73	14763.73	united health care	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	14763.73	14763.73	united health care	epo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	14763.73	14763.73	united health care	hmo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	24671.23	24671.23	united health care	ppo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	24671.23	24671.23	united health care	pos
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	24671.23	24671.23	united health care	hmo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	24671.23	24671.23	united health care	epo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	24671.23	24671.23	united health care	hmo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	172.79	172.79	united health care	ppo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	172.79	172.79	united health care	pos
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	172.79	172.79	united health care	hmo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	172.79	172.79	united health care	epo
Ultrasound of fetal umbilical artery flow rate	cpt	76820	172.79	172.79	29.68	29.68	263.3	263.3	219.42	219.42	O	172.79	172.79	united health care	hmo
"inj., bendeka 1 mg"	cpt	J9034	19816.19	19816.19	13726.13	13726.13	76845.62	76845.62	64038.02	64038.02	O	19816.19	19816.19	united health care	ppo
"inj., bendeka 1 mg"	cpt	J9034	19816.19	19816.19	13726.13	13726.13	76845.62	76845.62	64038.02	64038.02	O	19816.19	19816.19	united health care	pos
"inj., bendeka 1 mg"	cpt	J9034	19816.19	19816.19	13726.13	13726.13	76845.62	76845.62	64038.02	64038.02	O	19816.19	19816.19	united health care	hmo
"inj., bendeka 1 mg"	cpt	J9034	19816.19	19816.19	13726.13	13726.13	76845.62	76845.62	64038.02	64038.02	O	19816.19	19816.19	united health care	epo
"inj., bendeka 1 mg"	cpt	J9034	19816.19	19816.19	13726.13	13726.13	76845.62	76845.62	64038.02	64038.02	O	19816.19	19816.19	united health care	hmo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	105.74	105.74	united health care	ppo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	105.74	105.74	united health care	pos
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	105.74	105.74	united health care	hmo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	105.74	105.74	united health care	epo
Dehydroepiandrosterone (DHEA) hormone level	cpt	82626	105.74	105.74	20.9	20.9	169.18	169.18	140.98	140.98	O	105.74	105.74	united health care	hmo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	26280.06	26280.06	united health care	ppo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	26280.06	26280.06	united health care	pos
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	26280.06	26280.06	united health care	hmo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	26280.06	26280.06	united health care	epo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	26280.06	26280.06	united health care	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	hmo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	10996.19	10996.19	united health care	ppo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	10996.19	10996.19	united health care	pos
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	10996.19	10996.19	united health care	hmo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	10996.19	10996.19	united health care	epo
"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation"	cpt	36907	10996.19	10996.19	1444.99	1444.99	24849.47	24849.47	20707.89	20707.89	O	10996.19	10996.19	united health care	hmo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	88.25	88.25	united health care	ppo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	88.25	88.25	united health care	pos
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	88.25	88.25	united health care	hmo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	88.25	88.25	united health care	epo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	88.25	88.25	united health care	hmo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	10827.93	10827.93	united health care	ppo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	10827.93	10827.93	united health care	pos
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	10827.93	10827.93	united health care	hmo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	10827.93	10827.93	united health care	epo
cisplatin 10 mg injection	cpt	J9060	10827.93	10827.93	832.09	832.09	26673.94	26673.94	22228.28	22228.28	O	10827.93	10827.93	united health care	hmo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	10996.19	10996.19	united health care	ppo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	10996.19	10996.19	united health care	pos
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	10996.19	10996.19	united health care	hmo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	10996.19	10996.19	united health care	epo
"Insertion of needle and/or catheter into dialysis circuit, with imaging including radiological supervision and interpretation"	cpt	36901	10996.19	10996.19	1421.87	1421.87	8883.26	8883.26	7402.72	7402.72	O	10996.19	10996.19	united health care	hmo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	4667.45	4667.45	united health care	ppo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	4667.45	4667.45	united health care	pos
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	4667.45	4667.45	united health care	hmo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	4667.45	4667.45	united health care	epo
cyclophosphamide 100 mg inj	cpt	J9070	11286.59	11286.59	3343.78	3343.78	25827.6	25827.6	21523	21523	O	4667.45	4667.45	united health care	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1090.38	1090.38	united health care	ppo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1090.38	1090.38	united health care	pos
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1090.38	1090.38	united health care	hmo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1090.38	1090.38	united health care	epo
Arterial puncture withdrawal of blood for diagnosis	cpt	36600	1444.99	1444.99	224.22	224.22	1744.62	1744.62	1453.85	1453.85	O	1090.38	1090.38	united health care	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	pos
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	hmo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	epo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	hmo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	10103.97	10103.97	united health care	ppo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	10103.97	10103.97	united health care	pos
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	10103.97	10103.97	united health care	hmo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	10103.97	10103.97	united health care	epo
eribulin mesylate injection	cpt	J9179	10103.97	10103.97	2537.15	2537.15	15755.09	15755.09	13129.24	13129.24	O	10103.97	10103.97	united health care	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	147.87	147.87	united health care	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	147.87	147.87	united health care	pos
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	147.87	147.87	united health care	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	147.87	147.87	united health care	epo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	147.87	147.87	united health care	hmo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	160.58	160.58	united health care	ppo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	160.58	160.58	united health care	pos
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	160.58	160.58	united health care	hmo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	160.58	160.58	united health care	epo
Ultrasonic guidance imaging supervision and interpretation for insertion of needle	cpt	76942	207.4	207.4	160.58	160.58	256.94	256.94	214.12	214.12	O	160.58	160.58	united health care	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	8558.99	8558.99	united health care	ppo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	8558.99	8558.99	united health care	pos
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	8558.99	8558.99	united health care	hmo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	8558.99	8558.99	united health care	epo
Declotting infusion of implanted central venous access device or catheter	cpt	36593	8558.99	8558.99	2507.56	2507.56	20050.8	20050.8	16709	16709	O	8558.99	8558.99	united health care	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4667.45	4667.45	united health care	ppo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4667.45	4667.45	united health care	pos
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4667.45	4667.45	united health care	hmo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4667.45	4667.45	united health care	epo
fluorouracil injection	cpt	J9190	8184.57	8184.57	928.87	928.87	19294.19	19294.19	16078.49	16078.49	O	4667.45	4667.45	united health care	hmo
Renin (kidney enzyme) level	cpt	84244	97.79	97.79	21.55	21.55	156.46	156.46	130.38	130.38	O	97.79	97.79	united health care	ppo
Renin (kidney enzyme) level	cpt	84244	97.79	97.79	21.55	21.55	156.46	156.46	130.38	130.38	O	97.79	97.79	united health care	pos
Renin (kidney enzyme) level	cpt	84244	97.79	97.79	21.55	21.55	156.46	156.46	130.38	130.38	O	97.79	97.79	united health care	hmo
Renin (kidney enzyme) level	cpt	84244	97.79	97.79	21.55	21.55	156.46	156.46	130.38	130.38	O	97.79	97.79	united health care	epo
Renin (kidney enzyme) level	cpt	84244	97.79	97.79	21.55	21.55	156.46	156.46	130.38	130.38	O	97.79	97.79	united health care	hmo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	13474.58	13474.58	united health care	ppo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	13474.58	13474.58	united health care	pos
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	13474.58	13474.58	united health care	hmo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	13474.58	13474.58	united health care	epo
poisoning and toxic effects of drugs without mcc	ms-drg	918	13474.58	13474.58	2378.72	2378.72	17407.45	17407.45	14506.21	14506.21	I	13474.58	13474.58	united health care	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	147.87	147.87	united health care	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	147.87	147.87	united health care	pos
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	147.87	147.87	united health care	hmo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	147.87	147.87	united health care	epo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	147.87	147.87	united health care	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	173.63	173.63	united health care	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	173.63	173.63	united health care	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	173.63	173.63	united health care	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	173.63	173.63	united health care	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	11362.44	11362.44	96.59	96.59	3908.45	3908.45	3257.04	3257.04	O	173.63	173.63	united health care	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7348.19	7348.19	united health care	ppo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7348.19	7348.19	united health care	pos
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7348.19	7348.19	united health care	hmo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7348.19	7348.19	united health care	epo
in gemcitabine hcl nos 200mg	cpt	J9201	7649.74	7649.74	341.79	341.79	7331.44	7331.44	6109.53	6109.53	O	7348.19	7348.19	united health care	hmo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	11714.97	11714.97	united health care	ppo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	11714.97	11714.97	united health care	pos
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	11714.97	11714.97	united health care	hmo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	11714.97	11714.97	united health care	epo
"Removal of tailbone cyst, extensive"	cpt	11771	11714.97	11714.97	4573.79	4573.79	18530.16	18530.16	15441.8	15441.8	O	11714.97	11714.97	united health care	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	78.71	78.71	united health care	ppo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	78.71	78.71	united health care	pos
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	78.71	78.71	united health care	hmo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	78.71	78.71	united health care	epo
"Protein measurement, serum"	cpt	84165	78.71	78.71	9.55	9.55	125.93	125.93	104.94	104.94	O	78.71	78.71	united health care	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	67.41	67.41	united health care	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	67.41	67.41	united health care	pos
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	67.41	67.41	united health care	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	67.41	67.41	united health care	epo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	67.41	67.41	united health care	hmo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	2006.58	2006.58	united health care	ppo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	2006.58	2006.58	united health care	pos
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	2006.58	2006.58	united health care	hmo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	2006.58	2006.58	united health care	epo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	2006.58	2006.58	united health care	hmo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	4667.45	4667.45	united health care	ppo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	4667.45	4667.45	united health care	pos
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	4667.45	4667.45	united health care	hmo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	4667.45	4667.45	united health care	epo
methotrexate sodium inj	cpt	J9260	10076.53	10076.53	195.62	195.62	7467.91	7467.91	6223.26	6223.26	O	4667.45	4667.45	united health care	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	2110.35	2110.35	united health care	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	2110.35	2110.35	united health care	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	2110.35	2110.35	united health care	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	2110.35	2110.35	united health care	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	2110.35	2110.35	united health care	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	177.88	177.88	33.15	33.15	271.06	271.06	225.88	225.88	E	177.88	177.88	united health care	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	177.88	177.88	33.15	33.15	271.06	271.06	225.88	225.88	E	177.88	177.88	united health care	pos
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	177.88	177.88	33.15	33.15	271.06	271.06	225.88	225.88	E	177.88	177.88	united health care	hmo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	177.88	177.88	33.15	33.15	271.06	271.06	225.88	225.88	E	177.88	177.88	united health care	epo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	177.88	177.88	33.15	33.15	271.06	271.06	225.88	225.88	E	177.88	177.88	united health care	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	124.02	124.02	united health care	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	124.02	124.02	united health care	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	124.02	124.02	united health care	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	124.02	124.02	united health care	epo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	124.02	124.02	united health care	hmo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	7348.19	7348.19	united health care	ppo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	7348.19	7348.19	united health care	pos
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	7348.19	7348.19	united health care	hmo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	7348.19	7348.19	united health care	epo
paclitaxel protein bound	cpt	J9264	7348.19	7348.19	2255.17	2255.17	11757.1	11757.1	9797.58	9797.58	O	7348.19	7348.19	united health care	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	99.45	99.45	united health care	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	6018.33	6018.33	united health care	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	6018.33	6018.33	united health care	pos
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	6018.33	6018.33	united health care	hmo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	6018.33	6018.33	united health care	epo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes without mcc"	ms-drg	641	6018.33	6018.33	2500.28	2500.28	19856.36	19856.36	16546.97	16546.97	I	6018.33	6018.33	united health care	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	57.31	57.31	united health care	ppo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	57.31	57.31	united health care	pos
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	57.31	57.31	united health care	hmo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	57.31	57.31	united health care	epo
"Total protein level, urine"	cpt	84156	57.31	57.31	3.26	3.26	86.52	86.52	72.1	72.1	O	57.31	57.31	united health care	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	26265.21	26265.21	united health care	ppo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	26265.21	26265.21	united health care	pos
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	26265.21	26265.21	united health care	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	26265.21	26265.21	united health care	epo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	26265.21	26265.21	united health care	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	49.29	49.29	united health care	ppo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	49.29	49.29	united health care	pos
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	49.29	49.29	united health care	hmo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	49.29	49.29	united health care	epo
"Total protein level, blood"	cpt	84155	49.29	49.29	3.26	3.26	78.86	78.86	65.72	65.72	O	49.29	49.29	united health care	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	18.36	18.36	united health care	ppo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	18.36	18.36	united health care	pos
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	18.36	18.36	united health care	hmo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	18.36	18.36	united health care	epo
"Calcium level, total"	cpt	82310	18.36	18.36	4.59	4.59	41.84	41.84	34.87	34.87	O	18.36	18.36	united health care	hmo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	78.38	78.38	united health care	ppo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	78.38	78.38	united health care	pos
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	78.38	78.38	united health care	hmo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	78.38	78.38	united health care	epo
Prolactin (milk producing hormone) level	cpt	84146	78.38	78.38	17.24	17.24	125.41	125.41	104.51	104.51	O	78.38	78.38	united health care	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	217.43	217.43	31.21	31.21	347.89	347.89	289.91	289.91	E	217.43	217.43	united health care	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	12335.28	12335.28	united health care	ppo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	12335.28	12335.28	united health care	pos
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	12335.28	12335.28	united health care	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	12335.28	12335.28	united health care	epo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	12335.28	12335.28	united health care	hmo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	80.3	80.3	united health care	ppo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	80.3	80.3	united health care	pos
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	80.3	80.3	united health care	hmo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	80.3	80.3	united health care	epo
Dehydroepiandrosterone (DHEA-S) hormone level	cpt	82627	80.3	80.3	17.78	17.78	128.47	128.47	107.06	107.06	O	80.3	80.3	united health care	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	72.5	72.5	united health care	hmo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	16016.09	16016.09	united health care	ppo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	16016.09	16016.09	united health care	pos
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	16016.09	16016.09	united health care	hmo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	16016.09	16016.09	united health care	epo
"inj rituximab, hyaluronidase"	cpt	J9311	16016.09	16016.09	4264.13	4264.13	26906.82	26906.82	22422.35	22422.35	O	16016.09	16016.09	united health care	hmo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	65.8	65.8	united health care	ppo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	65.8	65.8	united health care	pos
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	65.8	65.8	united health care	hmo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	65.8	65.8	united health care	epo
Procalcitonin (hormone) level	cpt	84145	65.8	65.8	20.21	20.21	105.58	105.58	87.98	87.98	O	65.8	65.8	united health care	hmo
"inj., rituximab, 10 mg"	cpt	J9312	23327.69	23327.69	6727.46	6727.46	33944.59	33944.59	28287.16	28287.16	O	23327.69	23327.69	united health care	ppo
"inj., rituximab, 10 mg"	cpt	J9312	23327.69	23327.69	6727.46	6727.46	33944.59	33944.59	28287.16	28287.16	O	23327.69	23327.69	united health care	pos
"inj., rituximab, 10 mg"	cpt	J9312	23327.69	23327.69	6727.46	6727.46	33944.59	33944.59	28287.16	28287.16	O	23327.69	23327.69	united health care	hmo
"inj., rituximab, 10 mg"	cpt	J9312	23327.69	23327.69	6727.46	6727.46	33944.59	33944.59	28287.16	28287.16	O	23327.69	23327.69	united health care	epo
"inj., rituximab, 10 mg"	cpt	J9312	23327.69	23327.69	6727.46	6727.46	33944.59	33944.59	28287.16	28287.16	O	23327.69	23327.69	united health care	hmo
Procalcitonin (hormone) level	cpt	84145	87.98	87.98	24.21	24.21	105.58	105.58	87.98	87.98	E	65.99	65.99	united health care	ppo
Procalcitonin (hormone) level	cpt	84145	87.98	87.98	24.21	24.21	105.58	105.58	87.98	87.98	E	65.99	65.99	united health care	pos
Procalcitonin (hormone) level	cpt	84145	87.98	87.98	24.21	24.21	105.58	105.58	87.98	87.98	E	65.99	65.99	united health care	hmo
Procalcitonin (hormone) level	cpt	84145	87.98	87.98	24.21	24.21	105.58	105.58	87.98	87.98	E	65.99	65.99	united health care	epo
Procalcitonin (hormone) level	cpt	84145	87.98	87.98	24.21	24.21	105.58	105.58	87.98	87.98	E	65.99	65.99	united health care	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	epo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	17.83	17.83	116	116	96.67	96.67	E	72.5	72.5	united health care	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	3914.61	3914.61	united health care	ppo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	3914.61	3914.61	united health care	pos
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	3914.61	3914.61	united health care	hmo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	3914.61	3914.61	united health care	epo
Hydration infusion into a vein	cpt	96361	3914.61	3914.61	819.35	819.35	5749.4	5749.4	4791.17	4791.17	O	3914.61	3914.61	united health care	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	5526.84	5526.84	united health care	ppo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	5526.84	5526.84	united health care	pos
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	5526.84	5526.84	united health care	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	5526.84	5526.84	united health care	epo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	5526.84	5526.84	united health care	hmo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	ppo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	pos
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	hmo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	epo
Carboxyhemoglobin (protein) level	cpt	82375	73.94	73.94	10.96	10.96	118.3	118.3	98.58	98.58	O	73.94	73.94	united health care	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	ppo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	pos
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	epo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	237.71	237.71	united health care	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	237.71	237.71	united health care	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	237.71	237.71	united health care	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	237.71	237.71	united health care	epo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	237.71	237.71	united health care	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	ppo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	pos
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	hmo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	epo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	6865.24	6865.24	united health care	ppo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	6865.24	6865.24	united health care	pos
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	6865.24	6865.24	united health care	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	6865.24	6865.24	united health care	epo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	6865.24	6865.24	united health care	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	ppo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	pos
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	hmo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	epo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	68.29	68.29	united health care	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	ppo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	pos
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	hmo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	epo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	ppo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	pos
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	hmo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	epo
Detection test by immunoassay technique for Hepatitis B surface antigen	cpt	87340	53.98	53.98	9.19	9.19	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	3837.05	3837.05	united health care	ppo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	3837.05	3837.05	united health care	pos
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	3837.05	3837.05	united health care	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	3837.05	3837.05	united health care	epo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	3837.05	3837.05	united health care	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	3837.05	3837.05	united health care	ppo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	3837.05	3837.05	united health care	pos
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	3837.05	3837.05	united health care	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	3837.05	3837.05	united health care	epo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	3837.05	3837.05	united health care	hmo
"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11424	12136.25	12136.25	4009.69	4009.69	19418	19418	16181.67	16181.67	O	12136.25	12136.25	united health care	ppo
"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11424	12136.25	12136.25	4009.69	4009.69	19418	19418	16181.67	16181.67	O	12136.25	12136.25	united health care	pos
"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11424	12136.25	12136.25	4009.69	4009.69	19418	19418	16181.67	16181.67	O	12136.25	12136.25	united health care	hmo
"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11424	12136.25	12136.25	4009.69	4009.69	19418	19418	16181.67	16181.67	O	12136.25	12136.25	united health care	epo
"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals"	cpt	11424	12136.25	12136.25	4009.69	4009.69	19418	19418	16181.67	16181.67	O	12136.25	12136.25	united health care	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	6865.24	6865.24	united health care	ppo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	6865.24	6865.24	united health care	pos
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	6865.24	6865.24	united health care	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	6865.24	6865.24	united health care	epo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	6865.24	6865.24	united health care	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	246.13	246.13	united health care	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	246.13	246.13	united health care	pos
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	246.13	246.13	united health care	hmo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	246.13	246.13	united health care	epo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	246.13	246.13	united health care	hmo
renal failure without cc/mcc	ms-drg	684	10924.55	10924.55	3036.64	3036.64	15925.09	15925.09	13270.91	13270.91	I	10924.55	10924.55	united health care	ppo
renal failure without cc/mcc	ms-drg	684	10924.55	10924.55	3036.64	3036.64	15925.09	15925.09	13270.91	13270.91	I	10924.55	10924.55	united health care	pos
renal failure without cc/mcc	ms-drg	684	10924.55	10924.55	3036.64	3036.64	15925.09	15925.09	13270.91	13270.91	I	10924.55	10924.55	united health care	hmo
renal failure without cc/mcc	ms-drg	684	10924.55	10924.55	3036.64	3036.64	15925.09	15925.09	13270.91	13270.91	I	10924.55	10924.55	united health care	epo
renal failure without cc/mcc	ms-drg	684	10924.55	10924.55	3036.64	3036.64	15925.09	15925.09	13270.91	13270.91	I	10924.55	10924.55	united health care	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2689.93	2689.93	united health care	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2689.93	2689.93	united health care	pos
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2689.93	2689.93	united health care	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2689.93	2689.93	united health care	epo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2689.93	2689.93	united health care	hmo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	ppo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	pos
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	hmo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	epo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	hmo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	ppo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	pos
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	hmo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	epo
Prealbumin (protein) level	cpt	84134	49.76	49.76	12.98	12.98	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	698.81	698.81	united health care	ppo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	698.81	698.81	united health care	pos
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	698.81	698.81	united health care	hmo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	698.81	698.81	united health care	epo
"Management of radiation therapy simulation, simple"	cpt	77280	698.81	698.81	110.46	110.46	1118.09	1118.09	931.74	931.74	O	698.81	698.81	united health care	hmo
"albumin (human), 25%, 50ml"	cpt	P9047	6865.24	6865.24	849.62	849.62	14211.08	14211.08	11842.57	11842.57	O	6865.24	6865.24	united health care	ppo
"albumin (human), 25%, 50ml"	cpt	P9047	6865.24	6865.24	849.62	849.62	14211.08	14211.08	11842.57	11842.57	O	6865.24	6865.24	united health care	pos
"albumin (human), 25%, 50ml"	cpt	P9047	6865.24	6865.24	849.62	849.62	14211.08	14211.08	11842.57	11842.57	O	6865.24	6865.24	united health care	hmo
"albumin (human), 25%, 50ml"	cpt	P9047	6865.24	6865.24	849.62	849.62	14211.08	14211.08	11842.57	11842.57	O	6865.24	6865.24	united health care	epo
"albumin (human), 25%, 50ml"	cpt	P9047	6865.24	6865.24	849.62	849.62	14211.08	14211.08	11842.57	11842.57	O	6865.24	6865.24	united health care	hmo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	10370.93	10370.93	united health care	ppo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	10370.93	10370.93	united health care	pos
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	10370.93	10370.93	united health care	hmo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	10370.93	10370.93	united health care	epo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	10370.93	10370.93	united health care	hmo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	1316.33	1316.33	united health care	ppo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	1316.33	1316.33	united health care	pos
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	1316.33	1316.33	united health care	hmo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	1316.33	1316.33	united health care	epo
fosphenytoin inj pe	cpt	Q2009	6636.16	6636.16	944.61	944.61	8945.38	8945.38	7454.48	7454.48	O	1316.33	1316.33	united health care	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	ppo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	pos
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	epo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	40.46	40.46	united health care	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	4642.21	4642.21	united health care	ppo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	4642.21	4642.21	united health care	pos
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	4642.21	4642.21	united health care	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	4642.21	4642.21	united health care	epo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	4642.21	4642.21	united health care	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1318.11	1318.11	united health care	ppo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1318.11	1318.11	united health care	pos
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1318.11	1318.11	united health care	hmo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1318.11	1318.11	united health care	epo
"Management of radiation therapy, simulation, complex"	cpt	77290	1318.11	1318.11	296.91	296.91	2108.98	2108.98	1757.48	1757.48	O	1318.11	1318.11	united health care	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	ppo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	pos
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	hmo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	epo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	42.48	42.48	10.66	10.66	64.74	64.74	53.95	53.95	E	42.48	42.48	united health care	hmo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	182.3	182.3	united health care	ppo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	182.3	182.3	united health care	pos
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	182.3	182.3	united health care	hmo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	182.3	182.3	united health care	epo
Cervicovaginal secretion of placenta protein	cpt	84112	182.3	182.3	87.27	87.27	277.8	277.8	231.5	231.5	O	182.3	182.3	united health care	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1298.24	1298.24	united health care	ppo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1298.24	1298.24	united health care	pos
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1298.24	1298.24	united health care	hmo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1298.24	1298.24	united health care	epo
"Management of radiation therapy, 3D"	cpt	77295	1298.24	1298.24	223.56	223.56	2077.18	2077.18	1730.98	1730.98	O	1298.24	1298.24	united health care	hmo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	4865.15	4865.15	united health care	ppo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	4865.15	4865.15	united health care	pos
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	4865.15	4865.15	united health care	hmo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	4865.15	4865.15	united health care	epo
"hocm 150-199mg/ml iodine,1ml"	cpt	Q9959	4865.15	4865.15	1934.02	1934.02	18299.95	18299.95	15249.96	15249.96	E	4865.15	4865.15	united health care	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	376.55	376.55	united health care	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	376.55	376.55	united health care	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	376.55	376.55	united health care	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	376.55	376.55	united health care	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	376.55	376.55	united health care	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	ppo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	pos
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	hmo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	epo
Phosphate level	cpt	84100	27.03	27.03	4.22	4.22	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	hmo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	ppo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	pos
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	hmo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	epo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	hmo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	E	68.37	68.37	united health care	ppo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	E	68.37	68.37	united health care	pos
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	E	68.37	68.37	united health care	hmo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	E	68.37	68.37	united health care	epo
Smear for infectious agents	cpt	87210	68.37	68.37	5.18	5.18	109.39	109.39	91.16	91.16	E	68.37	68.37	united health care	hmo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	112.1	112.1	united health care	ppo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	112.1	112.1	united health care	pos
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	112.1	112.1	united health care	hmo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	112.1	112.1	united health care	epo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	112.1	112.1	united health care	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	58.99	58.99	united health care	ppo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	58.99	58.99	united health care	pos
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	58.99	58.99	united health care	hmo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	58.99	58.99	united health care	epo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	58.99	58.99	united health care	hmo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	168.54	168.54	united health care	ppo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	168.54	168.54	united health care	pos
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	168.54	168.54	united health care	hmo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	168.54	168.54	united health care	epo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	168.54	168.54	united health care	hmo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	3914.61	3914.61	united health care	ppo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	3914.61	3914.61	united health care	pos
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	3914.61	3914.61	united health care	hmo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	3914.61	3914.61	united health care	epo
"injection, famotidine, 20 mg"	cpt	S0028	6037.32	6037.32	1004.16	1004.16	14447.38	14447.38	12039.48	12039.48	O	3914.61	3914.61	united health care	hmo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	23111.69	23111.69	united health care	ppo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	23111.69	23111.69	united health care	pos
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	23111.69	23111.69	united health care	hmo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	23111.69	23111.69	united health care	epo
robotic surgical system	cpt	S2900	23111.69	23111.69	4282.09	4282.09	26894.08	26894.08	22411.73	22411.73	O	23111.69	23111.69	united health care	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	32.04	32.04	united health care	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	32.04	32.04	united health care	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	32.04	32.04	united health care	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	32.04	32.04	united health care	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	32.04	32.04	united health care	hmo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	111.3	111.3	united health care	ppo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	111.3	111.3	united health care	pos
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	111.3	111.3	united health care	hmo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	111.3	111.3	united health care	epo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	111.3	111.3	united health care	hmo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	72.35	72.35	united health care	ppo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	72.35	72.35	united health care	pos
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	72.35	72.35	united health care	hmo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	72.35	72.35	united health care	epo
Stool calprotectin (protein) level	cpt	83993	72.35	72.35	14.08	14.08	115.75	115.75	96.46	96.46	O	72.35	72.35	united health care	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	61.94	61.94	united health care	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	61.94	61.94	united health care	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	61.94	61.94	united health care	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	61.94	61.94	united health care	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	61.94	61.94	7.69	7.69	94.38	94.38	78.65	78.65	E	61.94	61.94	united health care	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	184.44	184.44	united health care	ppo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	184.44	184.44	united health care	pos
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	184.44	184.44	united health care	hmo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	184.44	184.44	united health care	epo
Calculation of radiation therapy dose	cpt	77300	224.29	224.29	28.88	28.88	295.1	295.1	245.92	245.92	O	184.44	184.44	united health care	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	11.13	11.13	united health care	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	11.13	11.13	united health care	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	11.13	11.13	united health care	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	11.13	11.13	united health care	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method"	cpt	87181	11.13	11.13	4.23	4.23	17.81	17.81	14.84	14.84	O	11.13	11.13	united health care	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	83.48	83.48	united health care	ppo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	83.48	83.48	united health care	pos
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	83.48	83.48	united health care	hmo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	83.48	83.48	united health care	epo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	83.48	83.48	united health care	hmo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	102.67	102.67	united health care	ppo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	102.67	102.67	united health care	pos
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	102.67	102.67	united health care	hmo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	102.67	102.67	united health care	epo
Parathormone (parathyroid hormone) level	cpt	83970	102.67	102.67	29.88	29.88	147.6	147.6	123	123	O	102.67	102.67	united health care	hmo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	12264.64	12264.64	united health care	ppo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	12264.64	12264.64	united health care	pos
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	12264.64	12264.64	united health care	hmo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	12264.64	12264.64	united health care	epo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	12264.64	12264.64	united health care	hmo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	2110.35	2110.35	united health care	ppo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	2110.35	2110.35	united health care	pos
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	2110.35	2110.35	united health care	hmo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	2110.35	2110.35	united health care	epo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	2110.35	2110.35	united health care	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	5714.16	5714.16	united health care	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	5714.16	5714.16	united health care	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	5714.16	5714.16	united health care	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	5714.16	5714.16	united health care	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	5714.16	5714.16	united health care	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	16775.47	16775.47	united health care	ppo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	16775.47	16775.47	united health care	pos
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	16775.47	16775.47	united health care	hmo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	16775.47	16775.47	united health care	epo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	16775.47	16775.47	united health care	hmo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3792.31	3792.31	united health care	ppo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3792.31	3792.31	united health care	pos
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3792.31	3792.31	united health care	hmo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3792.31	3792.31	united health care	epo
IVsolutions	revCode	258	3792.31	3792.31	2415.74	2415.74	18919.39	18919.39	15766.16	15766.16	E	3792.31	3792.31	united health care	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	131.18	131.18	united health care	ppo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	131.18	131.18	united health care	pos
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	131.18	131.18	united health care	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	131.18	131.18	united health care	epo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	179.27	179.27	5.79	5.79	209.88	209.88	174.9	174.9	E	131.18	131.18	united health care	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	11376.64	11376.64	united health care	ppo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	11376.64	11376.64	united health care	pos
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	11376.64	11376.64	united health care	hmo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	11376.64	11376.64	united health care	epo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	11376.64	11376.64	united health care	hmo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	7240.33	7240.33	united health care	ppo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	7240.33	7240.33	united health care	pos
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	7240.33	7240.33	united health care	hmo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	7240.33	7240.33	united health care	epo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	7240.33	7240.33	united health care	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3909.17	3909.17	united health care	ppo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3909.17	3909.17	united health care	pos
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3909.17	3909.17	united health care	hmo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3909.17	3909.17	united health care	epo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	3909.17	3909.17	united health care	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	131.18	131.18	united health care	ppo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	131.18	131.18	united health care	pos
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	131.18	131.18	united health care	hmo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	131.18	131.18	united health care	epo
"Creatine kinase (cardiac enzyme) level, total"	cpt	82550	131.18	131.18	5.79	5.79	68.11	68.11	56.76	56.76	O	131.18	131.18	united health care	hmo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	11003.96	11003.96	united health care	ppo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	11003.96	11003.96	united health care	pos
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	11003.96	11003.96	united health care	hmo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	11003.96	11003.96	united health care	epo
postpartum and post abortion diagnoses without o.r. procedures	ms-drg	776	11003.96	11003.96	2596.24	2596.24	9828.08	9828.08	8190.07	8190.07	I	11003.96	11003.96	united health care	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	123.06	123.06	united health care	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	123.06	123.06	united health care	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	123.06	123.06	united health care	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	123.06	123.06	united health care	epo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	426.6	426.6	10.27	10.27	196.9	196.9	164.08	164.08	E	123.06	123.06	united health care	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	89.87	89.87	united health care	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	89.87	89.87	united health care	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	89.87	89.87	united health care	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	89.87	89.87	united health care	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	89.87	89.87	united health care	hmo
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	23094.84	23094.84	united health care	ppo
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	23094.84	23094.84	united health care	pos
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	23094.84	23094.84	united health care	hmo
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	23094.84	23094.84	united health care	epo
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	23094.84	23094.84	united health care	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	87.68	87.68	united health care	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	87.68	87.68	united health care	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	87.68	87.68	united health care	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	87.68	87.68	united health care	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	122.75	122.75	34.92	34.92	140.29	140.29	116.91	116.91	E	87.68	87.68	united health care	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.49	17.49	united health care	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.49	17.49	united health care	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.49	17.49	united health care	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.49	17.49	united health care	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.49	17.49	united health care	hmo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	17092.44	17092.44	united health care	ppo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	17092.44	17092.44	united health care	pos
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	17092.44	17092.44	united health care	hmo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	17092.44	17092.44	united health care	epo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	17092.44	17092.44	united health care	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	3444.67	3444.67	united health care	ppo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	3444.67	3444.67	united health care	pos
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	3444.67	3444.67	united health care	hmo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	3444.67	3444.67	united health care	epo
Removal of skin and tissue	cpt	11045	3444.67	3444.67	258.55	258.55	3566.03	3566.03	2971.69	2971.69	O	3444.67	3444.67	united health care	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	1722.3	1722.3	united health care	ppo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	1722.3	1722.3	united health care	pos
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	1722.3	1722.3	united health care	hmo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	1722.3	1722.3	united health care	epo
Emergent insertion of breathing tube into windpipe cartilage using an endoscope	cpt	31500	2333.86	2333.86	766.73	766.73	4190.2	4190.2	3491.83	3491.83	E	1722.3	1722.3	united health care	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	24.65	24.65	united health care	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	24.65	24.65	united health care	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	24.65	24.65	united health care	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	24.65	24.65	united health care	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	24.65	24.65	4.61	4.61	39.43	39.43	32.86	32.86	E	24.65	24.65	united health care	hmo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	53.27	53.27	united health care	ppo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	53.27	53.27	united health care	pos
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	53.27	53.27	united health care	hmo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	53.27	53.27	united health care	epo
Metanephrines level	cpt	83835	53.27	53.27	15.07	15.07	87.36	87.36	72.8	72.8	O	53.27	53.27	united health care	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	5212.02	5212.02	united health care	ppo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	5212.02	5212.02	united health care	pos
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	5212.02	5212.02	united health care	hmo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	5212.02	5212.02	united health care	epo
Management of modulation radiotherapy planning	cpt	77301	5212.02	5212.02	1089.98	1089.98	8339.23	8339.23	6949.36	6949.36	O	5212.02	5212.02	united health care	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	ppo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	pos
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	hmo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	epo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	hmo
Radiation therapy plan intermediate for insertion of radioactive implant	cpt	77317	639.98	639.98	292.16	292.16	1023.96	1023.96	853.3	853.3	O	639.98	639.98	united health care	ppo
Radiation therapy plan intermediate for insertion of radioactive implant	cpt	77317	639.98	639.98	292.16	292.16	1023.96	1023.96	853.3	853.3	O	639.98	639.98	united health care	pos
Radiation therapy plan intermediate for insertion of radioactive implant	cpt	77317	639.98	639.98	292.16	292.16	1023.96	1023.96	853.3	853.3	O	639.98	639.98	united health care	hmo
Radiation therapy plan intermediate for insertion of radioactive implant	cpt	77317	639.98	639.98	292.16	292.16	1023.96	1023.96	853.3	853.3	O	639.98	639.98	united health care	epo
Radiation therapy plan intermediate for insertion of radioactive implant	cpt	77317	639.98	639.98	292.16	292.16	1023.96	1023.96	853.3	853.3	O	639.98	639.98	united health care	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	48.5	48.5	united health care	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	48.5	48.5	united health care	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	48.5	48.5	united health care	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	48.5	48.5	united health care	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	48.5	48.5	united health care	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	126.14	126.14	united health care	ppo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	126.14	126.14	united health care	pos
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	126.14	126.14	united health care	hmo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	126.14	126.14	united health care	epo
"Creatine kinase (cardiac enzyme) level, MB fraction only"	cpt	82553	126.14	126.14	10.27	10.27	185.76	185.76	154.8	154.8	O	126.14	126.14	united health care	hmo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	16311.44	16311.44	united health care	ppo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	16311.44	16311.44	united health care	pos
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	16311.44	16311.44	united health care	hmo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	16311.44	16311.44	united health care	epo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	16311.44	16311.44	united health care	hmo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	12553.76	12553.76	united health care	ppo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	12553.76	12553.76	united health care	pos
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	12553.76	12553.76	united health care	hmo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	12553.76	12553.76	united health care	epo
Removal or shaving of knee joint cartilage using an endoscope	cpt	29877	12553.76	12553.76	1328.48	1328.48	20960.54	20960.54	17467.12	17467.12	O	12553.76	12553.76	united health care	hmo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	160.59	160.59	united health care	ppo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	160.59	160.59	united health care	pos
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	160.59	160.59	united health care	hmo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	160.59	160.59	united health care	epo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	160.59	160.59	united health care	hmo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	30.37	30.37	united health care	ppo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	30.37	30.37	united health care	pos
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	30.37	30.37	united health care	hmo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	30.37	30.37	united health care	epo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	30.37	30.37	united health care	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	46.07	46.07	united health care	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	46.07	46.07	united health care	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	46.07	46.07	united health care	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	46.07	46.07	united health care	epo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	46.07	46.07	united health care	hmo
"Radiation treatment devices, design and construction, simple"	cpt	77332	217.04	217.04	111.3	111.3	347.26	347.26	289.38	289.38	O	217.04	217.04	united health care	ppo
"Radiation treatment devices, design and construction, simple"	cpt	77332	217.04	217.04	111.3	111.3	347.26	347.26	289.38	289.38	O	217.04	217.04	united health care	pos
"Radiation treatment devices, design and construction, simple"	cpt	77332	217.04	217.04	111.3	111.3	347.26	347.26	289.38	289.38	O	217.04	217.04	united health care	hmo
"Radiation treatment devices, design and construction, simple"	cpt	77332	217.04	217.04	111.3	111.3	347.26	347.26	289.38	289.38	O	217.04	217.04	united health care	epo
"Radiation treatment devices, design and construction, simple"	cpt	77332	217.04	217.04	111.3	111.3	347.26	347.26	289.38	289.38	O	217.04	217.04	united health care	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	epo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	hmo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	37.22	37.22	united health care	ppo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	37.22	37.22	united health care	pos
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	37.22	37.22	united health care	hmo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	37.22	37.22	united health care	epo
Bacterial culture for aerobic isolates	cpt	87077	37.22	37.22	7.19	7.19	56.72	56.72	47.27	47.27	E	37.22	37.22	united health care	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	403.86	403.86	united health care	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	403.86	403.86	united health care	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	403.86	403.86	united health care	hmo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	403.86	403.86	united health care	epo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	403.86	403.86	united health care	hmo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	129.14	129.14	united health care	ppo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	129.14	129.14	united health care	pos
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	129.14	129.14	united health care	hmo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	129.14	129.14	united health care	epo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	129.14	129.14	united health care	hmo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	10065.37	10065.37	united health care	ppo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	10065.37	10065.37	united health care	pos
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	10065.37	10065.37	united health care	hmo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	10065.37	10065.37	united health care	epo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	10065.37	10065.37	united health care	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	16160.85	16160.85	united health care	ppo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	16160.85	16160.85	united health care	pos
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	16160.85	16160.85	united health care	hmo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	16160.85	16160.85	united health care	epo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	16160.85	16160.85	united health care	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	57.31	57.31	united health care	ppo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	57.31	57.31	united health care	pos
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	57.31	57.31	united health care	hmo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	57.31	57.31	united health care	epo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	57.31	57.31	united health care	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	21865.72	21865.72	united health care	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	21865.72	21865.72	united health care	pos
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	21865.72	21865.72	united health care	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	21865.72	21865.72	united health care	epo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	21865.72	21865.72	united health care	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	194.78	194.78	united health care	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	194.78	194.78	united health care	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	194.78	194.78	united health care	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	194.78	194.78	united health care	epo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	194.78	194.78	united health care	hmo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2724.97	2724.97	united health care	ppo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2724.97	2724.97	united health care	pos
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2724.97	2724.97	united health care	hmo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2724.97	2724.97	united health care	epo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	2724.97	2724.97	united health care	hmo
Open treatment of dislocation at the connection of the midfoot to the forefoot	cpt	28615	26638.49	26638.49	26638.49	26638.49	42621.58	42621.58	35517.98	35517.98	O	26638.49	26638.49	united health care	ppo
Open treatment of dislocation at the connection of the midfoot to the forefoot	cpt	28615	26638.49	26638.49	26638.49	26638.49	42621.58	42621.58	35517.98	35517.98	O	26638.49	26638.49	united health care	pos
Open treatment of dislocation at the connection of the midfoot to the forefoot	cpt	28615	26638.49	26638.49	26638.49	26638.49	42621.58	42621.58	35517.98	35517.98	O	26638.49	26638.49	united health care	hmo
Open treatment of dislocation at the connection of the midfoot to the forefoot	cpt	28615	26638.49	26638.49	26638.49	26638.49	42621.58	42621.58	35517.98	35517.98	O	26638.49	26638.49	united health care	epo
Open treatment of dislocation at the connection of the midfoot to the forefoot	cpt	28615	26638.49	26638.49	26638.49	26638.49	42621.58	42621.58	35517.98	35517.98	O	26638.49	26638.49	united health care	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	pos
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	hmo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	epo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	43.88	43.88	united health care	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	20.27	20.27	united health care	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	20.27	20.27	united health care	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	20.27	20.27	united health care	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	20.27	20.27	united health care	epo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	20.27	20.27	united health care	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	3792.31	3792.31	united health care	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	3792.31	3792.31	united health care	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	3792.31	3792.31	united health care	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	3792.31	3792.31	united health care	epo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	3792.31	3792.31	united health care	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	ppo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	pos
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	hmo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	epo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	35.46	35.46	united health care	hmo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	8080.24	8080.24	united health care	ppo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	8080.24	8080.24	united health care	pos
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	8080.24	8080.24	united health care	hmo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	8080.24	8080.24	united health care	epo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	8080.24	8080.24	united health care	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	1392.99	1392.99	united health care	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	1392.99	1392.99	united health care	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	1392.99	1392.99	united health care	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	1392.99	1392.99	united health care	epo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	1392.99	1392.99	united health care	hmo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	90.32	90.32	united health care	ppo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	90.32	90.32	united health care	pos
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	90.32	90.32	united health care	hmo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	90.32	90.32	united health care	epo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	90.32	90.32	united health care	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	3587.65	3587.65	united health care	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	3587.65	3587.65	united health care	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	3587.65	3587.65	united health care	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	3587.65	3587.65	united health care	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	3587.65	3587.65	united health care	hmo
"Stool culture, additional pathogens"	cpt	87046	37.23	37.23	8.4	8.4	56.72	56.72	47.27	47.27	E	37.23	37.23	united health care	ppo
"Stool culture, additional pathogens"	cpt	87046	37.23	37.23	8.4	8.4	56.72	56.72	47.27	47.27	E	37.23	37.23	united health care	pos
"Stool culture, additional pathogens"	cpt	87046	37.23	37.23	8.4	8.4	56.72	56.72	47.27	47.27	E	37.23	37.23	united health care	hmo
"Stool culture, additional pathogens"	cpt	87046	37.23	37.23	8.4	8.4	56.72	56.72	47.27	47.27	E	37.23	37.23	united health care	epo
"Stool culture, additional pathogens"	cpt	87046	37.23	37.23	8.4	8.4	56.72	56.72	47.27	47.27	E	37.23	37.23	united health care	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	ppo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	pos
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	hmo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	epo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	53.98	53.98	united health care	hmo
Stool culture	cpt	87045	199.09	199.09	8.4	8.4	303.37	303.37	252.81	252.81	E	199.09	199.09	united health care	ppo
Stool culture	cpt	87045	199.09	199.09	8.4	8.4	303.37	303.37	252.81	252.81	E	199.09	199.09	united health care	pos
Stool culture	cpt	87045	199.09	199.09	8.4	8.4	303.37	303.37	252.81	252.81	E	199.09	199.09	united health care	hmo
Stool culture	cpt	87045	199.09	199.09	8.4	8.4	303.37	303.37	252.81	252.81	E	199.09	199.09	united health care	epo
Stool culture	cpt	87045	199.09	199.09	8.4	8.4	303.37	303.37	252.81	252.81	E	199.09	199.09	united health care	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	159.29	159.29	united health care	ppo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	159.29	159.29	united health care	pos
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	159.29	159.29	united health care	hmo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	159.29	159.29	united health care	epo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	159.29	159.29	united health care	hmo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	179.68	179.68	united health care	ppo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	179.68	179.68	united health care	pos
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	179.68	179.68	united health care	hmo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	179.68	179.68	united health care	epo
Bacterial blood culture	cpt	87040	179.68	179.68	9.18	9.18	264.6	264.6	220.5	220.5	O	179.68	179.68	united health care	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	51283.25	51283.25	united health care	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	51283.25	51283.25	united health care	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	51283.25	51283.25	united health care	hmo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	51283.25	51283.25	united health care	epo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	51283.25	51283.25	united health care	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	1366.61	1366.61	united health care	ppo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	1366.61	1366.61	united health care	pos
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	1366.61	1366.61	united health care	hmo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	1366.61	1366.61	united health care	epo
Design and construction of device for radiation therapy	cpt	77338	1366.61	1366.61	292.16	292.16	2186.57	2186.57	1822.14	1822.14	O	1366.61	1366.61	united health care	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	91.53	91.53	united health care	ppo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	91.53	91.53	united health care	pos
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	91.53	91.53	united health care	hmo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	91.53	91.53	united health care	epo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	91.53	91.53	united health care	hmo
Radiation therapy consultation	cpt	77370	298.92	298.92	110.46	110.46	478.27	478.27	398.56	398.56	O	298.92	298.92	united health care	ppo
Radiation therapy consultation	cpt	77370	298.92	298.92	110.46	110.46	478.27	478.27	398.56	398.56	O	298.92	298.92	united health care	pos
Radiation therapy consultation	cpt	77370	298.92	298.92	110.46	110.46	478.27	478.27	398.56	398.56	O	298.92	298.92	united health care	hmo
Radiation therapy consultation	cpt	77370	298.92	298.92	110.46	110.46	478.27	478.27	398.56	398.56	O	298.92	298.92	united health care	epo
Radiation therapy consultation	cpt	77370	298.92	298.92	110.46	110.46	478.27	478.27	398.56	398.56	O	298.92	298.92	united health care	hmo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	9709.02	9709.02	united health care	ppo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	9709.02	9709.02	united health care	pos
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	9709.02	9709.02	united health care	hmo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	9709.02	9709.02	united health care	epo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	9709.02	9709.02	united health care	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	27.03	27.03	united health care	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	27.03	27.03	united health care	pos
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	27.03	27.03	united health care	hmo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	27.03	27.03	united health care	epo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	27.03	27.03	united health care	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	264.62	264.62	united health care	ppo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	264.62	264.62	united health care	pos
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	264.62	264.62	united health care	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	264.62	264.62	united health care	epo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	O	264.62	264.62	united health care	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	7062.19	7062.19	united health care	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	7062.19	7062.19	united health care	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	7062.19	7062.19	united health care	hmo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	7062.19	7062.19	united health care	epo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	7062.19	7062.19	united health care	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	264.62	264.62	united health care	ppo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	264.62	264.62	united health care	pos
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	264.62	264.62	united health care	hmo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	264.62	264.62	united health care	epo
"Blood unit compatibility test, immediate spin technique"	cpt	86920	264.62	264.62	14.05	14.05	403.22	403.22	336.02	336.02	E	264.62	264.62	united health care	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	56.45	56.45	united health care	ppo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	56.45	56.45	united health care	pos
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	56.45	56.45	united health care	hmo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	56.45	56.45	united health care	epo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	56.45	56.45	united health care	hmo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	57.86	57.86	united health care	ppo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	57.86	57.86	united health care	pos
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	57.86	57.86	united health care	hmo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	57.86	57.86	united health care	epo
Blood typing for Rh (D) antigen	cpt	86901	57.86	57.86	2.66	2.66	90.31	90.31	75.26	75.26	E	57.86	57.86	united health care	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1605.9	1605.9	united health care	ppo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1605.9	1605.9	united health care	pos
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1605.9	1605.9	united health care	hmo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1605.9	1605.9	united health care	epo
"Intensity modulated radiation therapy delivery, complex"	cpt	77386	1605.9	1605.9	436.02	436.02	2569.44	2569.44	2141.2	2141.2	O	1605.9	1605.9	united health care	hmo
dental and oral diseases with cc	ms-drg	158	9311.37	9311.37	3170.15	3170.15	23073.84	23073.84	19228.2	19228.2	I	9311.37	9311.37	united health care	ppo
dental and oral diseases with cc	ms-drg	158	9311.37	9311.37	3170.15	3170.15	23073.84	23073.84	19228.2	19228.2	I	9311.37	9311.37	united health care	pos
dental and oral diseases with cc	ms-drg	158	9311.37	9311.37	3170.15	3170.15	23073.84	23073.84	19228.2	19228.2	I	9311.37	9311.37	united health care	hmo
dental and oral diseases with cc	ms-drg	158	9311.37	9311.37	3170.15	3170.15	23073.84	23073.84	19228.2	19228.2	I	9311.37	9311.37	united health care	epo
dental and oral diseases with cc	ms-drg	158	9311.37	9311.37	3170.15	3170.15	23073.84	23073.84	19228.2	19228.2	I	9311.37	9311.37	united health care	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	hmo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	199.55	199.55	united health care	ppo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	199.55	199.55	united health care	pos
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	199.55	199.55	united health care	hmo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	199.55	199.55	united health care	epo
Guidance for localization of target delivery of radiation treatment	cpt	77387	199.55	199.55	155.94	155.94	319.27	319.27	266.06	266.06	O	199.55	199.55	united health care	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	87.2	87.2	united health care	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	87.2	87.2	united health care	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	87.2	87.2	united health care	hmo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	87.2	87.2	united health care	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	E	87.2	87.2	united health care	hmo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	united health care	ppo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	united health care	pos
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	united health care	hmo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	united health care	epo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	99.45	99.45	united health care	hmo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	297.33	297.33	united health care	ppo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	297.33	297.33	united health care	pos
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	297.33	297.33	united health care	hmo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	297.33	297.33	united health care	epo
"Red blood cell antibody detection test, direct"	cpt	86880	297.33	297.33	4.79	4.79	475.73	475.73	396.44	396.44	O	297.33	297.33	united health care	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	ppo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	pos
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	hmo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	epo
Stool lactoferrin (immune system protein) analysis	cpt	83630	46.91	46.91	10.83	10.83	75.05	75.05	62.54	62.54	O	46.91	46.91	united health care	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	62.81	62.81	united health care	ppo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	62.81	62.81	united health care	pos
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	62.81	62.81	united health care	hmo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	62.81	62.81	united health care	epo
Screening test for red blood cell antibodies	cpt	86850	78	78	8.69	8.69	100.49	100.49	83.74	83.74	O	62.81	62.81	united health care	hmo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	65.94	65.94	united health care	ppo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	65.94	65.94	united health care	pos
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	65.94	65.94	united health care	hmo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	65.94	65.94	united health care	epo
Screening test for red blood cell antibodies	cpt	86850	65.94	65.94	8.69	8.69	100.49	100.49	83.74	83.74	E	65.94	65.94	united health care	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	628.85	628.85	united health care	ppo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	628.85	628.85	united health care	pos
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	628.85	628.85	united health care	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	628.85	628.85	united health care	epo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	628.85	628.85	united health care	hmo
other antepartum diagnoses without o.r. procedures with cc	ms-drg	832	7684.4	7684.4	1960.72	1960.72	12643.03	12643.03	10535.86	10535.86	I	7684.4	7684.4	united health care	ppo
other antepartum diagnoses without o.r. procedures with cc	ms-drg	832	7684.4	7684.4	1960.72	1960.72	12643.03	12643.03	10535.86	10535.86	I	7684.4	7684.4	united health care	pos
other antepartum diagnoses without o.r. procedures with cc	ms-drg	832	7684.4	7684.4	1960.72	1960.72	12643.03	12643.03	10535.86	10535.86	I	7684.4	7684.4	united health care	hmo
other antepartum diagnoses without o.r. procedures with cc	ms-drg	832	7684.4	7684.4	1960.72	1960.72	12643.03	12643.03	10535.86	10535.86	I	7684.4	7684.4	united health care	epo
other antepartum diagnoses without o.r. procedures with cc	ms-drg	832	7684.4	7684.4	1960.72	1960.72	12643.03	12643.03	10535.86	10535.86	I	7684.4	7684.4	united health care	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	76.32	76.32	united health care	ppo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	76.32	76.32	united health care	pos
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	76.32	76.32	united health care	hmo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	76.32	76.32	united health care	epo
Lactate dehydrogenase (enzyme) level	cpt	83615	76.32	76.32	5.37	5.37	115.2	115.2	96	96	O	76.32	76.32	united health care	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	76.32	76.32	united health care	ppo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	76.32	76.32	united health care	pos
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	76.32	76.32	united health care	hmo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	76.32	76.32	united health care	epo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	76.32	76.32	united health care	hmo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	ppo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	pos
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	hmo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	epo
Therapeutic radiology port films	cpt	77417	27.03	27.03	26.53	26.53	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	hmo
Special radiation treatment procedure	cpt	77470	469.7	469.7	423.74	423.74	677.98	677.98	564.98	564.98	O	423.74	423.74	united health care	ppo
Special radiation treatment procedure	cpt	77470	469.7	469.7	423.74	423.74	677.98	677.98	564.98	564.98	O	423.74	423.74	united health care	pos
Special radiation treatment procedure	cpt	77470	469.7	469.7	423.74	423.74	677.98	677.98	564.98	564.98	O	423.74	423.74	united health care	hmo
Special radiation treatment procedure	cpt	77470	469.7	469.7	423.74	423.74	677.98	677.98	564.98	564.98	O	423.74	423.74	united health care	epo
Special radiation treatment procedure	cpt	77470	469.7	469.7	423.74	423.74	677.98	677.98	564.98	564.98	O	423.74	423.74	united health care	hmo
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee	cpt	27337	11844.5	11844.5	11844.5	11844.5	18951.19	18951.19	15792.66	15792.66	O	11844.5	11844.5	united health care	ppo
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee	cpt	27337	11844.5	11844.5	11844.5	11844.5	18951.19	18951.19	15792.66	15792.66	O	11844.5	11844.5	united health care	pos
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee	cpt	27337	11844.5	11844.5	11844.5	11844.5	18951.19	18951.19	15792.66	15792.66	O	11844.5	11844.5	united health care	hmo
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee	cpt	27337	11844.5	11844.5	11844.5	11844.5	18951.19	18951.19	15792.66	15792.66	O	11844.5	11844.5	united health care	epo
Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee	cpt	27337	11844.5	11844.5	11844.5	11844.5	18951.19	18951.19	15792.66	15792.66	O	11844.5	11844.5	united health care	hmo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	50.92	50.92	united health care	ppo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	50.92	50.92	united health care	pos
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	50.92	50.92	united health care	hmo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	50.92	50.92	united health care	epo
Thyroglobulin (thyroid protein) antibody measurement	cpt	86800	50.92	50.92	14.15	14.15	77.59	77.59	64.66	64.66	O	50.92	50.92	united health care	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	46.06	46.06	united health care	ppo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	46.06	46.06	united health care	pos
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	46.06	46.06	united health care	hmo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	46.06	46.06	united health care	epo
Creatinine level to test for kidney function or muscle injury	cpt	82570	48.76	48.76	4.61	4.61	53.93	53.93	44.94	44.94	O	46.06	46.06	united health care	hmo
"High dose brachytherapy , 2- 12 channels"	cpt	77771	1543.89	1543.89	645.51	645.51	2470.22	2470.22	2058.52	2058.52	O	1543.89	1543.89	united health care	ppo
"High dose brachytherapy , 2- 12 channels"	cpt	77771	1543.89	1543.89	645.51	645.51	2470.22	2470.22	2058.52	2058.52	O	1543.89	1543.89	united health care	pos
"High dose brachytherapy , 2- 12 channels"	cpt	77771	1543.89	1543.89	645.51	645.51	2470.22	2470.22	2058.52	2058.52	O	1543.89	1543.89	united health care	hmo
"High dose brachytherapy , 2- 12 channels"	cpt	77771	1543.89	1543.89	645.51	645.51	2470.22	2470.22	2058.52	2058.52	O	1543.89	1543.89	united health care	epo
"High dose brachytherapy , 2- 12 channels"	cpt	77771	1543.89	1543.89	645.51	645.51	2470.22	2470.22	2058.52	2058.52	O	1543.89	1543.89	united health care	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	35.78	35.78	united health care	ppo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	35.78	35.78	united health care	pos
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	35.78	35.78	united health care	hmo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	35.78	35.78	united health care	epo
Analysis for antibody to varicella-zoster virus (chicken pox)	cpt	86787	35.78	35.78	7.94	7.94	57.24	57.24	47.7	47.7	O	35.78	35.78	united health care	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	1030.32	1030.32	united health care	ppo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	1030.32	1030.32	united health care	pos
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	1030.32	1030.32	united health care	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	1030.32	1030.32	united health care	epo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	1030.32	1030.32	united health care	hmo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	25102.09	25102.09	united health care	ppo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	25102.09	25102.09	united health care	pos
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	25102.09	25102.09	united health care	hmo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	25102.09	25102.09	united health care	epo
chronic obstructive pulmonary disease without cc/mcc	ms-drg	192	25102.09	25102.09	3596.24	3596.24	15877.78	15877.78	13231.48	13231.48	I	25102.09	25102.09	united health care	hmo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	1368.2	1368.2	united health care	ppo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	1368.2	1368.2	united health care	pos
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	1368.2	1368.2	united health care	hmo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	1368.2	1368.2	united health care	epo
"Bone and/or joint imaging, 3 phase study"	cpt	78315	1368.2	1368.2	253.85	253.85	2189.11	2189.11	1824.26	1824.26	O	1368.2	1368.2	united health care	hmo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	25007.97	25007.97	united health care	ppo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	25007.97	25007.97	united health care	pos
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	25007.97	25007.97	united health care	hmo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	25007.97	25007.97	united health care	epo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	25007.97	25007.97	united health care	hmo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.71	33.71	united health care	ppo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.71	33.71	united health care	pos
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.71	33.71	united health care	hmo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.71	33.71	united health care	epo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.71	33.71	united health care	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	3752.4	3752.4	united health care	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	3752.4	3752.4	united health care	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	3752.4	3752.4	united health care	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	3752.4	3752.4	united health care	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	5253.36	5253.36	334.96	334.96	6003.84	6003.84	5003.2	5003.2	E	3752.4	3752.4	united health care	hmo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	48.5	48.5	united health care	ppo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	48.5	48.5	united health care	pos
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	48.5	48.5	united health care	hmo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	48.5	48.5	united health care	epo
Lactic acid level	cpt	83605	64.66	64.66	10.29	10.29	76.32	76.32	63.6	63.6	O	48.5	48.5	united health care	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	63.6	63.6	united health care	ppo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	63.6	63.6	united health care	pos
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	63.6	63.6	united health care	hmo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	63.6	63.6	united health care	epo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	63.6	63.6	united health care	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	3752.4	3752.4	united health care	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	3752.4	3752.4	united health care	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	3752.4	3752.4	united health care	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	3752.4	3752.4	united health care	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	3752.4	3752.4	united health care	hmo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	106.53	106.53	united health care	ppo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	106.53	106.53	united health care	pos
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	106.53	106.53	united health care	hmo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	106.53	106.53	united health care	epo
Blood gases measurement	cpt	82803	142.04	142.04	23.19	23.19	170.45	170.45	142.04	142.04	E	106.53	106.53	united health care	hmo
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger	cpt	26111	11689.03	11689.03	11689.03	11689.03	18702.44	18702.44	15585.37	15585.37	O	11689.03	11689.03	united health care	ppo
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger	cpt	26111	11689.03	11689.03	11689.03	11689.03	18702.44	18702.44	15585.37	15585.37	O	11689.03	11689.03	united health care	pos
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger	cpt	26111	11689.03	11689.03	11689.03	11689.03	18702.44	18702.44	15585.37	15585.37	O	11689.03	11689.03	united health care	hmo
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger	cpt	26111	11689.03	11689.03	11689.03	11689.03	18702.44	18702.44	15585.37	15585.37	O	11689.03	11689.03	united health care	epo
Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger	cpt	26111	11689.03	11689.03	11689.03	11689.03	18702.44	18702.44	15585.37	15585.37	O	11689.03	11689.03	united health care	hmo
pneumothorax with cc	ms-drg	200	22906.66	22906.66	4418.11	4418.11	25021.14	25021.14	20850.95	20850.95	I	22906.66	22906.66	united health care	ppo
pneumothorax with cc	ms-drg	200	22906.66	22906.66	4418.11	4418.11	25021.14	25021.14	20850.95	20850.95	I	22906.66	22906.66	united health care	pos
pneumothorax with cc	ms-drg	200	22906.66	22906.66	4418.11	4418.11	25021.14	25021.14	20850.95	20850.95	I	22906.66	22906.66	united health care	hmo
pneumothorax with cc	ms-drg	200	22906.66	22906.66	4418.11	4418.11	25021.14	25021.14	20850.95	20850.95	I	22906.66	22906.66	united health care	epo
pneumothorax with cc	ms-drg	200	22906.66	22906.66	4418.11	4418.11	25021.14	25021.14	20850.95	20850.95	I	22906.66	22906.66	united health care	hmo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	13719.01	13719.01	united health care	ppo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	13719.01	13719.01	united health care	pos
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	13719.01	13719.01	united health care	hmo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	13719.01	13719.01	united health care	epo
Incision of tendon covering	cpt	26055	13719.01	13719.01	1097.92	1097.92	17011.03	17011.03	14175.86	14175.86	O	13719.01	13719.01	united health care	hmo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	118.85	118.85	united health care	ppo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	118.85	118.85	united health care	pos
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	118.85	118.85	united health care	hmo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	118.85	118.85	united health care	epo
Hepatitis B core antibody measurement	cpt	86704	118.85	118.85	10.72	10.72	190.16	190.16	158.47	158.47	O	118.85	118.85	united health care	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	204.66	204.66	united health care	ppo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	204.66	204.66	united health care	pos
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	204.66	204.66	united health care	hmo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	204.66	204.66	united health care	epo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	204.66	204.66	united health care	hmo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	48.5	48.5	united health care	ppo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	48.5	48.5	united health care	pos
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	48.5	48.5	united health care	hmo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	48.5	48.5	united health care	epo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	48.5	48.5	united health care	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	55.4	55.4	united health care	ppo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	55.4	55.4	united health care	pos
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	55.4	55.4	united health care	hmo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	55.4	55.4	united health care	epo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	55.4	55.4	united health care	hmo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	173837.62	173837.62	united health care	ppo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	173837.62	173837.62	united health care	pos
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	173837.62	173837.62	united health care	hmo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	173837.62	173837.62	united health care	epo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	173837.62	173837.62	united health care	hmo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	2311.63	2311.63	united health care	ppo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	2311.63	2311.63	united health care	pos
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	2311.63	2311.63	united health care	hmo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	2311.63	2311.63	united health care	epo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	2311.63	2311.63	united health care	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	71.63	71.63	united health care	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	71.63	71.63	united health care	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	71.63	71.63	united health care	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	71.63	71.63	united health care	epo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	71.63	71.63	united health care	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4915.33	4915.33	united health care	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4915.33	4915.33	united health care	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4915.33	4915.33	united health care	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4915.33	4915.33	united health care	epo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	4915.33	4915.33	united health care	hmo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	141718.36	141718.36	united health care	ppo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	141718.36	141718.36	united health care	pos
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	141718.36	141718.36	united health care	hmo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	141718.36	141718.36	united health care	epo
coronary bypass with cardiac catheterization with mcc	ms-drg	233	141718.36	141718.36	28603.68	28603.68	234499.09	234499.09	195415.91	195415.91	I	141718.36	141718.36	united health care	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	ppo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	pos
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	hmo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	epo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	27.03	27.03	united health care	hmo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	112527.02	112527.02	united health care	ppo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	112527.02	112527.02	united health care	pos
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	112527.02	112527.02	united health care	hmo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	112527.02	112527.02	united health care	epo
coronary bypass with cardiac catheterization without mcc	ms-drg	234	112527.02	112527.02	25784.61	25784.61	201221.45	201221.45	167684.54	167684.54	I	112527.02	112527.02	united health care	hmo
General health panel	cpt	80050	531.61	531.61	531.61	531.61	850.57	850.57	708.81	708.81	E	531.61	531.61	united health care	ppo
General health panel	cpt	80050	531.61	531.61	531.61	531.61	850.57	850.57	708.81	708.81	E	531.61	531.61	united health care	pos
General health panel	cpt	80050	531.61	531.61	531.61	531.61	850.57	850.57	708.81	708.81	E	531.61	531.61	united health care	hmo
General health panel	cpt	80050	531.61	531.61	531.61	531.61	850.57	850.57	708.81	708.81	E	531.61	531.61	united health care	epo
General health panel	cpt	80050	531.61	531.61	531.61	531.61	850.57	850.57	708.81	708.81	E	531.61	531.61	united health care	hmo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	104057.01	104057.01	united health care	ppo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	104057.01	104057.01	united health care	pos
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	104057.01	104057.01	united health care	hmo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	104057.01	104057.01	united health care	epo
coronary bypass without cardiac catheterization without mcc	ms-drg	236	104057.01	104057.01	21785.45	21785.45	127740.22	127740.22	106450.18	106450.18	I	104057.01	104057.01	united health care	hmo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	54.06	54.06	united health care	ppo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	54.06	54.06	united health care	pos
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	54.06	54.06	united health care	hmo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	54.06	54.06	united health care	epo
Creatinine clearance measurement to test for kidney function	cpt	82575	54.06	54.06	8.41	8.41	151.37	151.37	126.14	126.14	O	54.06	54.06	united health care	hmo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	202.48	202.48	united health care	ppo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	202.48	202.48	united health care	pos
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	202.48	202.48	united health care	hmo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	202.48	202.48	united health care	epo
General health panel	cpt	80050	202.48	202.48	22.42	22.42	323.96	323.96	269.97	269.97	O	202.48	202.48	united health care	hmo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	106.53	106.53	united health care	ppo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	106.53	106.53	united health care	pos
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	106.53	106.53	united health care	hmo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	106.53	106.53	united health care	epo
Blood gases measurement	cpt	82803	106.53	106.53	23.19	23.19	170.45	170.45	142.04	142.04	O	106.53	106.53	united health care	hmo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	48586.64	48586.64	united health care	ppo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	48586.64	48586.64	united health care	pos
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	48586.64	48586.64	united health care	hmo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	48586.64	48586.64	united health care	epo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	48586.64	48586.64	united health care	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	236.12	236.12	united health care	ppo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	236.12	236.12	united health care	pos
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	236.12	236.12	united health care	hmo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	236.12	236.12	united health care	epo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	236.12	236.12	united health care	hmo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	ppo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	pos
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	hmo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	epo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52876.69	52876.69	united health care	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52876.69	52876.69	united health care	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52876.69	52876.69	united health care	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52876.69	52876.69	united health care	epo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	52876.69	52876.69	united health care	hmo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	37.36	37.36	united health care	ppo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	37.36	37.36	united health care	pos
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	37.36	37.36	united health care	hmo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	37.36	37.36	united health care	epo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	37.36	37.36	united health care	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	67.61	67.61	united health care	ppo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	67.61	67.61	united health care	pos
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	67.61	67.61	united health care	hmo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	67.61	67.61	united health care	epo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	67.61	67.61	united health care	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	68604.42	68604.42	united health care	ppo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	68604.42	68604.42	united health care	pos
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	68604.42	68604.42	united health care	hmo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	68604.42	68604.42	united health care	epo
infectious and parasitic diseases with o.r. procedures with mcc	ms-drg	853	85704.11	85704.11	953.05	953.05	121357.7	121357.7	101131.42	101131.42	I	68604.42	68604.42	united health care	hmo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	29670.79	29670.79	united health care	ppo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	29670.79	29670.79	united health care	pos
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	29670.79	29670.79	united health care	hmo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	29670.79	29670.79	united health care	epo
infectious and parasitic diseases with o.r. procedures with cc	ms-drg	854	29670.79	29670.79	10706.37	10706.37	60009.55	60009.55	50007.96	50007.96	I	29670.79	29670.79	united health care	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	58.67	58.67	united health care	ppo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	58.67	58.67	united health care	pos
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	58.67	58.67	united health care	hmo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	58.67	58.67	united health care	epo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	58.67	58.67	united health care	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	epo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	27.83	27.83	united health care	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	144.13	144.13	united health care	ppo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	144.13	144.13	united health care	pos
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	144.13	144.13	united health care	hmo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	144.13	144.13	united health care	epo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	144.13	144.13	united health care	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	71.78	71.78	united health care	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	71.78	71.78	united health care	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	71.78	71.78	united health care	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	71.78	71.78	united health care	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9"	cpt	86301	79.34	79.34	18.51	18.51	109.39	109.39	91.16	91.16	O	71.78	71.78	united health care	hmo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	24078.21	24078.21	united health care	ppo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	24078.21	24078.21	united health care	pos
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	24078.21	24078.21	united health care	hmo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	24078.21	24078.21	united health care	epo
"acute myocardial infarction, discharged alive without cc/mcc"	ms-drg	282	24078.21	24078.21	5315.78	5315.78	40450.2	40450.2	33708.5	33708.5	I	24078.21	24078.21	united health care	hmo
postoperative or post-traumatic infections with o.r. procedures with mcc	ms-drg	856	65295.34	65295.34	23364.17	23364.17	104472.54	104472.54	87060.45	87060.45	I	65295.34	65295.34	united health care	ppo
postoperative or post-traumatic infections with o.r. procedures with mcc	ms-drg	856	65295.34	65295.34	23364.17	23364.17	104472.54	104472.54	87060.45	87060.45	I	65295.34	65295.34	united health care	pos
postoperative or post-traumatic infections with o.r. procedures with mcc	ms-drg	856	65295.34	65295.34	23364.17	23364.17	104472.54	104472.54	87060.45	87060.45	I	65295.34	65295.34	united health care	hmo
postoperative or post-traumatic infections with o.r. procedures with mcc	ms-drg	856	65295.34	65295.34	23364.17	23364.17	104472.54	104472.54	87060.45	87060.45	I	65295.34	65295.34	united health care	epo
postoperative or post-traumatic infections with o.r. procedures with mcc	ms-drg	856	65295.34	65295.34	23364.17	23364.17	104472.54	104472.54	87060.45	87060.45	I	65295.34	65295.34	united health care	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	165.17	165.17	united health care	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	165.17	165.17	united health care	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	165.17	165.17	united health care	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	165.17	165.17	united health care	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	165.17	165.17	united health care	hmo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	20454.64	20454.64	united health care	ppo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	20454.64	20454.64	united health care	pos
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	20454.64	20454.64	united health care	hmo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	20454.64	20454.64	united health care	epo
"circulatory disorders except ami, with cardiac catheterization without mcc"	ms-drg	287	20454.64	20454.64	6355.08	6355.08	40015	40015	33345.83	33345.83	I	20454.64	20454.64	united health care	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	61.22	61.22	united health care	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	61.22	61.22	united health care	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	61.22	61.22	united health care	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	61.22	61.22	united health care	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	61.22	61.22	united health care	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	29.53	29.53	united health care	ppo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	29.53	29.53	united health care	pos
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	29.53	29.53	united health care	hmo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	29.53	29.53	united health care	epo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	29.53	29.53	united health care	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	21478.52	21478.52	united health care	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	21478.52	21478.52	united health care	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	21478.52	21478.52	united health care	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	21478.52	21478.52	united health care	epo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	21478.52	21478.52	united health care	hmo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	107.33	107.33	united health care	ppo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	107.33	107.33	united health care	pos
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	107.33	107.33	united health care	hmo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	107.33	107.33	united health care	epo
"Phenytoin level, total"	cpt	80185	150.25	150.25	12.98	12.98	117.02	117.02	97.52	97.52	O	107.33	107.33	united health care	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	15968.17	15968.17	united health care	ppo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	15968.17	15968.17	united health care	pos
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	15968.17	15968.17	united health care	hmo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	15968.17	15968.17	united health care	epo
postoperative and post-traumatic infections with mcc	ms-drg	862	26149.85	26149.85	9402.85	9402.85	33753.85	33753.85	28128.21	28128.21	I	15968.17	15968.17	united health care	hmo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	169.34	169.34	united health care	ppo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	169.34	169.34	united health care	pos
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	169.34	169.34	united health care	hmo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	169.34	169.34	united health care	epo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	169.34	169.34	united health care	hmo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	22045.55	22045.55	united health care	ppo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	22045.55	22045.55	united health care	pos
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	22045.55	22045.55	united health care	hmo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	22045.55	22045.55	united health care	epo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	22045.55	22045.55	united health care	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	170.29	170.29	united health care	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	170.29	170.29	united health care	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	170.29	170.29	united health care	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	170.29	170.29	united health care	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	170.29	170.29	united health care	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	173.57	173.57	united health care	ppo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	173.57	173.57	united health care	pos
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	173.57	173.57	united health care	hmo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	173.57	173.57	united health care	epo
"X-ray of middle and lower spine, 2 views"	cpt	72080	173.57	173.57	18.96	18.96	270.94	270.94	225.78	225.78	O	173.57	173.57	united health care	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	49.58	49.58	united health care	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	49.58	49.58	united health care	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	49.58	49.58	united health care	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	49.58	49.58	united health care	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	49.58	49.58	united health care	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	united health care	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	united health care	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	united health care	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	united health care	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	193.82	193.82	united health care	hmo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	1368.51	1368.51	united health care	ppo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	1368.51	1368.51	united health care	pos
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	1368.51	1368.51	united health care	hmo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	1368.51	1368.51	united health care	epo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	1368.51	1368.51	united health care	hmo
heart failure and shock without cc/mcc	ms-drg	293	9035.93	9035.93	2941.69	2941.69	15739.96	15739.96	13116.63	13116.63	I	9035.93	9035.93	united health care	ppo
heart failure and shock without cc/mcc	ms-drg	293	9035.93	9035.93	2941.69	2941.69	15739.96	15739.96	13116.63	13116.63	I	9035.93	9035.93	united health care	pos
heart failure and shock without cc/mcc	ms-drg	293	9035.93	9035.93	2941.69	2941.69	15739.96	15739.96	13116.63	13116.63	I	9035.93	9035.93	united health care	hmo
heart failure and shock without cc/mcc	ms-drg	293	9035.93	9035.93	2941.69	2941.69	15739.96	15739.96	13116.63	13116.63	I	9035.93	9035.93	united health care	epo
heart failure and shock without cc/mcc	ms-drg	293	9035.93	9035.93	2941.69	2941.69	15739.96	15739.96	13116.63	13116.63	I	9035.93	9035.93	united health care	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	hmo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	222.6	222.6	united health care	ppo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	222.6	222.6	united health care	pos
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	222.6	222.6	united health care	hmo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	222.6	222.6	united health care	epo
Cardiolipin antibody (tissue antibody) measurement	cpt	86147	222.6	222.6	22.64	22.64	356.16	356.16	296.8	296.8	O	222.6	222.6	united health care	hmo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	6873.58	6873.58	united health care	ppo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	6873.58	6873.58	united health care	pos
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	6873.58	6873.58	united health care	hmo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	6873.58	6873.58	united health care	epo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	6873.58	6873.58	united health care	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	54.6	54.6	united health care	ppo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	54.6	54.6	united health care	pos
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	54.6	54.6	united health care	hmo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	54.6	54.6	united health care	epo
"Measurement C-reactive protein for detection of infection or inflammation, high sensitivity"	cpt	86141	54.6	54.6	10.31	10.31	149.16	149.16	124.3	124.3	O	54.6	54.6	united health care	hmo
"X-ray of middle spine, 3 views"	cpt	72072	243.94	243.94	21.37	21.37	384.14	384.14	320.12	320.12	E	243.94	243.94	united health care	ppo
"X-ray of middle spine, 3 views"	cpt	72072	243.94	243.94	21.37	21.37	384.14	384.14	320.12	320.12	E	243.94	243.94	united health care	pos
"X-ray of middle spine, 3 views"	cpt	72072	243.94	243.94	21.37	21.37	384.14	384.14	320.12	320.12	E	243.94	243.94	united health care	hmo
"X-ray of middle spine, 3 views"	cpt	72072	243.94	243.94	21.37	21.37	384.14	384.14	320.12	320.12	E	243.94	243.94	united health care	epo
"X-ray of middle spine, 3 views"	cpt	72072	243.94	243.94	21.37	21.37	384.14	384.14	320.12	320.12	E	243.94	243.94	united health care	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	274.63	274.63	united health care	ppo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	274.63	274.63	united health care	pos
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	274.63	274.63	united health care	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	274.63	274.63	united health care	epo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	274.63	274.63	21.37	21.37	418.49	418.49	348.74	348.74	E	274.63	274.63	united health care	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	268.09	268.09	united health care	ppo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	268.09	268.09	united health care	pos
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	268.09	268.09	united health care	hmo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	268.09	268.09	united health care	epo
"X-ray of lower and sacral spine, 2 or 3 views"	cpt	72100	268.09	268.09	21.37	21.37	418.49	418.49	348.74	348.74	O	268.09	268.09	united health care	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	3814.04	3814.04	united health care	ppo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	3814.04	3814.04	united health care	pos
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	3814.04	3814.04	united health care	hmo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	3814.04	3814.04	united health care	epo
Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare	cpt	45385	3814.04	3814.04	1237.74	1237.74	6150.4	6150.4	5125.33	5125.33	O	3814.04	3814.04	united health care	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	339.55	339.55	united health care	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	339.55	339.55	united health care	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	339.55	339.55	united health care	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	339.55	339.55	united health care	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	339.55	339.55	11.91	11.91	460.1	460.1	383.42	383.42	E	339.55	339.55	united health care	hmo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	415.7	415.7	united health care	ppo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	415.7	415.7	united health care	pos
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	415.7	415.7	united health care	hmo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	415.7	415.7	united health care	epo
"X-ray of upper spine, 6 or more views"	cpt	72052	415.7	415.7	35.2	35.2	633.46	633.46	527.88	527.88	O	415.7	415.7	united health care	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	3589.03	3589.03	united health care	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	3589.03	3589.03	united health care	pos
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	3589.03	3589.03	united health care	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	3589.03	3589.03	united health care	epo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	3589.03	3589.03	united health care	hmo
hiv with major related condition without cc/mcc	ms-drg	976	17984.05	17984.05	17984.05	17984.05	28774.48	28774.48	23978.73	23978.73	I	17984.05	17984.05	united health care	ppo
hiv with major related condition without cc/mcc	ms-drg	976	17984.05	17984.05	17984.05	17984.05	28774.48	28774.48	23978.73	23978.73	I	17984.05	17984.05	united health care	pos
hiv with major related condition without cc/mcc	ms-drg	976	17984.05	17984.05	17984.05	17984.05	28774.48	28774.48	23978.73	23978.73	I	17984.05	17984.05	united health care	hmo
hiv with major related condition without cc/mcc	ms-drg	976	17984.05	17984.05	17984.05	17984.05	28774.48	28774.48	23978.73	23978.73	I	17984.05	17984.05	united health care	epo
hiv with major related condition without cc/mcc	ms-drg	976	17984.05	17984.05	17984.05	17984.05	28774.48	28774.48	23978.73	23978.73	I	17984.05	17984.05	united health care	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	575.98	575.98	united health care	ppo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	575.98	575.98	united health care	pos
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	575.98	575.98	united health care	hmo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	575.98	575.98	united health care	epo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	575.98	575.98	united health care	hmo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	13381.81	13381.81	united health care	ppo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	13381.81	13381.81	united health care	pos
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	13381.81	13381.81	united health care	hmo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	13381.81	13381.81	united health care	epo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	13381.81	13381.81	united health care	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	102.07	102.07	united health care	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	102.07	102.07	united health care	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	102.07	102.07	united health care	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	102.07	102.07	united health care	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	102.07	102.07	united health care	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	2708.94	2708.94	united health care	ppo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	2708.94	2708.94	united health care	pos
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	2708.94	2708.94	united health care	hmo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	2708.94	2708.94	united health care	epo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	2708.94	2708.94	united health care	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	45.55	45.55	united health care	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	45.55	45.55	united health care	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	45.55	45.55	united health care	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	45.55	45.55	united health care	epo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	45.55	45.55	united health care	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	ppo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	pos
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	hmo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	epo
Kidney function blood test panel	cpt	80069	47.82	47.82	7.72	7.72	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2918.38	2918.38	united health care	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2918.38	2918.38	united health care	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2918.38	2918.38	united health care	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2918.38	2918.38	united health care	epo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2918.38	2918.38	united health care	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	413.4	413.4	united health care	ppo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	413.4	413.4	united health care	pos
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	413.4	413.4	united health care	hmo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	413.4	413.4	united health care	epo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	413.4	413.4	united health care	hmo
Fine needle aspiration of first lesion using CT guidance	cpt	10009	5239.66	5239.66	531.75	531.75	8383.45	8383.45	6986.21	6986.21	O	5239.66	5239.66	united health care	ppo
Fine needle aspiration of first lesion using CT guidance	cpt	10009	5239.66	5239.66	531.75	531.75	8383.45	8383.45	6986.21	6986.21	O	5239.66	5239.66	united health care	pos
Fine needle aspiration of first lesion using CT guidance	cpt	10009	5239.66	5239.66	531.75	531.75	8383.45	8383.45	6986.21	6986.21	O	5239.66	5239.66	united health care	hmo
Fine needle aspiration of first lesion using CT guidance	cpt	10009	5239.66	5239.66	531.75	531.75	8383.45	8383.45	6986.21	6986.21	O	5239.66	5239.66	united health care	epo
Fine needle aspiration of first lesion using CT guidance	cpt	10009	5239.66	5239.66	531.75	531.75	8383.45	8383.45	6986.21	6986.21	O	5239.66	5239.66	united health care	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	1170.32	1170.32	united health care	ppo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	1170.32	1170.32	united health care	pos
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	1170.32	1170.32	united health care	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	1170.32	1170.32	united health care	epo
CT scan of upper spine	cpt	72125	1170.32	1170.32	93.83	93.83	1783.34	1783.34	1486.12	1486.12	E	1170.32	1170.32	united health care	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	47.22	47.22	united health care	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	47.22	47.22	united health care	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	47.22	47.22	united health care	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	47.22	47.22	united health care	epo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	47.22	47.22	united health care	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	epo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	61.53	61.53	united health care	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	1170.32	1170.32	united health care	ppo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	1170.32	1170.32	united health care	pos
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	1170.32	1170.32	united health care	hmo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	1170.32	1170.32	united health care	epo
CT scan of upper spine	cpt	72125	1170.32	1170.32	88.61	88.61	1783.34	1783.34	1486.12	1486.12	O	1170.32	1170.32	united health care	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	230.55	230.55	united health care	ppo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	230.55	230.55	united health care	pos
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	230.55	230.55	united health care	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	230.55	230.55	united health care	epo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	230.55	230.55	22.45	22.45	368.88	368.88	307.4	307.4	O	230.55	230.55	united health care	hmo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	27.03	27.03	united health care	ppo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	27.03	27.03	united health care	pos
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	27.03	27.03	united health care	hmo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	27.03	27.03	united health care	epo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	27.03	27.03	united health care	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	39.16	39.16	21.37	21.37	368.88	368.88	307.4	307.4	E	39.16	39.16	united health care	ppo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	39.16	39.16	21.37	21.37	368.88	368.88	307.4	307.4	E	39.16	39.16	united health care	pos
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	39.16	39.16	21.37	21.37	368.88	368.88	307.4	307.4	E	39.16	39.16	united health care	hmo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	39.16	39.16	21.37	21.37	368.88	368.88	307.4	307.4	E	39.16	39.16	united health care	epo
"X-ray of spine of neck, 2 or 3 views"	cpt	72040	39.16	39.16	21.37	21.37	368.88	368.88	307.4	307.4	E	39.16	39.16	united health care	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	223.4	223.4	united health care	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	223.4	223.4	united health care	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	223.4	223.4	united health care	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	223.4	223.4	united health care	epo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	223.4	223.4	united health care	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	190.01	190.01	united health care	ppo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	190.01	190.01	united health care	pos
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	190.01	190.01	united health care	hmo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	190.01	190.01	united health care	epo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	190.01	190.01	united health care	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.3	9.3	united health care	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.3	9.3	united health care	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.3	9.3	united health care	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.3	9.3	united health care	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.3	9.3	united health care	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	4.61	4.61	72.88	72.88	60.73	60.73	E	45.55	45.55	united health care	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	4.61	4.61	72.88	72.88	60.73	60.73	E	45.55	45.55	united health care	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	4.61	4.61	72.88	72.88	60.73	60.73	E	45.55	45.55	united health care	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	4.61	4.61	72.88	72.88	60.73	60.73	E	45.55	45.55	united health care	epo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	4.61	4.61	72.88	72.88	60.73	60.73	E	45.55	45.55	united health care	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	69.96	69.96	united health care	ppo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	69.96	69.96	united health care	pos
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	69.96	69.96	united health care	hmo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	69.96	69.96	united health care	epo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	69.96	69.96	united health care	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	187.42	187.42	united health care	ppo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	187.42	187.42	united health care	pos
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	187.42	187.42	united health care	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	187.42	187.42	united health care	epo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	187.42	187.42	united health care	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5592.58	5592.58	united health care	ppo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5592.58	5592.58	united health care	pos
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5592.58	5592.58	united health care	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5592.58	5592.58	united health care	epo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	5592.58	5592.58	united health care	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	pos
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	epo
CT scan of blood vessels in chest with contrast	cpt	71275	1195.68	1195.68	159.21	159.21	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	535.83	535.83	united health care	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	535.83	535.83	united health care	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	535.83	535.83	united health care	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	535.83	535.83	united health care	epo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	535.83	535.83	united health care	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	united health care	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	united health care	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	united health care	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	united health care	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	81.09	81.09	united health care	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	535.83	535.83	united health care	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	535.83	535.83	united health care	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	535.83	535.83	united health care	hmo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	535.83	535.83	united health care	epo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	E	535.83	535.83	united health care	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	298.13	298.13	united health care	ppo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	298.13	298.13	united health care	pos
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	298.13	298.13	united health care	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	298.13	298.13	united health care	epo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	298.13	298.13	united health care	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	hmo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	epo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	511.19	511.19	90.7	90.7	817.9	817.9	681.58	681.58	E	511.19	511.19	united health care	ppo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	511.19	511.19	90.7	90.7	817.9	817.9	681.58	681.58	E	511.19	511.19	united health care	pos
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	511.19	511.19	90.7	90.7	817.9	817.9	681.58	681.58	E	511.19	511.19	united health care	hmo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	511.19	511.19	90.7	90.7	817.9	817.9	681.58	681.58	E	511.19	511.19	united health care	epo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	511.19	511.19	90.7	90.7	817.9	817.9	681.58	681.58	E	511.19	511.19	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	united health care	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	united health care	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	united health care	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	166.07	166.07	united health care	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	1225.57	1225.57	united health care	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	1225.57	1225.57	united health care	pos
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	1225.57	1225.57	united health care	hmo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	1225.57	1225.57	united health care	epo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	1225.57	1225.57	united health care	hmo
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	ppo
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	pos
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	hmo
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	epo
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	68.37	68.37	united health care	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	654.29	654.29	united health care	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	654.29	654.29	united health care	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	654.29	654.29	united health care	hmo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	654.29	654.29	united health care	epo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	654.29	654.29	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	united health care	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	united health care	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	united health care	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	59.86	59.86	united health care	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2285.63	2285.63	united health care	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2285.63	2285.63	united health care	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2285.63	2285.63	united health care	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2285.63	2285.63	united health care	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	2285.63	2285.63	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	96.11	96.11	united health care	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	96.11	96.11	united health care	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	96.11	96.11	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	96.11	96.11	united health care	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	96.11	96.11	5.75	5.75	153.78	153.78	128.15	128.15	E	96.11	96.11	united health care	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	372.86	372.86	united health care	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	372.86	372.86	united health care	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	372.86	372.86	united health care	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	372.86	372.86	united health care	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	521.99	521.99	15.25	15.25	596.57	596.57	497.14	497.14	E	372.86	372.86	united health care	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	epo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	1195.68	1195.68	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	united health care	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	united health care	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	united health care	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	united health care	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	37.92	37.92	united health care	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2285.63	2285.63	united health care	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2285.63	2285.63	united health care	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2285.63	2285.63	united health care	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2285.63	2285.63	united health care	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	2285.63	2285.63	united health care	hmo
postoperative and post-traumatic infections without mcc	ms-drg	863	15967.49	15967.49	2487.74	2487.74	15221.04	15221.04	12684.2	12684.2	I	15967.49	15967.49	united health care	ppo
postoperative and post-traumatic infections without mcc	ms-drg	863	15967.49	15967.49	2487.74	2487.74	15221.04	15221.04	12684.2	12684.2	I	15967.49	15967.49	united health care	pos
postoperative and post-traumatic infections without mcc	ms-drg	863	15967.49	15967.49	2487.74	2487.74	15221.04	15221.04	12684.2	12684.2	I	15967.49	15967.49	united health care	hmo
postoperative and post-traumatic infections without mcc	ms-drg	863	15967.49	15967.49	2487.74	2487.74	15221.04	15221.04	12684.2	12684.2	I	15967.49	15967.49	united health care	epo
postoperative and post-traumatic infections without mcc	ms-drg	863	15967.49	15967.49	2487.74	2487.74	15221.04	15221.04	12684.2	12684.2	I	15967.49	15967.49	united health care	hmo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	50.5	50.5	united health care	ppo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	50.5	50.5	united health care	pos
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	50.5	50.5	united health care	hmo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	50.5	50.5	united health care	epo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	50.5	50.5	united health care	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	epo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1986.81	1986.81	united health care	ppo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1986.81	1986.81	united health care	pos
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1986.81	1986.81	united health care	hmo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1986.81	1986.81	united health care	epo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1986.81	1986.81	united health care	hmo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	898.85	898.85	united health care	ppo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	898.85	898.85	united health care	pos
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	898.85	898.85	united health care	hmo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	898.85	898.85	united health care	epo
CT scan pelvis with contrast	cpt	72193	898.85	898.85	158.85	158.85	1507.32	1507.32	1256.1	1256.1	O	898.85	898.85	united health care	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	75.05	75.05	united health care	ppo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	75.05	75.05	united health care	pos
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	75.05	75.05	united health care	hmo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	75.05	75.05	united health care	epo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	75.05	75.05	united health care	hmo
CT scan pelvis with contrast	cpt	72193	989.18	989.18	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	989.18	989.18	united health care	ppo
CT scan pelvis with contrast	cpt	72193	989.18	989.18	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	989.18	989.18	united health care	pos
CT scan pelvis with contrast	cpt	72193	989.18	989.18	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	989.18	989.18	united health care	hmo
CT scan pelvis with contrast	cpt	72193	989.18	989.18	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	989.18	989.18	united health care	epo
CT scan pelvis with contrast	cpt	72193	989.18	989.18	161.43	161.43	1507.32	1507.32	1256.1	1256.1	E	989.18	989.18	united health care	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1933.28	1933.28	united health care	ppo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1933.28	1933.28	united health care	pos
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1933.28	1933.28	united health care	hmo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1933.28	1933.28	united health care	epo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1933.28	1933.28	united health care	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	34.58	34.58	united health care	ppo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	34.58	34.58	united health care	pos
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	34.58	34.58	united health care	hmo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	34.58	34.58	united health care	epo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	34.58	34.58	united health care	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	841.91	841.91	united health care	ppo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	841.91	841.91	united health care	pos
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	841.91	841.91	united health care	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	841.91	841.91	united health care	epo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	841.91	841.91	united health care	hmo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	31.85	31.85	united health care	ppo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	31.85	31.85	united health care	pos
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	31.85	31.85	united health care	hmo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	31.85	31.85	united health care	epo
Antibody identification test for white blood cell antibodies	cpt	86021	31.85	31.85	13.39	13.39	172.28	172.28	143.57	143.57	O	31.85	31.85	united health care	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	pos
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	hmo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	epo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1942.19	1942.19	united health care	hmo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	1688.63	1688.63	united health care	ppo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	1688.63	1688.63	united health care	pos
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	1688.63	1688.63	united health care	hmo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	1688.63	1688.63	united health care	epo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	1688.63	1688.63	united health care	hmo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	841.91	841.91	united health care	ppo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	841.91	841.91	united health care	pos
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	841.91	841.91	united health care	hmo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	841.91	841.91	united health care	epo
bls-emergency	cpt	A0429	841.91	841.91	304.23	304.23	1293.62	1293.62	1078.02	1078.02	O	841.91	841.91	united health care	hmo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	ppo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	pos
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	hmo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	epo
MRI scan of middle spinal canal before and after contrast	cpt	72157	2577.39	2577.39	219.52	219.52	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	hmo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	33.41	33.41	united health care	ppo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	33.41	33.41	united health care	pos
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	33.41	33.41	united health care	hmo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	33.41	33.41	united health care	epo
"Blood glucose (sugar) tolerance test, each additional beyond 3 specimens"	cpt	82952	33.41	33.41	3.49	3.49	52.15	52.15	43.46	43.46	O	33.41	33.41	united health care	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	423.74	423.74	united health care	ppo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	423.74	423.74	united health care	pos
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	423.74	423.74	united health care	hmo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	423.74	423.74	united health care	epo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	423.74	423.74	united health care	hmo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	23.85	23.85	united health care	ppo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	23.85	23.85	united health care	pos
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	23.85	23.85	united health care	hmo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	23.85	23.85	united health care	epo
"Coagulation assessment blood test, substitution, plasma fractions"	cpt	85732	23.85	23.85	4.28	4.28	38.16	38.16	31.8	31.8	O	23.85	23.85	united health care	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1833.84	1833.84	united health care	ppo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1833.84	1833.84	united health care	pos
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1833.84	1833.84	united health care	hmo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1833.84	1833.84	united health care	epo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1833.84	1833.84	united health care	hmo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	ppo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	pos
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	hmo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	epo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	2577.39	2577.39	united health care	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	252.09	252.09	united health care	ppo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	252.09	252.09	united health care	pos
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	252.09	252.09	united health care	hmo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	252.09	252.09	united health care	epo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	252.09	252.09	23.05	23.05	384.14	384.14	320.12	320.12	E	252.09	252.09	united health care	hmo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	59746.02	59746.02	united health care	ppo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	59746.02	59746.02	united health care	pos
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	59746.02	59746.02	united health care	hmo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	59746.02	59746.02	united health care	epo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	59746.02	59746.02	united health care	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	232.14	232.14	united health care	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	232.14	232.14	united health care	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	232.14	232.14	united health care	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	232.14	232.14	united health care	epo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	232.14	232.14	united health care	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	1642.08	1642.08	united health care	ppo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	1642.08	1642.08	united health care	pos
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	1642.08	1642.08	united health care	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	1642.08	1642.08	united health care	epo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	1642.08	1642.08	united health care	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1652.81	1652.81	united health care	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1652.81	1652.81	united health care	pos
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1652.81	1652.81	united health care	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1652.81	1652.81	united health care	epo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	1652.81	1652.81	united health care	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	10082.72	10082.72	united health care	ppo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	10082.72	10082.72	united health care	pos
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	10082.72	10082.72	united health care	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	10082.72	10082.72	united health care	epo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	10082.72	10082.72	united health care	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	5421.31	5421.31	united health care	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	5421.31	5421.31	united health care	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	5421.31	5421.31	united health care	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	5421.31	5421.31	united health care	epo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	5421.31	5421.31	united health care	hmo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	152.64	152.64	20.47	20.47	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	ppo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	152.64	152.64	20.47	20.47	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	pos
"X-ray of pelvis, 1 or 2 views"	cpt	72170	152.64	152.64	20.47	20.47	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	hmo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	152.64	152.64	20.47	20.47	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	epo
"X-ray of pelvis, 1 or 2 views"	cpt	72170	152.64	152.64	20.47	20.47	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	35.04	35.04	united health care	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	35.04	35.04	united health care	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	35.04	35.04	united health care	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	35.04	35.04	united health care	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	35.04	35.04	united health care	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	epo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	2710.24	2710.24	united health care	ppo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	2710.24	2710.24	united health care	pos
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	2710.24	2710.24	united health care	hmo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	2710.24	2710.24	united health care	epo
tc99m medronate	cpt	A9503	2710.24	2710.24	376.66	376.66	5915.28	5915.28	4929.4	4929.4	O	2710.24	2710.24	united health care	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	127330.68	127330.68	united health care	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	127330.68	127330.68	united health care	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	127330.68	127330.68	united health care	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	127330.68	127330.68	united health care	epo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	127330.68	127330.68	united health care	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	92.1	92.1	united health care	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	92.1	92.1	united health care	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	92.1	92.1	united health care	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	92.1	92.1	united health care	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	92.1	92.1	united health care	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	345.82	345.82	united health care	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	345.82	345.82	united health care	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	345.82	345.82	united health care	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	345.82	345.82	united health care	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	345.82	345.82	united health care	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	2994.51	2994.51	united health care	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	2994.51	2994.51	united health care	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	2994.51	2994.51	united health care	hmo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	2994.51	2994.51	united health care	epo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	2994.51	2994.51	united health care	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	232.14	232.14	united health care	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	232.14	232.14	united health care	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	232.14	232.14	united health care	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	232.14	232.14	united health care	epo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	232.14	232.14	united health care	hmo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	38438.58	38438.58	united health care	ppo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	38438.58	38438.58	united health care	pos
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	38438.58	38438.58	united health care	hmo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	38438.58	38438.58	united health care	epo
peritoneal adhesiolysis without cc/mcc	ms-drg	337	38438.58	38438.58	7551.91	7551.91	64945.27	64945.27	54121.06	54121.06	I	38438.58	38438.58	united health care	hmo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	ppo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	pos
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	hmo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	epo
"X-ray of pelvis, minimum of 2 views"	cpt	72220	152.64	152.64	18.36	18.36	244.22	244.22	203.52	203.52	E	152.64	152.64	united health care	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	17.46	17.46	272.21	272.21	226.84	226.84	E	178.64	178.64	united health care	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	178.64	178.64	united health care	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	178.64	178.64	united health care	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	178.64	178.64	united health care	hmo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	178.64	178.64	united health care	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	178.64	178.64	united health care	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	2189.43	2189.43	united health care	ppo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	2189.43	2189.43	united health care	pos
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	2189.43	2189.43	united health care	hmo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	2189.43	2189.43	united health care	epo
"Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level"	cpt	64483	2189.43	2189.43	657.1	657.1	2335.45	2335.45	1946.21	1946.21	O	2189.43	2189.43	united health care	hmo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	30.21	30.21	united health care	ppo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	30.21	30.21	united health care	pos
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	30.21	30.21	united health care	hmo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	30.21	30.21	united health care	epo
"Clotting factor X assessment test, diluted"	cpt	85613	30.21	30.21	5.42	5.42	48.34	48.34	40.28	40.28	O	30.21	30.21	united health care	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	6259.46	6259.46	united health care	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	6259.46	6259.46	united health care	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	6259.46	6259.46	united health care	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	6259.46	6259.46	united health care	epo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	6259.46	6259.46	united health care	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1477.69	1477.69	united health care	ppo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1477.69	1477.69	united health care	pos
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1477.69	1477.69	united health care	hmo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1477.69	1477.69	united health care	epo
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	cpt	62323	1477.69	1477.69	165.81	165.81	2354.11	2354.11	1961.76	1961.76	O	1477.69	1477.69	united health care	hmo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	60.42	60.42	united health care	ppo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	60.42	60.42	united health care	pos
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	60.42	60.42	united health care	hmo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	60.42	60.42	united health care	epo
Platelet function test	cpt	85597	60.42	60.42	10.84	10.84	96.67	96.67	80.56	80.56	O	60.42	60.42	united health care	hmo
Injection of substance into spinal canal of lower back or sacrum	cpt	62322	1477.69	1477.69	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	1477.69	1477.69	united health care	ppo
Injection of substance into spinal canal of lower back or sacrum	cpt	62322	1477.69	1477.69	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	1477.69	1477.69	united health care	pos
Injection of substance into spinal canal of lower back or sacrum	cpt	62322	1477.69	1477.69	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	1477.69	1477.69	united health care	hmo
Injection of substance into spinal canal of lower back or sacrum	cpt	62322	1477.69	1477.69	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	1477.69	1477.69	united health care	epo
Injection of substance into spinal canal of lower back or sacrum	cpt	62322	1477.69	1477.69	505.78	505.78	1667.24	1667.24	1389.37	1389.37	O	1477.69	1477.69	united health care	hmo
Fibrinogen (factor 1) activity measurement	cpt	85384	51	51	8.65	8.65	102.52	102.52	85.43	85.43	O	51	51	united health care	ppo
Fibrinogen (factor 1) activity measurement	cpt	85384	51	51	8.65	8.65	102.52	102.52	85.43	85.43	O	51	51	united health care	pos
Fibrinogen (factor 1) activity measurement	cpt	85384	51	51	8.65	8.65	102.52	102.52	85.43	85.43	O	51	51	united health care	hmo
Fibrinogen (factor 1) activity measurement	cpt	85384	51	51	8.65	8.65	102.52	102.52	85.43	85.43	O	51	51	united health care	epo
Fibrinogen (factor 1) activity measurement	cpt	85384	51	51	8.65	8.65	102.52	102.52	85.43	85.43	O	51	51	united health care	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	2833.93	2833.93	united health care	ppo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	2833.93	2833.93	united health care	pos
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	2833.93	2833.93	united health care	hmo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	2833.93	2833.93	united health care	epo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	2833.93	2833.93	united health care	hmo
Fibrinogen (factor 1) activity measurement	cpt	85384	64.07	64.07	64.07	64.07	102.52	102.52	85.43	85.43	E	64.07	64.07	united health care	ppo
Fibrinogen (factor 1) activity measurement	cpt	85384	64.07	64.07	64.07	64.07	102.52	102.52	85.43	85.43	E	64.07	64.07	united health care	pos
Fibrinogen (factor 1) activity measurement	cpt	85384	64.07	64.07	64.07	64.07	102.52	102.52	85.43	85.43	E	64.07	64.07	united health care	hmo
Fibrinogen (factor 1) activity measurement	cpt	85384	64.07	64.07	64.07	64.07	102.52	102.52	85.43	85.43	E	64.07	64.07	united health care	epo
Fibrinogen (factor 1) activity measurement	cpt	85384	64.07	64.07	64.07	64.07	102.52	102.52	85.43	85.43	E	64.07	64.07	united health care	hmo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	7803.63	7803.63	united health care	ppo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	7803.63	7803.63	united health care	pos
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	7803.63	7803.63	united health care	hmo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	7803.63	7803.63	united health care	epo
Biopsy of prostate gland	cpt	55700	8816.24	8816.24	1569.38	1569.38	15572.48	15572.48	12977.07	12977.07	O	7803.63	7803.63	united health care	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	155.65	155.65	united health care	ppo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	155.65	155.65	united health care	pos
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	155.65	155.65	united health care	hmo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	155.65	155.65	united health care	epo
"X-ray of chest, 1 view"	cpt	71045	155.65	155.65	13.25	13.25	242.95	242.95	202.46	202.46	O	155.65	155.65	united health care	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	26638.49	26638.49	united health care	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	26638.49	26638.49	united health care	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	26638.49	26638.49	united health care	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	26638.49	26638.49	united health care	epo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	26638.49	26638.49	united health care	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	82.6	82.6	united health care	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	82.6	82.6	united health care	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	82.6	82.6	united health care	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	82.6	82.6	united health care	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	82.6	82.6	united health care	hmo
"brachytx, non-str,hdr ir-192"	cpt	C1717	16700.63	16700.63	5450.85	5450.85	24193.44	24193.44	20161.2	20161.2	O	16700.63	16700.63	united health care	ppo
"brachytx, non-str,hdr ir-192"	cpt	C1717	16700.63	16700.63	5450.85	5450.85	24193.44	24193.44	20161.2	20161.2	O	16700.63	16700.63	united health care	pos
"brachytx, non-str,hdr ir-192"	cpt	C1717	16700.63	16700.63	5450.85	5450.85	24193.44	24193.44	20161.2	20161.2	O	16700.63	16700.63	united health care	hmo
"brachytx, non-str,hdr ir-192"	cpt	C1717	16700.63	16700.63	5450.85	5450.85	24193.44	24193.44	20161.2	20161.2	O	16700.63	16700.63	united health care	epo
"brachytx, non-str,hdr ir-192"	cpt	C1717	16700.63	16700.63	5450.85	5450.85	24193.44	24193.44	20161.2	20161.2	O	16700.63	16700.63	united health care	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	17009.14	17009.14	united health care	ppo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	17009.14	17009.14	united health care	pos
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	17009.14	17009.14	united health care	hmo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	17009.14	17009.14	united health care	epo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	17009.14	17009.14	united health care	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	82.6	82.6	united health care	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	82.6	82.6	united health care	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	82.6	82.6	united health care	hmo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	82.6	82.6	united health care	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	82.6	82.6	united health care	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	10996.19	10996.19	united health care	ppo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	10996.19	10996.19	united health care	pos
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	10996.19	10996.19	united health care	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	10996.19	10996.19	united health care	epo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	10996.19	10996.19	united health care	hmo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	6865.24	6865.24	united health care	ppo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	6865.24	6865.24	united health care	pos
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	6865.24	6865.24	united health care	hmo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	6865.24	6865.24	united health care	epo
Critical care delivery critically ill or injured patient	cpt	99292	14238.66	14238.66	1117.84	1117.84	12017.2	12017.2	10014.33	10014.33	O	6865.24	6865.24	united health care	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	151.85	151.85	united health care	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	151.85	151.85	united health care	pos
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	151.85	151.85	united health care	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	151.85	151.85	united health care	epo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	151.85	151.85	united health care	hmo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	22.61	22.61	19.15	19.15	249.31	249.31	207.76	207.76	E	22.61	22.61	united health care	ppo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	22.61	22.61	19.15	19.15	249.31	249.31	207.76	207.76	E	22.61	22.61	united health care	pos
"X-ray of upper arm, minimum of 2 views"	cpt	73060	22.61	22.61	19.15	19.15	249.31	249.31	207.76	207.76	E	22.61	22.61	united health care	hmo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	22.61	22.61	19.15	19.15	249.31	249.31	207.76	207.76	E	22.61	22.61	united health care	epo
"X-ray of upper arm, minimum of 2 views"	cpt	73060	22.61	22.61	19.15	19.15	249.31	249.31	207.76	207.76	E	22.61	22.61	united health care	hmo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	20.28	20.28	united health care	ppo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	20.28	20.28	united health care	pos
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	20.28	20.28	united health care	hmo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	20.28	20.28	united health care	epo
Urine volume measurement	cpt	81050	20.28	20.28	3.24	3.24	32.44	32.44	27.03	27.03	O	20.28	20.28	united health care	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	59.86	59.86	united health care	ppo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	59.86	59.86	united health care	pos
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	59.86	59.86	united health care	hmo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	59.86	59.86	united health care	epo
"Ketone bodies analysis, quantitative"	cpt	82010	59.86	59.86	7.27	7.27	95.77	95.77	79.81	79.81	E	59.86	59.86	united health care	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	5325.99	5325.99	united health care	ppo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	5325.99	5325.99	united health care	pos
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	5325.99	5325.99	united health care	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	5325.99	5325.99	united health care	epo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	5325.99	5325.99	united health care	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	17035.81	17035.81	united health care	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	17035.81	17035.81	united health care	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	17035.81	17035.81	united health care	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	17035.81	17035.81	united health care	epo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	17035.81	17035.81	united health care	hmo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	ppo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	pos
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	hmo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	epo
"Platelet count, automated test"	cpt	85049	25.7	25.7	3.98	3.98	39.17	39.17	32.64	32.64	O	25.7	25.7	united health care	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	ppo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	pos
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	hmo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	epo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	ppo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	pos
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	hmo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	epo
"Red blood count, automated test"	cpt	85045	26.24	26.24	3.55	3.55	41.98	41.98	34.98	34.98	O	26.24	26.24	united health care	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	3009.12	3009.12	united health care	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	3009.12	3009.12	united health care	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	3009.12	3009.12	united health care	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	3009.12	3009.12	united health care	epo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	3009.12	3009.12	united health care	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	28.84	28.84	united health care	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	28.84	28.84	united health care	pos
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	28.84	28.84	united health care	hmo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	28.84	28.84	united health care	epo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	28.84	28.84	united health care	hmo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	2356.82	2356.82	united health care	ppo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	2356.82	2356.82	united health care	pos
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	2356.82	2356.82	united health care	hmo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	2356.82	2356.82	united health care	epo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	2356.82	2356.82	united health care	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3567.22	3567.22	united health care	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3567.22	3567.22	united health care	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3567.22	3567.22	united health care	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3567.22	3567.22	united health care	epo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	3567.22	3567.22	united health care	hmo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	23096.99	23096.99	united health care	ppo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	23096.99	23096.99	united health care	pos
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	23096.99	23096.99	united health care	hmo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	23096.99	23096.99	united health care	epo
guide wire	cpt	C1769	23096.99	23096.99	1592.33	1592.33	47378.09	47378.09	39481.74	39481.74	E	23096.99	23096.99	united health care	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	16039.46	16039.46	united health care	ppo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	16039.46	16039.46	united health care	pos
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	16039.46	16039.46	united health care	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	16039.46	16039.46	united health care	epo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	16039.46	16039.46	united health care	hmo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	13.52	13.52	united health care	ppo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	13.52	13.52	united health care	pos
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	13.52	13.52	united health care	hmo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	13.52	13.52	united health care	epo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	13.52	13.52	united health care	hmo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6117.97	6117.97	united health care	ppo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6117.97	6117.97	united health care	pos
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6117.97	6117.97	united health care	hmo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6117.97	6117.97	united health care	epo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	6117.97	6117.97	united health care	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	541.4	541.4	united health care	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	541.4	541.4	united health care	pos
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	541.4	541.4	united health care	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	541.4	541.4	united health care	epo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	541.4	541.4	united health care	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	793.25	793.25	united health care	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	793.25	793.25	united health care	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	793.25	793.25	united health care	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	793.25	793.25	united health care	epo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	793.25	793.25	united health care	hmo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	ppo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	pos
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	hmo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	epo
"Hydroxyprogesterone, 17-D (synthetic hormone) level"	cpt	83498	85.07	85.07	16.24	16.24	136.1	136.1	113.42	113.42	O	85.07	85.07	united health care	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	pos
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	hmo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	epo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	28.7	28.7	united health care	hmo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	149.46	149.46	united health care	ppo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	149.46	149.46	united health care	pos
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	149.46	149.46	united health care	hmo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	149.46	149.46	united health care	epo
Adrenocorticotropic hormone (ACTH) level	cpt	82024	149.46	149.46	34.35	34.35	239.14	239.14	199.28	199.28	O	149.46	149.46	united health care	hmo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	31.01	31.01	united health care	ppo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	31.01	31.01	united health care	pos
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	31.01	31.01	united health care	hmo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	31.01	31.01	united health care	epo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	31.01	31.01	united health care	hmo
"X-ray of forearm, 2 views"	cpt	73090	163.61	163.61	16.56	16.56	249.31	249.31	207.76	207.76	E	163.61	163.61	united health care	ppo
"X-ray of forearm, 2 views"	cpt	73090	163.61	163.61	16.56	16.56	249.31	249.31	207.76	207.76	E	163.61	163.61	united health care	pos
"X-ray of forearm, 2 views"	cpt	73090	163.61	163.61	16.56	16.56	249.31	249.31	207.76	207.76	E	163.61	163.61	united health care	hmo
"X-ray of forearm, 2 views"	cpt	73090	163.61	163.61	16.56	16.56	249.31	249.31	207.76	207.76	E	163.61	163.61	united health care	epo
"X-ray of forearm, 2 views"	cpt	73090	163.61	163.61	16.56	16.56	249.31	249.31	207.76	207.76	E	163.61	163.61	united health care	hmo
"Blood count, hemoglobin"	cpt	85018	25.22	25.22	2.11	2.11	49.61	49.61	41.34	41.34	E	25.22	25.22	united health care	ppo
"Blood count, hemoglobin"	cpt	85018	25.22	25.22	2.11	2.11	49.61	49.61	41.34	41.34	E	25.22	25.22	united health care	pos
"Blood count, hemoglobin"	cpt	85018	25.22	25.22	2.11	2.11	49.61	49.61	41.34	41.34	E	25.22	25.22	united health care	hmo
"Blood count, hemoglobin"	cpt	85018	25.22	25.22	2.11	2.11	49.61	49.61	41.34	41.34	E	25.22	25.22	united health care	epo
"Blood count, hemoglobin"	cpt	85018	25.22	25.22	2.11	2.11	49.61	49.61	41.34	41.34	E	25.22	25.22	united health care	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	epo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	49.76	49.76	united health care	hmo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	16489.31	16489.31	united health care	ppo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	16489.31	16489.31	united health care	pos
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	16489.31	16489.31	united health care	hmo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	16489.31	16489.31	united health care	epo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	16489.31	16489.31	united health care	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	195.33	195.33	united health care	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	195.33	195.33	united health care	pos
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	195.33	195.33	united health care	hmo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	195.33	195.33	united health care	epo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	195.33	195.33	united health care	hmo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	30.21	30.21	united health care	ppo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	30.21	30.21	united health care	pos
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	30.21	30.21	united health care	hmo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	30.21	30.21	united health care	epo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	30.21	30.21	united health care	hmo
"Emergency department visit, self limited or minor problem"	cpt	99281	137.73	137.73	56.33	56.33	209.88	209.88	174.9	174.9	E	137.73	137.73	united health care	ppo
"Emergency department visit, self limited or minor problem"	cpt	99281	137.73	137.73	56.33	56.33	209.88	209.88	174.9	174.9	E	137.73	137.73	united health care	pos
"Emergency department visit, self limited or minor problem"	cpt	99281	137.73	137.73	56.33	56.33	209.88	209.88	174.9	174.9	E	137.73	137.73	united health care	hmo
"Emergency department visit, self limited or minor problem"	cpt	99281	137.73	137.73	56.33	56.33	209.88	209.88	174.9	174.9	E	137.73	137.73	united health care	epo
"Emergency department visit, self limited or minor problem"	cpt	99281	137.73	137.73	56.33	56.33	209.88	209.88	174.9	174.9	E	137.73	137.73	united health care	hmo
"Established patient office or other outpatient, visit typically 40 minutes"	cpt	99215	467.02	467.02	178.52	178.52	3877.06	3877.06	3230.88	3230.88	O	467.02	467.02	united health care	ppo
"Established patient office or other outpatient, visit typically 40 minutes"	cpt	99215	467.02	467.02	178.52	178.52	3877.06	3877.06	3230.88	3230.88	O	467.02	467.02	united health care	pos
"Established patient office or other outpatient, visit typically 40 minutes"	cpt	99215	467.02	467.02	178.52	178.52	3877.06	3877.06	3230.88	3230.88	O	467.02	467.02	united health care	hmo
"Established patient office or other outpatient, visit typically 40 minutes"	cpt	99215	467.02	467.02	178.52	178.52	3877.06	3877.06	3230.88	3230.88	O	467.02	467.02	united health care	epo
"Established patient office or other outpatient, visit typically 40 minutes"	cpt	99215	467.02	467.02	178.52	178.52	3877.06	3877.06	3230.88	3230.88	O	467.02	467.02	united health care	hmo
Red blood cell concentration measurement	cpt	85014	22.63	22.63	2.11	2.11	44.52	44.52	37.1	37.1	E	22.63	22.63	united health care	ppo
Red blood cell concentration measurement	cpt	85014	22.63	22.63	2.11	2.11	44.52	44.52	37.1	37.1	E	22.63	22.63	united health care	pos
Red blood cell concentration measurement	cpt	85014	22.63	22.63	2.11	2.11	44.52	44.52	37.1	37.1	E	22.63	22.63	united health care	hmo
Red blood cell concentration measurement	cpt	85014	22.63	22.63	2.11	2.11	44.52	44.52	37.1	37.1	E	22.63	22.63	united health care	epo
Red blood cell concentration measurement	cpt	85014	22.63	22.63	2.11	2.11	44.52	44.52	37.1	37.1	E	22.63	22.63	united health care	hmo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	1656.52	1656.52	united health care	ppo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	1656.52	1656.52	united health care	pos
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	1656.52	1656.52	united health care	hmo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	1656.52	1656.52	united health care	epo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	1656.52	1656.52	united health care	hmo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	23096.99	23096.99	united health care	ppo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	23096.99	23096.99	united health care	pos
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	23096.99	23096.99	united health care	hmo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	23096.99	23096.99	united health care	epo
"catheter, guiding"	cpt	C1887	23096.99	23096.99	1429.11	1429.11	64540.26	64540.26	53783.55	53783.55	E	23096.99	23096.99	united health care	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	232.89	232.89	united health care	ppo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	232.89	232.89	united health care	pos
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	232.89	232.89	united health care	hmo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	232.89	232.89	united health care	epo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	232.89	232.89	united health care	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	78.71	78.71	united health care	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	78.71	78.71	united health care	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	78.71	78.71	united health care	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	78.71	78.71	united health care	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	78.71	78.71	united health care	hmo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	14578.4	14578.4	united health care	ppo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	14578.4	14578.4	united health care	pos
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	14578.4	14578.4	united health care	hmo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	14578.4	14578.4	united health care	epo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	14578.4	14578.4	united health care	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	194.95	194.95	united health care	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	194.95	194.95	united health care	pos
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	194.95	194.95	united health care	hmo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	194.95	194.95	united health care	epo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	194.95	194.95	united health care	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	united health care	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	united health care	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	united health care	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	united health care	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	51.68	51.68	united health care	hmo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	23096.99	23096.99	united health care	ppo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	23096.99	23096.99	united health care	pos
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	23096.99	23096.99	united health care	hmo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	23096.99	23096.99	united health care	epo
"intro/sheath, non-laser"	cpt	C1894	23096.99	23096.99	1723.62	1723.62	54105.9	54105.9	45088.25	45088.25	E	23096.99	23096.99	united health care	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	16160.85	16160.85	united health care	ppo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	16160.85	16160.85	united health care	pos
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	16160.85	16160.85	united health care	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	16160.85	16160.85	united health care	epo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	16160.85	16160.85	united health care	hmo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	827.97	827.97	united health care	ppo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	827.97	827.97	united health care	pos
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	827.97	827.97	united health care	hmo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	827.97	827.97	united health care	epo
"Established patient office or other outpatient visit, typically 10 minutes"	cpt	99212	827.97	827.97	65.61	65.61	1122.79	1122.79	935.66	935.66	O	827.97	827.97	united health care	hmo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	12072.4	12072.4	united health care	ppo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	12072.4	12072.4	united health care	pos
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	12072.4	12072.4	united health care	hmo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	12072.4	12072.4	united health care	epo
Partial removal of breast	cpt	19301	12072.4	12072.4	221.33	221.33	22422.11	22422.11	18685.09	18685.09	O	12072.4	12072.4	united health care	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	96.49	96.49	united health care	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	96.49	96.49	united health care	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	96.49	96.49	united health care	hmo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	96.49	96.49	united health care	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	96.49	96.49	united health care	hmo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	235.82	235.82	united health care	ppo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	235.82	235.82	united health care	pos
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	235.82	235.82	united health care	hmo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	235.82	235.82	united health care	epo
"Established patient office or other outpatient visit, typically 5 minutes"	cpt	99211	259.15	259.15	51.31	51.31	427.9	427.9	356.58	356.58	O	235.82	235.82	united health care	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	16039.46	16039.46	united health care	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	16039.46	16039.46	united health care	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	16039.46	16039.46	united health care	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	16039.46	16039.46	united health care	epo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	16039.46	16039.46	united health care	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	221.81	221.81	united health care	hmo
"X-ray of skull, complete, minimum of 4 views"	cpt	70260	342.65	342.65	24.84	24.84	548.23	548.23	456.86	456.86	O	342.65	342.65	united health care	ppo
"X-ray of skull, complete, minimum of 4 views"	cpt	70260	342.65	342.65	24.84	24.84	548.23	548.23	456.86	456.86	O	342.65	342.65	united health care	pos
"X-ray of skull, complete, minimum of 4 views"	cpt	70260	342.65	342.65	24.84	24.84	548.23	548.23	456.86	456.86	O	342.65	342.65	united health care	hmo
"X-ray of skull, complete, minimum of 4 views"	cpt	70260	342.65	342.65	24.84	24.84	548.23	548.23	456.86	456.86	O	342.65	342.65	united health care	epo
"X-ray of skull, complete, minimum of 4 views"	cpt	70260	342.65	342.65	24.84	24.84	548.23	548.23	456.86	456.86	O	342.65	342.65	united health care	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	232.89	232.89	united health care	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	232.89	232.89	united health care	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	232.89	232.89	united health care	hmo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	232.89	232.89	united health care	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	232.89	232.89	united health care	hmo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2233.71	2233.71	united health care	ppo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2233.71	2233.71	united health care	pos
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2233.71	2233.71	united health care	hmo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2233.71	2233.71	united health care	epo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2233.71	2233.71	united health care	hmo
"X-ray of skull, less than 4 views"	cpt	70250	186.03	186.03	21.31	21.31	297.65	297.65	248.04	248.04	E	186.03	186.03	united health care	ppo
"X-ray of skull, less than 4 views"	cpt	70250	186.03	186.03	21.31	21.31	297.65	297.65	248.04	248.04	E	186.03	186.03	united health care	pos
"X-ray of skull, less than 4 views"	cpt	70250	186.03	186.03	21.31	21.31	297.65	297.65	248.04	248.04	E	186.03	186.03	united health care	hmo
"X-ray of skull, less than 4 views"	cpt	70250	186.03	186.03	21.31	21.31	297.65	297.65	248.04	248.04	E	186.03	186.03	united health care	epo
"X-ray of skull, less than 4 views"	cpt	70250	186.03	186.03	21.31	21.31	297.65	297.65	248.04	248.04	E	186.03	186.03	united health care	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	45.32	45.32	united health care	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	45.32	45.32	united health care	pos
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	45.32	45.32	united health care	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	45.32	45.32	united health care	epo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	45.32	45.32	united health care	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	16039.46	16039.46	united health care	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	16039.46	16039.46	united health care	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	16039.46	16039.46	united health care	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	16039.46	16039.46	united health care	epo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	16039.46	16039.46	united health care	hmo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	19333.82	19333.82	united health care	ppo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	19333.82	19333.82	united health care	pos
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	19333.82	19333.82	united health care	hmo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	19333.82	19333.82	united health care	epo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	19333.82	19333.82	united health care	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	122.23	122.23	united health care	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	122.23	122.23	united health care	pos
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	122.23	122.23	united health care	hmo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	122.23	122.23	united health care	epo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	122.23	122.23	united health care	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	23096.99	23096.99	united health care	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	23096.99	23096.99	united health care	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	23096.99	23096.99	united health care	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	23096.99	23096.99	united health care	epo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	23096.99	23096.99	1592.33	1592.33	46025.03	46025.03	38354.19	38354.19	E	23096.99	23096.99	united health care	hmo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	7574.88	7574.88	united health care	ppo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	7574.88	7574.88	united health care	pos
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	7574.88	7574.88	united health care	hmo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	7574.88	7574.88	united health care	epo
cirrhosis and alcoholic hepatitis with cc	ms-drg	433	10629.2	10629.2	5338.33	5338.33	25230.89	25230.89	21025.74	21025.74	I	7574.88	7574.88	united health care	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	epo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	47.82	47.82	united health care	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15942.66	15942.66	united health care	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15942.66	15942.66	united health care	pos
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15942.66	15942.66	united health care	hmo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15942.66	15942.66	united health care	epo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	15942.66	15942.66	united health care	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	6390.02	6390.02	united health care	ppo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	6390.02	6390.02	united health care	pos
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	6390.02	6390.02	united health care	hmo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	6390.02	6390.02	united health care	epo
admin influenza virus vac	cpt	G0008	14191.44	14191.44	325.88	325.88	451.68	451.68	376.4	376.4	O	6390.02	6390.02	united health care	hmo
Aldosterone hormone level	cpt	82088	141.51	141.51	39.93	39.93	226.42	226.42	188.68	188.68	O	141.51	141.51	united health care	ppo
Aldosterone hormone level	cpt	82088	141.51	141.51	39.93	39.93	226.42	226.42	188.68	188.68	O	141.51	141.51	united health care	pos
Aldosterone hormone level	cpt	82088	141.51	141.51	39.93	39.93	226.42	226.42	188.68	188.68	O	141.51	141.51	united health care	hmo
Aldosterone hormone level	cpt	82088	141.51	141.51	39.93	39.93	226.42	226.42	188.68	188.68	O	141.51	141.51	united health care	epo
Aldosterone hormone level	cpt	82088	141.51	141.51	39.93	39.93	226.42	226.42	188.68	188.68	O	141.51	141.51	united health care	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	897.77	897.77	united health care	ppo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	897.77	897.77	united health care	pos
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	897.77	897.77	united health care	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	897.77	897.77	united health care	epo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	897.77	897.77	united health care	hmo
"X-ray of fingers, minimum of 2 views"	cpt	73140	160.27	160.27	23.94	23.94	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	ppo
"X-ray of fingers, minimum of 2 views"	cpt	73140	160.27	160.27	23.94	23.94	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	pos
"X-ray of fingers, minimum of 2 views"	cpt	73140	160.27	160.27	23.94	23.94	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	hmo
"X-ray of fingers, minimum of 2 views"	cpt	73140	160.27	160.27	23.94	23.94	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	epo
"X-ray of fingers, minimum of 2 views"	cpt	73140	160.27	160.27	23.94	23.94	244.22	244.22	203.52	203.52	E	160.27	160.27	united health care	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	424.12	424.12	united health care	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	424.12	424.12	united health care	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	424.12	424.12	united health care	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	424.12	424.12	united health care	epo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	424.12	424.12	united health care	hmo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	2295.35	2295.35	united health care	ppo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	2295.35	2295.35	united health care	pos
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	2295.35	2295.35	united health care	hmo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	2295.35	2295.35	united health care	epo
colorectal scrn; hi risk ind	cpt	G0105	2295.35	2295.35	676.71	676.71	3566.56	3566.56	2972.13	2972.13	O	2295.35	2295.35	united health care	hmo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	13320.63	13320.63	united health care	ppo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	13320.63	13320.63	united health care	pos
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	13320.63	13320.63	united health care	hmo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	13320.63	13320.63	united health care	epo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	13320.63	13320.63	united health care	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	3567.98	3567.98	united health care	ppo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	3567.98	3567.98	united health care	pos
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	3567.98	3567.98	united health care	hmo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	3567.98	3567.98	united health care	epo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	3567.98	3567.98	united health care	hmo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	100.17	100.17	united health care	ppo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	100.17	100.17	united health care	pos
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	100.17	100.17	united health care	hmo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	100.17	100.17	united health care	epo
"Alpha-fetoprotein (AFP) level, serum"	cpt	82105	100.17	100.17	14.92	14.92	160.27	160.27	133.56	133.56	O	100.17	100.17	united health care	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	2133.45	2133.45	united health care	ppo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	2133.45	2133.45	united health care	pos
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	2133.45	2133.45	united health care	hmo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	2133.45	2133.45	united health care	epo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	2133.45	2133.45	united health care	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	1124.67	1124.67	united health care	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	1124.67	1124.67	united health care	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	1124.67	1124.67	united health care	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	1124.67	1124.67	united health care	epo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	10624.85	10624.85	64.2	64.2	2173.44	2173.44	1811.2	1811.2	O	1124.67	1124.67	united health care	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	6677.69	6677.69	united health care	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	6677.69	6677.69	united health care	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	6677.69	6677.69	united health care	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	6677.69	6677.69	united health care	epo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	6677.69	6677.69	united health care	hmo
disorders of pancreas except malignancy without cc/mcc	ms-drg	440	13723.07	13723.07	3523.84	3523.84	16448.54	16448.54	13707.12	13707.12	I	13723.07	13723.07	united health care	ppo
disorders of pancreas except malignancy without cc/mcc	ms-drg	440	13723.07	13723.07	3523.84	3523.84	16448.54	16448.54	13707.12	13707.12	I	13723.07	13723.07	united health care	pos
disorders of pancreas except malignancy without cc/mcc	ms-drg	440	13723.07	13723.07	3523.84	3523.84	16448.54	16448.54	13707.12	13707.12	I	13723.07	13723.07	united health care	hmo
disorders of pancreas except malignancy without cc/mcc	ms-drg	440	13723.07	13723.07	3523.84	3523.84	16448.54	16448.54	13707.12	13707.12	I	13723.07	13723.07	united health care	epo
disorders of pancreas except malignancy without cc/mcc	ms-drg	440	13723.07	13723.07	3523.84	3523.84	16448.54	16448.54	13707.12	13707.12	I	13723.07	13723.07	united health care	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	477.01	477.01	united health care	ppo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	477.01	477.01	united health care	pos
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	477.01	477.01	united health care	hmo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	477.01	477.01	united health care	epo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	477.01	477.01	united health care	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	1581.58	1581.58	united health care	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	1581.58	1581.58	united health care	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	1581.58	1581.58	united health care	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	1581.58	1581.58	united health care	epo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	3099.83	3099.83	107.4	107.4	1865.47	1865.47	1554.56	1554.56	O	1581.58	1581.58	united health care	hmo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	356.16	356.16	united health care	ppo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	356.16	356.16	united health care	pos
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	356.16	356.16	united health care	hmo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	356.16	356.16	united health care	epo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	356.16	356.16	united health care	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	2239.34	2239.34	united health care	ppo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	2239.34	2239.34	united health care	pos
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	2239.34	2239.34	united health care	hmo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	2239.34	2239.34	united health care	epo
"Evaluation of physical therapy, typically 20 minutes"	cpt	97161	2239.34	2239.34	90.94	90.94	2042.4	2042.4	1702	1702	O	2239.34	2239.34	united health care	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	6232.06	6232.06	united health care	ppo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	6232.06	6232.06	united health care	pos
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	6232.06	6232.06	united health care	hmo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	6232.06	6232.06	united health care	epo
"Biopsy of breast accessed through the skin with ultrasound guidance, first lesion"	cpt	19083	6232.06	6232.06	1196.5	1196.5	8369.4	8369.4	6974.5	6974.5	O	6232.06	6232.06	united health care	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	hmo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	epo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	2039.29	2039.29	united health care	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	518.7	518.7	united health care	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	518.7	518.7	united health care	pos
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	518.7	518.7	united health care	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	518.7	518.7	united health care	epo
"Injections of lower or sacral spine facet joint using imaging guidance, third and any additional level(s)"	cpt	64495	3530.58	3530.58	518.7	518.7	4884.82	4884.82	4070.68	4070.68	O	518.7	518.7	united health care	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	228.98	228.98	united health care	ppo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	228.98	228.98	united health care	pos
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	228.98	228.98	united health care	hmo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	228.98	228.98	united health care	epo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	228.98	228.98	united health care	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	518.7	518.7	united health care	ppo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	518.7	518.7	united health care	pos
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	518.7	518.7	united health care	hmo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	518.7	518.7	united health care	epo
"Injections of lower or sacral spine facet joint using imaging guidance, second level"	cpt	64494	3530.58	3530.58	518.7	518.7	4848.4	4848.4	4040.33	4040.33	O	518.7	518.7	united health care	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	6503.5	6503.5	united health care	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	6503.5	6503.5	united health care	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	6503.5	6503.5	united health care	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	6503.5	6503.5	united health care	epo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	6503.5	6503.5	united health care	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	35.39	35.39	united health care	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	35.39	35.39	united health care	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	35.39	35.39	united health care	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	35.39	35.39	united health care	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	35.39	35.39	united health care	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	2460.86	2460.86	united health care	ppo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	2460.86	2460.86	united health care	pos
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	2460.86	2460.86	united health care	hmo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	2460.86	2460.86	united health care	epo
"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes"	cpt	97530	2460.86	2460.86	213.15	213.15	4459.52	4459.52	3716.27	3716.27	O	2460.86	2460.86	united health care	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	34.19	34.19	united health care	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	34.19	34.19	united health care	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	34.19	34.19	united health care	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	34.19	34.19	united health care	epo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	34.19	34.19	united health care	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	6491.02	6491.02	united health care	ppo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	6491.02	6491.02	united health care	pos
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	6491.02	6491.02	united health care	hmo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	6491.02	6491.02	united health care	epo
"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes"	cpt	97140	6491.02	6491.02	634.07	634.07	5543.27	5543.27	4619.39	4619.39	O	6491.02	6491.02	united health care	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6390.02	6390.02	united health care	ppo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6390.02	6390.02	united health care	pos
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6390.02	6390.02	united health care	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6390.02	6390.02	united health care	epo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	6390.02	6390.02	united health care	hmo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	2498.67	2498.67	united health care	ppo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	2498.67	2498.67	united health care	pos
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	2498.67	2498.67	united health care	hmo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	2498.67	2498.67	united health care	epo
"Therapeutic massage to 1 or more areas, each 15 minutes"	cpt	97124	2498.67	2498.67	249.22	249.22	4774.56	4774.56	3978.8	3978.8	O	2498.67	2498.67	united health care	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	147.5	147.5	united health care	ppo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	147.5	147.5	united health care	pos
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	147.5	147.5	united health care	hmo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	147.5	147.5	united health care	epo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	147.5	147.5	26.78	26.78	230.23	230.23	191.86	191.86	E	147.5	147.5	united health care	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	hmo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	epo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	ppo
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	pos
Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour	cpt	96367	5454.5	5454.5	1366.77	1366.77	16410.96	16410.96	13675.8	13675.8	O	4881.58	4881.58	united health care medicare advantage	hmo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	hmo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	ppo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	pos
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	epo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	ppo
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	pos
regadenoson injection	cpt	J2785	10082.72	10082.72	1489.46	1489.46	18139.98	18139.98	15116.65	15116.65	E	1965.52	1965.52	united health care medicare advantage	hmo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	hmo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	ppo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	pos
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	epo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	ppo
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	pos
"injection, udenyca 0.5 mg"	cpt	Q5111	8950.42	8950.42	4309.68	4309.68	42825.26	42825.26	35687.72	35687.72	O	4881.58	4881.58	united health care medicare advantage	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	hmo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	epo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	pos
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	1952.13	1952.13	united health care medicare advantage	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	hmo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	pos
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	epo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	pos
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	889.62	889.62	united health care medicare advantage	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	hmo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	ppo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	pos
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	epo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	ppo
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	pos
tc99m mebrofenin	cpt	A9537	1195.84	1195.84	348.86	348.86	1897.82	1897.82	1581.52	1581.52	O	418.12	418.12	united health care medicare advantage	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	hmo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	ppo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	pos
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	epo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	ppo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	pos
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	296.91	296.91	united health care medicare advantage	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	hmo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	epo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	pos
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	22.38	22.38	united health care medicare advantage	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	hmo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	epo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	15.08	15.08	united health care medicare advantage	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	hmo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	epo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	99.29	99.29	united health care medicare advantage	hmo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	hmo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	ppo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	pos
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	epo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	ppo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	pos
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	388.31	388.31	united health care medicare advantage	hmo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	hmo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	ppo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	pos
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	epo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	ppo
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	pos
leuprolide acetate suspnsion	cpt	J9217	2006.58	2006.58	266.58	266.58	3210.53	3210.53	2675.44	2675.44	O	759.67	759.67	united health care medicare advantage	hmo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	hmo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	ppo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	pos
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	epo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	ppo
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	pos
kidney and urinary tract infections with mcc	ms-drg	689	10878.75	10878.75	6312.25	6312.25	26935.22	26935.22	22446.02	22446.02	I	7109.98	7109.98	united health care medicare advantage	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	hmo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	epo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	pos
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	197.85	197.85	united health care medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	epo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis"	cpt	96366	3225.5	3225.5	710.99	710.99	7846.93	7846.93	6539.11	6539.11	E	2102.95	2102.95	united health care medicare advantage	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	hmo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	ppo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	pos
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	epo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	ppo
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	pos
Infusion of different chemotherapy drug or substance into a vein up to 1 hour	cpt	96417	8152.79	8152.79	4881.58	4881.58	29983.2	29983.2	24986	24986	O	4881.58	4881.58	united health care medicare advantage	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	hmo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	ppo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	pos
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	epo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	ppo
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	pos
Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle	cpt	96402	2772.2	2772.2	266.58	266.58	8842.94	8842.94	7369.12	7369.12	O	1472.58	1472.58	united health care medicare advantage	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	hmo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	epo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	6.36	6.36	united health care medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	62.1	62.1	united health care medicare advantage	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	hmo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	epo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	pos
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	hmo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	epo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	ppo
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	pos
"Evaluation of physical therapy, typically 45 minutes"	cpt	97163	6677.69	6677.69	1054.94	1054.94	16181.48	16181.48	13484.57	13484.57	E	2075.54	2075.54	united health care medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	992.27	992.27	united health care medicare advantage	hmo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	hmo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	ppo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	pos
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	epo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	ppo
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	pos
Total removal of breast	cpt	19303	4639.61	4639.61	4547.22	4547.22	27091.91	27091.91	22576.59	22576.59	O	4547.22	4547.22	united health care medicare advantage	hmo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	hmo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	ppo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	pos
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	epo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	ppo
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	pos
non-heu tc-99m add-on/dose	cpt	Q9969	1130.05	1130.05	586.4	586.4	8903.83	8903.83	7419.86	7419.86	O	1128.66	1128.66	united health care medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	epo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	69.29	69.29	united health care medicare advantage	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	hmo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	69.71	69.71	united health care medicare advantage	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	hmo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	epo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	ppo
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	pos
Nuclear medicine study with CT imaging skull base to mid-thigh	cpt	78815	4915.33	4915.33	1196.94	1196.94	7672.7	7672.7	6393.92	6393.92	O	1278.4	1278.4	united health care medicare advantage	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	hmo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	epo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	pos
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	5.18	5.18	united health care medicare advantage	hmo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	hmo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	ppo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	pos
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	epo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	ppo
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	pos
Removal of both knee cartilages using an endoscope	cpt	29880	16311.44	16311.44	2252.71	2252.71	22144.92	22144.92	18454.1	18454.1	O	2425.05	2425.05	united health care medicare advantage	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	hmo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	ppo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	pos
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	epo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	ppo
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	pos
embolization protect syst	cpt	C1884	14120.9	14120.9	8185.32	8185.32	75631.02	75631.02	63025.85	63025.85	O	14036.18	14036.18	united health care medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	hmo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	epo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	pos
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1067.2	1067.2	united health care medicare advantage	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	hmo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	pos
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	epo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	pos
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	2440.04	2440.04	united health care medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	epo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes"	cpt	99152	16039.46	16039.46	2411.79	2411.79	26116.43	26116.43	21763.69	21763.69	O	13951.45	13951.45	united health care medicare advantage	hmo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	hmo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	ppo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	pos
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	epo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	ppo
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	pos
"cath, trans atherec,rotation"	cpt	C1724	14120.9	14120.9	14120.9	14120.9	119615.33	119615.33	99679.44	99679.44	O	14120.9	14120.9	united health care medicare advantage	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	hmo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	8.07	8.07	united health care medicare advantage	hmo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	hmo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	ppo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	pos
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	epo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	ppo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	pos
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	1952.13	1952.13	united health care medicare advantage	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	hmo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	epo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	pos
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	770.82	770.82	united health care medicare advantage	hmo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	hmo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	ppo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	pos
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	epo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	ppo
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	pos
Evaluation of swallowing function	cpt	92610	2136.63	2136.63	869.58	869.58	17501.99	17501.99	14584.99	14584.99	E	2082.23	2082.23	united health care medicare advantage	hmo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	hmo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	ppo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	pos
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	epo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	ppo
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	pos
etoposide injection	cpt	J9181	5489.65	5489.65	299.23	299.23	26754.95	26754.95	22295.79	22295.79	O	4881.58	4881.58	united health care medicare advantage	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	hmo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	epo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	29.78	29.78	united health care medicare advantage	hmo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	hmo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	ppo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	pos
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	epo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	ppo
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	pos
complications of treatment with cc	ms-drg	920	10317.22	10317.22	3798.86	3798.86	15884.95	15884.95	13237.46	13237.46	I	6154.82	6154.82	united health care medicare advantage	hmo
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	hmo
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	ppo
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	pos
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	epo
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	ppo
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	pos
hypertension with mcc	ms-drg	304	7313.51	7313.51	4015.28	4015.28	32827.03	32827.03	27355.86	27355.86	I	5197.6	5197.6	united health care medicare advantage	hmo
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	hmo
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	ppo
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	pos
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	epo
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	ppo
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	pos
"cath, thrombectomy/embolect"	cpt	C1757	13951.45	13951.45	8630.33	8630.33	38902.45	38902.45	32418.71	32418.71	O	13951.45	13951.45	united health care medicare advantage	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	hmo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	ppo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	pos
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	epo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	ppo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	pos
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	4906.66	4906.66	united health care medicare advantage	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	hmo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	ppo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	pos
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	epo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	ppo
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	pos
diphenhydramine hcl injectio	cpt	J1200	17916.14	17916.14	474.34	474.34	16100.98	16100.98	13417.48	13417.48	O	1965.52	1965.52	united health care medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	10.56	10.56	united health care medicare advantage	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	hmo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	pos
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	epo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	pos
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	1379.67	1379.67	united health care medicare advantage	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	hmo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	epo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	pos
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	536.02	536.02	united health care medicare advantage	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	hmo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	ppo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	pos
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	epo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	ppo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	pos
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	99.29	99.29	united health care medicare advantage	hmo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	hmo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	ppo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	pos
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	epo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	ppo
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	pos
X-ray of large bowel with air contrast	cpt	74280	318.52	318.52	158.53	158.53	1001.06	1001.06	834.22	834.22	O	158.53	158.53	united health care medicare advantage	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	hmo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	9.02	9.02	united health care medicare advantage	hmo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	hmo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	ppo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	pos
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	epo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	ppo
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	pos
"cath, trans atherectomy, dir"	cpt	C1714	14120.9	14120.9	11449.31	11449.31	97804.18	97804.18	81503.48	81503.48	O	13951.45	13951.45	united health care medicare advantage	hmo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	hmo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	ppo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	pos
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	epo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	ppo
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	pos
inj ferric carboxymaltos 1mg	cpt	J1439	2651.78	2651.78	763.52	763.52	4104.74	4104.74	3420.62	3420.62	O	992.27	992.27	united health care medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	1067.2	1067.2	united health care medicare advantage	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	hmo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	pos
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	epo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	pos
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	69.29	69.29	united health care medicare advantage	hmo
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	hmo
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	ppo
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	pos
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	epo
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	ppo
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	pos
Removal of joint lining from two or more knee joint compartments using an endoscope	cpt	29876	2425.05	2425.05	2425.05	2425.05	21015.66	21015.66	17513.05	17513.05	O	2425.05	2425.05	united health care medicare advantage	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	hmo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	hmo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	epo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	pos
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	1032.79	1032.79	united health care medicare advantage	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	hmo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	epo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	pos
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	8.74	8.74	united health care medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	pos
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	epo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	pos
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	1267.16	1267.16	united health care medicare advantage	hmo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	hmo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	ppo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	pos
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	epo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	ppo
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	pos
"Measurement of complement (immune system proteins), total hemolytic"	cpt	86162	20.32	20.32	18.07	18.07	149.56	149.56	124.63	124.63	O	20.32	20.32	united health care medicare advantage	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	hmo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	epo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	2.7	2.7	united health care medicare advantage	hmo
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	hmo
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	ppo
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	pos
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	epo
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	ppo
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	pos
"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin, initial vessel"	cpt	37184	13951.45	13951.45	13951.45	13951.45	162973.19	162973.19	135810.99	135810.99	O	13951.45	13951.45	united health care medicare advantage	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	hmo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	5.18	5.18	united health care medicare advantage	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	hmo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	ppo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	pos
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	epo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	ppo
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	pos
carboplatin injection	cpt	J9045	23772.44	23772.44	1279.57	1279.57	25273.42	25273.42	21061.18	21061.18	O	4881.58	4881.58	united health care medicare advantage	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	hmo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	epo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	ppo
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	pos
fosaprepitant injection	cpt	J1453	7649.74	7649.74	2286.87	2286.87	24852.24	24852.24	20710.2	20710.2	O	4881.58	4881.58	united health care medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	6.47	6.47	united health care medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	hmo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	415.61	415.61	united health care medicare advantage	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	hmo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	epo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	ppo
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	pos
palonosetron hcl	cpt	J2469	9805.54	9805.54	2458.54	2458.54	22005.6	22005.6	18338	18338	O	4881.58	4881.58	united health care medicare advantage	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	hmo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	16.8	16.8	united health care medicare advantage	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	hmo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	epo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	pos
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	1965.52	1965.52	united health care medicare advantage	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	hmo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	epo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	pos
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	4282.09	4282.09	united health care medicare advantage	hmo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	hmo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	ppo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	pos
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	epo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	ppo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	pos
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	5064.95	5064.95	united health care medicare advantage	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	hmo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	epo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	70.7	70.7	united health care medicare advantage	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	hmo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	united health care medicare advantage	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	hmo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	ppo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	pos
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	epo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	ppo
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	pos
CT scan head or brain	cpt	70450	1642.08	1642.08	13.89	13.89	2644.49	2644.49	2203.74	2203.74	O	97.9	97.9	united health care medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	hmo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	epo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	ppo
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	pos
"Moderate sedation services by physician also performing a procedure, additional 15 minutes"	cpt	99153	16039.46	16039.46	2411.79	2411.79	24539.93	24539.93	20449.94	20449.94	O	13951.45	13951.45	united health care medicare advantage	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	hmo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	pos
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	epo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	pos
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	2455.02	2455.02	united health care medicare advantage	hmo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	hmo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	ppo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	pos
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	epo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	ppo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	pos
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	770.82	770.82	united health care medicare advantage	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	hmo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	epo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	pos
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	4881.58	4881.58	united health care medicare advantage	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	hmo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	epo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	ppo
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	pos
"Evaluation of physical therapy, typically 30 minutes"	cpt	97162	2116.34	2116.34	2041.43	2041.43	17108.82	17108.82	14257.35	14257.35	E	2116.34	2116.34	united health care medicare advantage	hmo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	hmo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	ppo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	pos
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	epo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	ppo
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	pos
acetaminophen injection	cpt	J0131	21270.9	21270.9	720.95	720.95	9509.64	9509.64	7924.7	7924.7	E	2048.12	2048.12	united health care medicare advantage	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	hmo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	epo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	pos
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	hmo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	ppo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	pos
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	epo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	ppo
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	pos
"Radiation treatment delivery, complex"	cpt	77412	660.29	660.29	205.21	205.21	1006.15	1006.15	838.46	838.46	O	205.21	205.21	united health care medicare advantage	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	hmo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	epo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	pos
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	8.08	8.08	united health care medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	10082.72	10082.72	1489.46	1489.46	18299.95	18299.95	15249.96	15249.96	E	1965.52	1965.52	united health care medicare advantage	hmo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	hmo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	ppo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	pos
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	epo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	ppo
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	pos
inj heparin sodium per 1000u	cpt	J1644	23096.99	23096.99	1153.4	1153.4	14665.32	14665.32	12221.1	12221.1	E	2116.34	2116.34	united health care medicare advantage	hmo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	hmo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	ppo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	pos
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	epo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	ppo
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	pos
transient ischemia without thrombolytic	ms-drg	69	5809.49	5809.49	4000.83	4000.83	27147.31	27147.31	22622.76	22622.76	I	5559.48	5559.48	united health care medicare advantage	hmo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	hmo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	ppo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	pos
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	epo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	ppo
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	pos
"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure"	cpt	37227	14120.9	14120.9	13053.92	13053.92	119615.33	119615.33	99679.44	99679.44	O	13951.45	13951.45	united health care medicare advantage	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	hmo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	2.25	2.25	united health care medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	hmo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	676.44	676.44	united health care medicare advantage	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	hmo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	pos
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	epo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	pos
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	4282.09	4282.09	united health care medicare advantage	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	hmo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	ppo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	pos
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	epo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	ppo
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	pos
inj heparin sodium per 1000u	cpt	J1644	16160.85	16160.85	2489.54	2489.54	24660.7	24660.7	20550.58	20550.58	O	8238.08	8238.08	united health care medicare advantage	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	hmo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	epo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	206.45	206.45	united health care medicare advantage	hmo
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	hmo
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	ppo
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	pos
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	epo
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	ppo
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	pos
fractures of hip and pelvis without mcc	ms-drg	536	5056.63	5056.63	4866.91	4866.91	16940.58	16940.58	14117.15	14117.15	I	4866.91	4866.91	united health care medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	hmo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	epo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	70.09	70.09	united health care medicare advantage	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	hmo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	epo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	ppo
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	pos
inj enoxaparin sodium	cpt	J1650	8278.58	8278.58	1189.42	1189.42	15756.58	15756.58	13130.48	13130.48	E	2102.95	2102.95	united health care medicare advantage	hmo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	hmo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	ppo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	pos
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	epo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	ppo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	pos
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	388.31	388.31	united health care medicare advantage	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	hmo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	epo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	pos
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	1108.98	1108.98	united health care medicare advantage	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	hmo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	epo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	pos
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1128.66	1128.66	united health care medicare advantage	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	hmo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	ppo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	pos
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	epo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	ppo
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	pos
morphine sulfate injection	cpt	J2270	19270.59	19270.59	689	689	13027.27	13027.27	10856.06	10856.06	O	13951.45	13951.45	united health care medicare advantage	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	hmo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	epo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	pos
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	8.65	8.65	united health care medicare advantage	hmo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	hmo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	ppo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	pos
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	epo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	ppo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	pos
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	2048.12	2048.12	united health care medicare advantage	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	hmo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	epo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	pos
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	710.37	710.37	united health care medicare advantage	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	hmo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	epo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	ppo
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	pos
septicemia or severe sepsis with mv >96 hours	ms-drg	870	127330.68	127330.68	11468.13	11468.13	196722.26	196722.26	163935.22	163935.22	I	11468.13	11468.13	united health care medicare advantage	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	hmo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	8.46	8.46	united health care medicare advantage	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	hmo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	ppo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	pos
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	epo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	ppo
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	pos
"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report"	cpt	93288	215.45	215.45	31.47	31.47	344.71	344.71	287.26	287.26	O	31.47	31.47	united health care medicare advantage	hmo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	hmo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	ppo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	pos
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	epo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	ppo
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	pos
"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure"	cpt	37228	14120.9	14120.9	11383.48	11383.48	92185.34	92185.34	76821.12	76821.12	O	13951.45	13951.45	united health care medicare advantage	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	hmo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	ppo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	pos
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	epo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	ppo
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	pos
"intro/sheath, non-laser"	cpt	C1894	16160.85	16160.85	2524.71	2524.71	31247.75	31247.75	26039.79	26039.79	O	13951.45	13951.45	united health care medicare advantage	hmo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	hmo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	ppo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	pos
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	epo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	ppo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	pos
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	829.53	829.53	united health care medicare advantage	hmo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	hmo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	ppo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	pos
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	epo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	ppo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	pos
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	388.31	388.31	united health care medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	hmo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	ppo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	pos
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	epo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	ppo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	pos
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	206.45	206.45	united health care medicare advantage	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	hmo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	pos
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	epo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	pos
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	2524.71	2524.71	united health care medicare advantage	hmo
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	hmo
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	ppo
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	pos
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	epo
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	ppo
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	pos
"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure"	cpt	37229	14120.9	14120.9	14120.9	14120.9	97473.85	97473.85	81228.21	81228.21	O	14120.9	14120.9	united health care medicare advantage	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	hmo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	ppo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	pos
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	epo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	ppo
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	pos
"stent, non-coa/non-cov w/del"	cpt	C1876	14120.9	14120.9	2674.06	2674.06	69550.22	69550.22	57958.52	57958.52	O	13951.45	13951.45	united health care medicare advantage	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	hmo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	epo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	14.18	14.18	united health care medicare advantage	hmo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	hmo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	ppo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	pos
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	epo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	ppo
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	pos
absorpt drg >16 <=48 w/o bdr	cpt	A6252	278.52	278.52	100.65	100.65	1273.49	1273.49	1061.24	1061.24	O	100.65	100.65	united health care medicare advantage	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	hmo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	202.33	202.33	united health care medicare advantage	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	hmo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	pos
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	epo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	pos
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	2425.05	2425.05	united health care medicare advantage	hmo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	hmo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	ppo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	pos
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	epo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	ppo
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	pos
furosemide injection	cpt	J1940	5563.26	5563.26	934.71	934.71	10630.08	10630.08	8858.4	8858.4	E	1952.13	1952.13	united health care medicare advantage	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	hmo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	pos
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	epo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	pos
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	4547.22	4547.22	united health care medicare advantage	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	hmo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	epo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	pos
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	47.76	47.76	united health care medicare advantage	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	hmo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	ppo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	pos
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	epo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	ppo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	pos
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	331.51	331.51	united health care medicare advantage	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	hmo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	ppo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	pos
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	epo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	ppo
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	pos
furosemide injection	cpt	J1940	4187.14	4187.14	309.3	309.3	12590.1	12590.1	10491.75	10491.75	O	1965.52	1965.52	united health care medicare advantage	hmo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	hmo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	ppo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	pos
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	epo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	ppo
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	pos
"Removal of tissue from wounds per session, each additional 20 sq cm"	cpt	97598	257.49	257.49	151.7	151.7	2237.82	2237.82	1864.85	1864.85	O	151.7	151.7	united health care medicare advantage	hmo
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	hmo
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	ppo
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	pos
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	epo
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	ppo
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	pos
absorpt drg > 48 sq in w/o b	cpt	A6253	1346.02	1346.02	100.65	100.65	2537.39	2537.39	2114.49	2114.49	O	100.65	100.65	united health care medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	7694.58	7694.58	1325.13	1325.13	16579.92	16579.92	13816.6	13816.6	E	2048.12	2048.12	united health care medicare advantage	hmo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	hmo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	ppo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	pos
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	epo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	ppo
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	pos
Repair of groin hernia patient age 5 years or older	cpt	49505	2754.5	2754.5	2537.42	2537.42	19425.92	19425.92	16188.27	16188.27	O	2754.5	2754.5	united health care medicare advantage	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	hmo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	pos
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	epo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	pos
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	3518.3	3518.3	united health care medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	hmo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	ppo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	pos
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	epo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	ppo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	pos
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	948.37	948.37	united health care medicare advantage	hmo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	hmo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	ppo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	pos
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	epo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	ppo
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	pos
levetiracetam injection	cpt	J1953	3173.26	3173.26	180.31	180.31	4085.39	4085.39	3404.49	3404.49	E	508.17	508.17	united health care medicare advantage	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	hmo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	ppo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	pos
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	epo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	ppo
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	pos
tc99m sestamibi	cpt	A9500	10082.72	10082.72	1489.46	1489.46	18292.38	18292.38	15243.65	15243.65	E	1965.52	1965.52	united health care medicare advantage	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	hmo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	6.01	6.01	united health care medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	hmo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	426.62	426.62	united health care medicare advantage	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	hmo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	epo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	united health care medicare advantage	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	hmo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	epo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	ppo
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	pos
Natriuretic peptide (heart and blood vessel protein) level	cpt	83880	89.87	89.87	23.26	23.26	140.29	140.29	116.91	116.91	O	39.26	39.26	united health care medicare advantage	hmo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	hmo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	ppo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	pos
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	epo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	ppo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	pos
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	2425.05	2425.05	united health care medicare advantage	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	hmo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	ppo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	pos
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	epo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	ppo
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	pos
Imaging of liver and bile duct system with use of drugs	cpt	78227	1030.32	1030.32	345.06	345.06	1648.51	1648.51	1373.76	1373.76	O	418.12	418.12	united health care medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	ppo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	pos
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	epo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	ppo
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	pos
Transfusion of blood or blood products	cpt	36430	3837.05	3837.05	1238.1	1238.1	9634.22	9634.22	8028.52	8028.52	E	1952.13	1952.13	united health care medicare advantage	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	hmo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	ppo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	pos
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	epo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	ppo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	pos
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	11672.55	11672.55	united health care medicare advantage	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	hmo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	epo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	ppo
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	pos
hospital observation per hr	cpt	G0378	8278.58	8278.58	1934.02	1934.02	14212.01	14212.01	11843.34	11843.34	E	2006.82	2006.82	united health care medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	hmo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	epo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	ppo
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	pos
Insertion of catheter in left heart for imaging of blood vessels and left lower heart including imaging interpretation and supervision and injection	cpt	93458	16100.16	16100.16	700.09	700.09	27567.08	27567.08	22972.57	22972.57	O	2524.71	2524.71	united health care medicare advantage	hmo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	hmo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	ppo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	pos
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	epo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	ppo
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	pos
lorazepam injection	cpt	J2060	3662.54	3662.54	465.08	465.08	6132.2	6132.2	5110.17	5110.17	E	508.17	508.17	united health care medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	hmo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	9.71	9.71	united health care medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	ppo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	pos
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	epo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	ppo
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	pos
rbc leukocytes reduced	cpt	P9016	6865.24	6865.24	707.85	707.85	3894.85	3894.85	3245.71	3245.71	O	1965.52	1965.52	united health care medicare advantage	hmo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	hmo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	ppo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	pos
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	epo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	ppo
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	pos
syncope and collapse	ms-drg	312	5784.83	5784.83	5099.7	5099.7	21273.84	21273.84	17728.2	17728.2	I	5099.7	5099.7	united health care medicare advantage	hmo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	hmo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	ppo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	pos
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	epo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	ppo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	pos
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	2425.05	2425.05	united health care medicare advantage	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	hmo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	ppo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	pos
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	epo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	ppo
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	pos
Repair of groin hernia using an endoscope	cpt	49650	19046.96	19046.96	3914.78	3914.78	27702.36	27702.36	23085.3	23085.3	O	4282.09	4282.09	united health care medicare advantage	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	hmo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	epo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	10597.75	10597.75	united health care medicare advantage	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	hmo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	epo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	214.42	214.42	united health care medicare advantage	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	hmo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	pos
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	epo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	pos
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	97.31	97.31	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	pos
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	epo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	pos
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1134.65	1134.65	united health care medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	hmo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	1965.52	1965.52	united health care medicare advantage	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	hmo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	ppo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	pos
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	epo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	ppo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	pos
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	82.1	82.1	united health care medicare advantage	hmo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	hmo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	ppo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	pos
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	epo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	ppo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	pos
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	2425.05	2425.05	united health care medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	pos
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	epo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	pos
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	6290.88	6290.88	united health care medicare advantage	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	hmo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	epo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	8625.11	8625.11	united health care medicare advantage	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	hmo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	epo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	pos
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	277.79	277.79	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	pos
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	epo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	pos
normal saline solution infus	cpt	J7040	13467.02	13467.02	607.33	607.33	6728.22	6728.22	5606.85	5606.85	E	1952.13	1952.13	united health care medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	hmo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	20.65	20.65	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	pos
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	epo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	pos
normal saline solution infus	cpt	J7030	14120.9	14120.9	1215.96	1215.96	7236.16	7236.16	6030.13	6030.13	O	13951.45	13951.45	united health care medicare advantage	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	hmo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	epo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	6.7	6.7	united health care medicare advantage	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	hmo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	ppo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	pos
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	epo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	ppo
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	pos
hospital outpt clinic visit	cpt	G0463	343.78	343.78	100.65	100.65	200.98	200.98	167.48	167.48	O	100.65	100.65	united health care medicare advantage	hmo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	hmo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	ppo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	pos
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	epo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	ppo
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	pos
multiple sclerosis and cerebellar ataxia without cc/mcc	ms-drg	60	12264.64	12264.64	4928.35	4928.35	22907.23	22907.23	19089.36	19089.36	I	5287.75	5287.75	united health care medicare advantage	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	hmo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	epo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	pos
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	4.29	4.29	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	hmo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	pos
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	epo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	pos
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	2034.24	2034.24	united health care medicare advantage	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	hmo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	ppo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	pos
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	epo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	ppo
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	pos
hospital observation per hr	cpt	G0378	6461	6461	1357.6	1357.6	26060.05	26060.05	21716.71	21716.71	O	1965.52	1965.52	united health care medicare advantage	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	hmo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	20.05	20.05	united health care medicare advantage	hmo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	hmo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	ppo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	pos
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	epo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	ppo
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	pos
mesh (implantable)	cpt	C1781	7519.16	7519.16	2754.5	2754.5	27398.15	27398.15	22831.79	22831.79	O	2754.5	2754.5	united health care medicare advantage	hmo
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	hmo
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	ppo
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	pos
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	epo
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	ppo
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	pos
Iron level	cpt	83540	1862.13	1862.13	5.75	5.75	114.6	114.6	95.5	95.5	E	1862.13	1862.13	united health care medicare advantage	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	hmo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	ppo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	pos
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	epo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	ppo
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	pos
inj magnesium sulfate	cpt	J3475	13951.45	13951.45	832.09	832.09	17617.84	17617.84	14681.53	14681.53	O	13951.45	13951.45	united health care medicare advantage	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	hmo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	epo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	ppo
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	pos
f18 fdg	cpt	A9552	6259.46	6259.46	1199.86	1199.86	9771.23	9771.23	8142.69	8142.69	O	1278.4	1278.4	united health care medicare advantage	hmo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	hmo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	ppo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	pos
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	epo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	ppo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	pos
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	9413.16	9413.16	united health care medicare advantage	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	hmo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	4.43	4.43	united health care medicare advantage	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	hmo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	ppo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	pos
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	epo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	ppo
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	pos
"Balloon dilation of esophagus, stomach and upper small bowel using a flexible endoscope"	cpt	43249	4236.59	4236.59	1293.56	1293.56	5704.44	5704.44	4753.7	4753.7	O	1379.67	1379.67	united health care medicare advantage	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	hmo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	16.99	16.99	united health care medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	hmo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	7.77	7.77	united health care medicare advantage	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	hmo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	epo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	ppo
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	pos
"Emergency department visit, problem with significant threat to life or function"	cpt	99285	7986.58	7986.58	609.71	609.71	9248.9	9248.9	7707.42	7707.42	E	1952.13	1952.13	united health care medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	hmo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	ppo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	pos
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	epo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	ppo
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	pos
rbc leukocytes reduced	cpt	P9016	3837.05	3837.05	936.47	936.47	8320.81	8320.81	6934.01	6934.01	E	1952.13	1952.13	united health care medicare advantage	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	hmo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	epo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	3792.31	3792.31	919.47	919.47	10709.24	10709.24	8924.37	8924.37	E	1965.52	1965.52	united health care medicare advantage	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	hmo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	epo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	18.39	18.39	united health care medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	2102.95	2102.95	united health care medicare advantage	hmo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	hmo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	ppo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	pos
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	epo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	ppo
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	pos
extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	981	29373.69	29373.69	1364	1364	90106.88	90106.88	75089.07	75089.07	I	1364	1364	united health care medicare advantage	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	hmo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	ppo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	pos
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	epo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	ppo
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	pos
"Evaluation of occupational therapy established plan of care, typically 60 minutes"	cpt	97167	2109.65	2109.65	1084.08	1084.08	16816.88	16816.88	14014.07	14014.07	E	2109.65	2109.65	united health care medicare advantage	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	hmo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	epo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	ppo
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	pos
Urine microalbumin (protein) level	cpt	82043	47.82	47.82	5.14	5.14	72.88	72.88	60.73	60.73	O	5.78	5.78	united health care medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	9805.54	9805.54	1660.16	1660.16	20760	20760	17300	17300	O	4881.58	4881.58	united health care medicare advantage	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	hmo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	epo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	pos
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	6.47	6.47	united health care medicare advantage	hmo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	hmo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	ppo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	pos
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	epo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	ppo
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	pos
tirofiban hcl	cpt	J3246	14156.17	14156.17	8630.33	8630.33	79426.56	79426.56	66188.8	66188.8	O	13951.45	13951.45	united health care medicare advantage	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	hmo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	ppo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	pos
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	epo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	ppo
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	pos
Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle	cpt	96401	15419.2	15419.2	851.57	851.57	18354.96	18354.96	15295.8	15295.8	O	3014.64	3014.64	united health care medicare advantage	hmo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	hmo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	ppo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	pos
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	epo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	ppo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	pos
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	83.26	83.26	united health care medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	hmo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	ppo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	pos
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	epo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	ppo
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	pos
Transfusion of blood or blood products	cpt	36430	6865.24	6865.24	663.49	663.49	3881.7	3881.7	3234.75	3234.75	O	1965.52	1965.52	united health care medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	hmo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	epo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	pos
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	829.53	829.53	united health care medicare advantage	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	hmo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	epo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	pos
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	58.51	58.51	united health care medicare advantage	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	hmo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	ppo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	pos
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	epo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	ppo
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	pos
ambulatory surgical boot eac	cpt	L3260	572.85	572.85	102.7	102.7	1959.44	1959.44	1632.87	1632.87	O	151.7	151.7	united health care medicare advantage	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	hmo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	ppo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	pos
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	epo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	ppo
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	pos
"Critical care delivery critically ill or injured patient, first 30-74 minutes"	cpt	99291	5325.99	5325.99	787.11	787.11	9663.88	9663.88	8053.23	8053.23	O	1965.52	1965.52	united health care medicare advantage	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	hmo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	pos
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	epo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	pos
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	2754.5	2754.5	united health care medicare advantage	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	hmo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	epo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	ppo
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	pos
Radiation therapy consultation per week	cpt	77336	194.78	194.78	109.9	109.9	311.64	311.64	259.7	259.7	O	109.9	109.9	united health care medicare advantage	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	hmo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	ppo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	pos
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	epo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	ppo
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	pos
"injection, fulvestrant"	cpt	J9395	10340.17	10340.17	1275.13	1275.13	9285.05	9285.05	7737.54	7737.54	O	2185.48	2185.48	united health care medicare advantage	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	hmo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	pos
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	epo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	pos
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	4282.09	4282.09	united health care medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	2102.95	2102.95	united health care medicare advantage	hmo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	hmo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	ppo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	pos
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	epo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	ppo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	pos
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	2102.95	2102.95	united health care medicare advantage	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	hmo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	epo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	8.17	8.17	united health care medicare advantage	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	hmo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	epo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	98.3	98.3	united health care medicare advantage	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	hmo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	ppo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	pos
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	epo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	ppo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	pos
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	750.44	750.44	united health care medicare advantage	hmo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	hmo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	ppo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	pos
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	epo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	ppo
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	pos
fentanyl citrate injection	cpt	J3010	21270.9	21270.9	669.04	669.04	8781.7	8781.7	7318.08	7318.08	E	829.53	829.53	united health care medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	26702.62	26702.62	906.43	906.43	6417.79	6417.79	5348.16	5348.16	O	1965.52	1965.52	united health care medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	hmo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	epo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	pos
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	800.18	800.18	united health care medicare advantage	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	hmo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	ppo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	pos
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	epo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	ppo
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	pos
"catheter, guiding"	cpt	C1887	14156.17	14156.17	2489.54	2489.54	59222.6	59222.6	49352.17	49352.17	O	14036.18	14036.18	united health care medicare advantage	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	hmo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	epo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	12634.22	12634.22	united health care medicare advantage	hmo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	hmo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	ppo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	pos
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	epo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	ppo
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	pos
Vancomycin (antibiotic) level	cpt	80202	36.28	36.28	12.04	12.04	89.04	89.04	74.2	74.2	O	13.54	13.54	united health care medicare advantage	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	hmo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	ppo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	pos
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	epo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	ppo
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	pos
"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older"	cpt	36561	12335.28	12335.28	2329.97	2329.97	18210.46	18210.46	15175.38	15175.38	O	2455.02	2455.02	united health care medicare advantage	hmo
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	hmo
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	ppo
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	pos
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	epo
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	ppo
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	pos
ciprofloxacin iv	cpt	J0744	1952.13	1952.13	1158.82	1158.82	14026.28	14026.28	11688.57	11688.57	E	1952.13	1952.13	united health care medicare advantage	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	hmo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	ppo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	pos
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	epo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	ppo
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	pos
"Removal of tissue from wounds per session, first 20 sq cms or less"	cpt	97597	964.3	964.3	151.7	151.7	1106.5	1106.5	922.08	922.08	O	151.7	151.7	united health care medicare advantage	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	hmo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	ppo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	pos
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	epo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	ppo
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	pos
"cath, bal dil, non-vascular"	cpt	C1726	3539.01	3539.01	1283.27	1283.27	5848.52	5848.52	4873.77	4873.77	O	1379.67	1379.67	united health care medicare advantage	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	hmo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	epo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	pos
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	161.43	161.43	united health care medicare advantage	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	hmo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	20.05	20.05	united health care medicare advantage	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	hmo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	ppo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	pos
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	epo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	ppo
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	pos
"port, indwelling, imp"	cpt	C1788	4400.88	4400.88	2275.09	2275.09	18357.68	18357.68	15298.07	15298.07	O	2455.02	2455.02	united health care medicare advantage	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	hmo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	epo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	69.29	69.29	united health care medicare advantage	hmo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	hmo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	ppo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	pos
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	epo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	ppo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	pos
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	750.44	750.44	united health care medicare advantage	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	hmo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	ppo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	pos
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	epo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	ppo
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	pos
guide wire	cpt	C1769	16039.46	16039.46	2524.71	2524.71	29114.52	29114.52	24262.1	24262.1	O	13951.45	13951.45	united health care medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	3844.63	3844.63	412.37	412.37	3941.83	3941.83	3284.86	3284.86	O	926.57	926.57	united health care medicare advantage	hmo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	hmo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	ppo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	pos
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	epo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	ppo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	pos
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	1965.52	1965.52	united health care medicare advantage	hmo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	hmo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	ppo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	pos
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	epo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	ppo
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	pos
permanent cardiac pacemaker implant with cc	ms-drg	243	20821.91	20821.91	11977.95	11977.95	67115.8	67115.8	55929.83	55929.83	I	11977.95	11977.95	united health care medicare advantage	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	hmo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	epo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	pos
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	950.89	950.89	united health care medicare advantage	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	hmo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	ppo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	pos
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	epo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	ppo
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	pos
"cath, translumin non-laser"	cpt	C1725	14120.9	14120.9	8127.49	8127.49	59442.06	59442.06	49535.05	49535.05	O	14036.18	14036.18	united health care medicare advantage	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	hmo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	ppo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	pos
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	epo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	ppo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	pos
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10161.85	10161.85	united health care medicare advantage	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	hmo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	epo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	pos
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	338.27	338.27	united health care medicare advantage	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	hmo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	13.39	13.39	united health care medicare advantage	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	hmo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	epo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	pos
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1128.66	1128.66	united health care medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	hmo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	epo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	pos
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	2102.95	2102.95	united health care medicare advantage	hmo
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	hmo
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	ppo
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	pos
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	epo
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	ppo
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	pos
"epoetin alfa, non-esrd"	cpt	J0885	356.73	356.73	346.53	346.53	2339.21	2339.21	1949.34	1949.34	O	346.53	346.53	united health care medicare advantage	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	hmo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	ppo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	pos
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	epo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	ppo
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	pos
hip and femur procedures except major joint with cc	ms-drg	481	22569.55	22569.55	11724.47	11724.47	73732.43	73732.43	61443.69	61443.69	I	11724.47	11724.47	united health care medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	hmo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	ppo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	pos
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	epo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	ppo
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	pos
intracranial hemorrhage or cerebral infarction with mcc	ms-drg	64	16230.79	16230.79	11088.29	11088.29	48903.64	48903.64	40753.03	40753.03	I	11531.6	11531.6	united health care medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	hmo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.33	51.33	united health care medicare advantage	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	hmo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	ppo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	pos
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	epo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	ppo
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	pos
denosumab injection	cpt	J0897	5612.54	5612.54	926.57	926.57	4592.54	4592.54	3827.12	3827.12	O	1247.63	1247.63	united health care medicare advantage	hmo
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	hmo
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	ppo
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	pos
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	epo
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	ppo
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	pos
amputation for circulatory system disorders except upper limb and toe with cc	ms-drg	240	16419.17	16419.17	11166.18	11166.18	56139.05	56139.05	46782.54	46782.54	I	16419.17	16419.17	united health care medicare advantage	hmo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	21.14	21.14	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	21.14	21.14	veterans affairs	ppo
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	2.86	2.86	veterans affairs	veterans affairs plan
Special Gram or Giemsa stain for microorganism	cpt	87205	58.99	58.99	2.86	2.86	94.38	94.38	78.65	78.65	O	2.86	2.86	veterans affairs	ppo
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	4564.9	4564.9	veterans affairs	veterans affairs plan
other kidney and urinary tract diagnoses with cc	ms-drg	699	7639.53	7639.53	4542.34	4542.34	24963.2	24963.2	20802.67	20802.67	I	4564.9	4564.9	veterans affairs	ppo
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	6.95	6.95	veterans affairs	veterans affairs plan
Pancreatic elastase (enzyme) measurement	cpt	82656	159.29	159.29	6.95	6.95	254.86	254.86	212.38	212.38	O	6.95	6.95	veterans affairs	ppo
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	84.05	84.05	veterans affairs	veterans affairs plan
Irrigation of implanted venous access drug delivery device	cpt	96523	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	84.05	84.05	veterans affairs	ppo
Special Gram or Giemsa stain for microorganism	cpt	87205	82.58	82.58	3.8	3.8	94.38	94.38	78.65	78.65	E	82.58	82.58	veterans affairs	veterans affairs plan
Special Gram or Giemsa stain for microorganism	cpt	87205	82.58	82.58	3.8	3.8	94.38	94.38	78.65	78.65	E	82.58	82.58	veterans affairs	ppo
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	5.5	5.5	veterans affairs	veterans affairs plan
"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution"	cpt	87186	32.04	32.04	5.5	5.5	51.25	51.25	42.71	42.71	O	5.5	5.5	veterans affairs	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	79.61	79.61	veterans affairs	veterans affairs plan
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	79.61	79.61	veterans affairs	ppo
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	5.6	5.6	veterans affairs	veterans affairs plan
Gammaglobulin (immune system protein) measurement	cpt	82784	46.91	46.91	5.6	5.6	75.05	75.05	62.54	62.54	O	5.6	5.6	veterans affairs	ppo
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	125.7	125.7	veterans affairs	veterans affairs plan
CT scan of blood vessels in chest with contrast	cpt	71275	1225.57	1225.57	125.7	125.7	1913.09	1913.09	1594.24	1594.24	E	125.7	125.7	veterans affairs	ppo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	7.28	7.28	veterans affairs	veterans affairs plan
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	7.28	7.28	veterans affairs	ppo
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	688.83	688.83	veterans affairs	veterans affairs plan
"Emergency department visit, problem of high severity"	cpt	99284	3567.22	3567.22	306.66	306.66	5029.38	5029.38	4191.15	4191.15	E	688.83	688.83	veterans affairs	ppo
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	187.99	187.99	veterans affairs	veterans affairs plan
General	revCode	250	2110.35	2110.35	187.99	187.99	5478.17	5478.17	4565.14	4565.14	E	187.99	187.99	veterans affairs	ppo
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2796.08	2796.08	veterans affairs	veterans affairs plan
"mri w/o fol w/cont, breast,"	cpt	C8908	2796.08	2796.08	332.86	332.86	3655.21	3655.21	3046.01	3046.01	O	2796.08	2796.08	veterans affairs	ppo
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	5478.66	5478.66	veterans affairs	veterans affairs plan
gastrointestinal hemorrhage with cc	ms-drg	378	8605.42	8605.42	4373.52	4373.52	27388.28	27388.28	22823.57	22823.57	I	5478.66	5478.66	veterans affairs	ppo
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	5.36	5.36	veterans affairs	veterans affairs plan
Smear for parasites	cpt	87177	83.48	83.48	5.36	5.36	133.56	133.56	111.3	111.3	O	5.36	5.36	veterans affairs	ppo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	11.16	11.16	veterans affairs	veterans affairs plan
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	11.16	11.16	veterans affairs	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	2.87	2.87	veterans affairs	veterans affairs plan
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	2.87	2.87	veterans affairs	ppo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	5489.29	5489.29	veterans affairs	veterans affairs plan
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	5489.29	5489.29	veterans affairs	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	127.89	127.89	veterans affairs	veterans affairs plan
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	127.89	127.89	veterans affairs	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	301.93	301.93	veterans affairs	veterans affairs plan
Insertion of needle into vein for collection of blood sample	cpt	36415	8278.58	8278.58	301.93	301.93	7432.02	7432.02	6193.35	6193.35	E	301.93	301.93	veterans affairs	ppo
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	5489.29	5489.29	veterans affairs	veterans affairs plan
IVsolutions	revCode	258	11376.64	11376.64	1139.9	1139.9	18202.62	18202.62	15168.85	15168.85	O	5489.29	5489.29	veterans affairs	ppo
"infections, female reproductive system without cc/mcc"	ms-drg	759	4954.74	4954.74	2807.47	2807.47	20152.96	20152.96	16794.13	16794.13	I	4954.74	4954.74	veterans affairs	veterans affairs plan
"infections, female reproductive system without cc/mcc"	ms-drg	759	4954.74	4954.74	2807.47	2807.47	20152.96	20152.96	16794.13	16794.13	I	4954.74	4954.74	veterans affairs	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	19.83	19.83	veterans affairs	veterans affairs plan
"X-ray of elbow, minimum of 3 views"	cpt	73080	178.54	178.54	18.16	18.16	318	318	265	265	O	19.83	19.83	veterans affairs	ppo
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	8.2	8.2	veterans affairs	veterans affairs plan
"Nephelometry, test method using light"	cpt	83883	27.32	27.32	8.2	8.2	200.98	200.98	167.48	167.48	O	8.2	8.2	veterans affairs	ppo
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	11478.18	11478.18	veterans affairs	veterans affairs plan
"ischemic stroke, precerebral occlusion or transient ischemia with thrombolytic agent with mcc"	ms-drg	61	40043.51	40043.51	11478.18	11478.18	64676.57	64676.57	53897.14	53897.14	I	11478.18	11478.18	veterans affairs	ppo
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	563.29	563.29	veterans affairs	veterans affairs plan
General	revCode	270	7240.33	7240.33	563.29	563.29	7424.89	7424.89	6187.41	6187.41	E	563.29	563.29	veterans affairs	ppo
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	6403.21	6403.21	veterans affairs	veterans affairs plan
Removal of skin and bone first 20 sq cm or less	cpt	11044	6403.21	6403.21	1171.1	1171.1	4542.24	4542.24	3785.2	3785.2	O	6403.21	6403.21	veterans affairs	ppo
postpartum and post abortion diagnoses with o.r. procedures	ms-drg	769	6011.29	6011.29	4613.41	4613.41	37023.35	37023.35	30852.79	30852.79	I	6011.29	6011.29	veterans affairs	veterans affairs plan
postpartum and post abortion diagnoses with o.r. procedures	ms-drg	769	6011.29	6011.29	4613.41	4613.41	37023.35	37023.35	30852.79	30852.79	I	6011.29	6011.29	veterans affairs	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	211.67	211.67	veterans affairs	veterans affairs plan
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	O	211.67	211.67	veterans affairs	ppo
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	1367.16	1367.16	veterans affairs	veterans affairs plan
General	revCode	270	3909.17	3909.17	278.52	278.52	8905.74	8905.74	7421.45	7421.45	O	1367.16	1367.16	veterans affairs	ppo
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1192.31	1192.31	veterans affairs	veterans affairs plan
colon ca scrn not hi rsk ind	cpt	G0121	2133.45	2133.45	618.13	618.13	3570.85	3570.85	2975.71	2975.71	O	1192.31	1192.31	veterans affairs	ppo
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	7590.35	7590.35	veterans affairs	veterans affairs plan
complications of treatment with mcc	ms-drg	919	11802.59	11802.59	7590.35	7590.35	35571.22	35571.22	29642.68	29642.68	I	7590.35	7590.35	veterans affairs	ppo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	1628.83	1628.83	veterans affairs	veterans affairs plan
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	1628.83	1628.83	veterans affairs	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	3.46	3.46	veterans affairs	veterans affairs plan
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	3.46	3.46	veterans affairs	ppo
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	5353.39	5353.39	veterans affairs	veterans affairs plan
cesarean section with sterilization with cc	ms-drg	784	23094.84	23094.84	3311.09	3311.09	26725.74	26725.74	22271.45	22271.45	I	5353.39	5353.39	veterans affairs	ppo
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	224.23	224.23	veterans affairs	veterans affairs plan
CT scan of abdomen and pelvis with contrast	cpt	74177	2285.63	2285.63	198.18	198.18	3657	3657	3047.5	3047.5	E	224.23	224.23	veterans affairs	ppo
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	203.52	203.52	veterans affairs	veterans affairs plan
"X-ray of shoulder, 1 view"	cpt	73020	203.52	203.52	13.25	13.25	244.22	244.22	203.52	203.52	O	203.52	203.52	veterans affairs	ppo
normal newborn	ms-drg	795	2082.25	2082.25	707.81	707.81	4256.4	4256.4	3547	3547	I	817.8	817.8	veterans affairs	veterans affairs plan
normal newborn	ms-drg	795	2082.25	2082.25	707.81	707.81	4256.4	4256.4	3547	3547	I	817.8	817.8	veterans affairs	ppo
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	9907.54	9907.54	veterans affairs	veterans affairs plan
General	revCode	370	9907.54	9907.54	2076.66	2076.66	28909.84	28909.84	24091.53	24091.53	O	9907.54	9907.54	veterans affairs	ppo
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	16572.45	16572.45	veterans affairs	veterans affairs plan
joint device (implantable)	cpt	C1776	16572.45	16572.45	4942.26	4942.26	40335.2	40335.2	33612.67	33612.67	O	16572.45	16572.45	veterans affairs	ppo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	148.72	148.72	veterans affairs	veterans affairs plan
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	148.72	148.72	veterans affairs	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	4.86	4.86	veterans affairs	veterans affairs plan
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	4.86	4.86	veterans affairs	ppo
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	114.84	114.84	veterans affairs	veterans affairs plan
"Bacterial colony count, urine"	cpt	87086	160.59	160.59	7.18	7.18	256.94	256.94	214.12	214.12	E	114.84	114.84	veterans affairs	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	50.56	50.56	veterans affairs	veterans affairs plan
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	50.56	50.56	veterans affairs	ppo
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	11420.91	11420.91	veterans affairs	veterans affairs plan
acetaminophen injection	cpt	J0131	11420.91	11420.91	2274.34	2274.34	24287.22	24287.22	20239.35	20239.35	O	11420.91	11420.91	veterans affairs	ppo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1628.83	1628.83	veterans affairs	veterans affairs plan
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1628.83	1628.83	veterans affairs	ppo
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	5.14	5.14	veterans affairs	veterans affairs plan
Bacterial culture for aerobic isolates	cpt	87077	35.46	35.46	5.14	5.14	56.72	56.72	47.27	47.27	O	5.14	5.14	veterans affairs	ppo
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	9907.54	9907.54	veterans affairs	veterans affairs plan
Partial removal of collar bone at shoulder using an endoscope	cpt	29824	9907.54	9907.54	5299.29	5299.29	29878.18	29878.18	24898.48	24898.48	O	9907.54	9907.54	veterans affairs	ppo
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9907.54	9907.54	veterans affairs	veterans affairs plan
Extensive removal of shoulder joint tissue using an endoscope	cpt	29823	9907.54	9907.54	2425.05	2425.05	28656.25	28656.25	23880.21	23880.21	O	9907.54	9907.54	veterans affairs	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	146.62	146.62	veterans affairs	veterans affairs plan
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	146.62	146.62	veterans affairs	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	4.04	4.04	veterans affairs	veterans affairs plan
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	4.04	4.04	veterans affairs	ppo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	127.89	127.89	veterans affairs	veterans affairs plan
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	127.89	127.89	veterans affairs	ppo
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	2.61	2.61	veterans affairs	veterans affairs plan
"Blood test, clotting time"	cpt	85610	50.5	50.5	2.61	2.61	76.96	76.96	64.13	64.13	E	2.61	2.61	veterans affairs	ppo
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	6.34	6.34	veterans affairs	veterans affairs plan
"Bacterial culture, any source, except blood, anaerobic"	cpt	87075	57.31	57.31	6.34	6.34	91.7	91.7	76.42	76.42	O	6.34	6.34	veterans affairs	ppo
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	119.9	119.9	veterans affairs	veterans affairs plan
CT scan chest with contrast	cpt	71260	1195.68	1195.68	119.9	119.9	1913.09	1913.09	1594.24	1594.24	O	119.9	119.9	veterans affairs	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	7339.89	7339.89	veterans affairs	veterans affairs plan
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	7339.89	7339.89	veterans affairs	ppo
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	15628.14	15628.14	veterans affairs	veterans affairs plan
General	revCode	710	16160.85	16160.85	2524.71	2524.71	40897.36	40897.36	34081.13	34081.13	O	15628.14	15628.14	veterans affairs	ppo
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	32.64	32.64	veterans affairs	veterans affairs plan
"Blood test, clotting time"	cpt	85610	32.64	32.64	3.82	3.82	39.17	39.17	32.64	32.64	O	32.64	32.64	veterans affairs	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	5.77	5.77	veterans affairs	veterans affairs plan
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	5.77	5.77	veterans affairs	ppo
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	311.64	311.64	138.5	138.5	1779.53	1779.53	1482.94	1482.94	E	138.5	138.5	veterans affairs	veterans affairs plan
"Application of non-moveable, short arm splint (forearm to hand)"	cpt	29125	311.64	311.64	138.5	138.5	1779.53	1779.53	1482.94	1482.94	E	138.5	138.5	veterans affairs	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	268.55	268.55	veterans affairs	veterans affairs plan
"Emergency department visit, moderately severe problem"	cpt	99283	917.66	917.66	194.68	194.68	1178.7	1178.7	982.25	982.25	E	268.55	268.55	veterans affairs	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	197.1	197.1	7.67	7.67	193.44	193.44	161.2	161.2	E	197.1	197.1	veterans affairs	veterans affairs plan
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	197.1	197.1	7.67	7.67	193.44	193.44	161.2	161.2	E	197.1	197.1	veterans affairs	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	29.09	29.09	veterans affairs	veterans affairs plan
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	29.09	29.09	veterans affairs	ppo
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	549.41	549.41	veterans affairs	veterans affairs plan
ground mileage	cpt	A0425	2862	2862	352.05	352.05	1347.05	1347.05	1122.54	1122.54	O	549.41	549.41	veterans affairs	ppo
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	62.45	62.45	veterans affairs	veterans affairs plan
Magnesium level	cpt	83735	90.32	90.32	5.96	5.96	137.63	137.63	114.69	114.69	E	62.45	62.45	veterans affairs	ppo
Spinal tap with drainage of spinal fluid	cpt	62272	6841.37	6841.37	1003.2	1003.2	4703.68	4703.68	3919.73	3919.73	E	6841.37	6841.37	veterans affairs	veterans affairs plan
Spinal tap with drainage of spinal fluid	cpt	62272	6841.37	6841.37	1003.2	1003.2	4703.68	4703.68	3919.73	3919.73	E	6841.37	6841.37	veterans affairs	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1573.95	1573.95	veterans affairs	veterans affairs plan
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility"	cpt	96376	21270.9	21270.9	988.09	988.09	15790.75	15790.75	13158.96	13158.96	E	1573.95	1573.95	veterans affairs	ppo
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	2.63	2.63	veterans affairs	veterans affairs plan
Blood glucose (sugar) level	cpt	82947	7.28	7.28	2.63	2.63	39.17	39.17	32.64	32.64	O	2.63	2.63	veterans affairs	ppo
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	5.69	5.69	veterans affairs	veterans affairs plan
"Stool culture, additional pathogens"	cpt	87046	35.46	35.46	5.69	5.69	56.72	56.72	47.27	47.27	O	5.69	5.69	veterans affairs	ppo
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1077.63	1077.63	veterans affairs	veterans affairs plan
"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96375	3931.6	3931.6	677.23	677.23	7636.26	7636.26	6363.55	6363.55	E	1077.63	1077.63	veterans affairs	ppo
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12934.28	12934.28	veterans affairs	veterans affairs plan
cefazolin sodium injection	cpt	J0690	19270.59	19270.59	2269.35	2269.35	22085.86	22085.86	18404.88	18404.88	O	12934.28	12934.28	veterans affairs	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	38.26	38.26	veterans affairs	veterans affairs plan
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	38.26	38.26	2.92	2.92	45.91	45.91	38.26	38.26	O	38.26	38.26	veterans affairs	ppo
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	20.14	20.14	veterans affairs	veterans affairs plan
"X-ray of lower leg, 2 views"	cpt	73590	178.64	178.64	18.86	18.86	272.21	272.21	226.84	226.84	E	20.14	20.14	veterans affairs	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	319.86	319.86	veterans affairs	veterans affairs plan
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	3587.65	3587.65	249.39	249.39	5548.68	5548.68	4623.9	4623.9	E	319.86	319.86	veterans affairs	ppo
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	329.79	329.79	veterans affairs	veterans affairs plan
ceftriaxone sodium injection	cpt	J0696	2110.35	2110.35	197.85	197.85	5644.36	5644.36	4703.63	4703.63	E	329.79	329.79	veterans affairs	ppo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	6276.26	6276.26	veterans affairs	veterans affairs plan
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	6276.26	6276.26	veterans affairs	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	29.09	29.09	veterans affairs	veterans affairs plan
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	25.58	25.58	384.14	384.14	320.12	320.12	E	29.09	29.09	veterans affairs	ppo
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	688.83	688.83	veterans affairs	veterans affairs plan
"Injection of drug or substance into a vein for therapy, diagnosis, or prevention"	cpt	96374	3514.38	3514.38	601.44	601.44	5094.24	5094.24	4245.2	4245.2	E	688.83	688.83	veterans affairs	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	22.18	22.18	veterans affairs	veterans affairs plan
"X-ray of ankle, minimum of 3 views"	cpt	73610	221.81	221.81	21.31	21.31	354.89	354.89	295.74	295.74	E	22.18	22.18	veterans affairs	ppo
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	5.69	5.69	veterans affairs	veterans affairs plan
Stool culture	cpt	87045	53.98	53.98	5.69	5.69	86.36	86.36	71.97	71.97	O	5.69	5.69	veterans affairs	ppo
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	6841.37	6841.37	veterans affairs	veterans affairs plan
prochlorperazine injection	cpt	J0780	6841.37	6841.37	518.15	518.15	4145	4145	3454.17	3454.17	E	6841.37	6841.37	veterans affairs	ppo
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	8029.89	8029.89	veterans affairs	veterans affairs plan
prochlorperazine injection	cpt	J0780	8029.89	8029.89	56.46	56.46	5245	5245	4370.83	4370.83	O	8029.89	8029.89	veterans affairs	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	veterans affairs	veterans affairs plan
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	51.31	51.31	veterans affairs	ppo
"injection, dalbavancin"	cpt	J0875	4878.62	4878.62	2187.19	2187.19	11412.58	11412.58	9510.48	9510.48	E	2738.51	2738.51	veterans affairs	veterans affairs plan
"injection, dalbavancin"	cpt	J0875	4878.62	4878.62	2187.19	2187.19	11412.58	11412.58	9510.48	9510.48	E	2738.51	2738.51	veterans affairs	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	3.08	3.08	veterans affairs	veterans affairs plan
Blood creatinine level	cpt	82565	27.03	27.03	3.08	3.08	32.44	32.44	27.03	27.03	E	3.08	3.08	veterans affairs	ppo
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	254.75	254.75	veterans affairs	veterans affairs plan
"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention"	cpt	96372	2102.95	2102.95	197.85	197.85	6005.21	6005.21	5004.34	5004.34	E	254.75	254.75	veterans affairs	ppo
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch	cpt	64450	791.56	791.56	261.74	261.74	1660.08	1660.08	1383.4	1383.4	O	261.74	261.74	veterans affairs	veterans affairs plan
Injection of anesthetic agent and/or steroid into other peripheral nerve or branch	cpt	64450	791.56	791.56	261.74	261.74	1660.08	1660.08	1383.4	1383.4	O	261.74	261.74	veterans affairs	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	128.21	128.21	veterans affairs	veterans affairs plan
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	128.21	128.21	veterans affairs	ppo
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	261.74	261.74	veterans affairs	veterans affairs plan
methylprednisolone 40 mg inj	cpt	J1030	1477.69	1477.69	165.81	165.81	1671.17	1671.17	1392.64	1392.64	O	261.74	261.74	veterans affairs	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	20.57	20.57	veterans affairs	veterans affairs plan
"X-ray of foot, minimum of 3 views"	cpt	73630	258.78	258.78	20.35	20.35	354.89	354.89	295.74	295.74	E	20.57	20.57	veterans affairs	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	9.08	9.08	veterans affairs	veterans affairs plan
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	9.08	9.08	veterans affairs	ppo
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	549.41	549.41	veterans affairs	veterans affairs plan
als1-emergency	cpt	A0427	750.44	750.44	357.95	357.95	1709.57	1709.57	1424.64	1424.64	O	549.41	549.41	veterans affairs	ppo
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	197.85	197.85	veterans affairs	veterans affairs plan
dexamethasone sodium phos	cpt	J1100	10844.92	10844.92	197.85	197.85	1351.63	1351.63	1126.36	1126.36	E	197.85	197.85	veterans affairs	ppo
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	veterans affairs	veterans affairs plan
MRI scan of lower spinal canal	cpt	72148	1688.63	1688.63	121.82	121.82	3107.5	3107.5	2589.58	2589.58	E	206.45	206.45	veterans affairs	ppo
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	7417.71	7417.71	veterans affairs	veterans affairs plan
Removal of skin and tissue first 20 sq cm or less	cpt	11042	7417.71	7417.71	277.65	277.65	1395.25	1395.25	1162.71	1162.71	O	7417.71	7417.71	veterans affairs	ppo
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	11420.91	11420.91	veterans affairs	veterans affairs plan
dexamethasone sodium phos	cpt	J1100	11420.91	11420.91	2351.21	2351.21	22005.6	22005.6	18338	18338	O	11420.91	11420.91	veterans affairs	ppo
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	6841.37	6841.37	veterans affairs	veterans affairs plan
hydromorphone injection	cpt	J1170	21270.9	21270.9	602.83	602.83	6392.24	6392.24	5326.87	5326.87	E	6841.37	6841.37	veterans affairs	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	308.94	308.94	veterans affairs	veterans affairs plan
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3914.61	3914.61	275.34	275.34	2883.62	2883.62	2403.02	2403.02	O	308.94	308.94	veterans affairs	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	10.33	10.33	veterans affairs	veterans affairs plan
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	10.33	10.33	veterans affairs	ppo
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	15628.14	15628.14	veterans affairs	veterans affairs plan
hydromorphone injection	cpt	J1170	19270.59	19270.59	2440.04	2440.04	24828.17	24828.17	20690.14	20690.14	O	15628.14	15628.14	veterans affairs	ppo
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1908.07	1908.07	veterans affairs	veterans affairs plan
"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour"	cpt	96365	3225.5	3225.5	643.21	643.21	5950.79	5950.79	4958.99	4958.99	E	1908.07	1908.07	veterans affairs	ppo
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	6841.37	6841.37	veterans affairs	veterans affairs plan
diphenhydramine hcl injectio	cpt	J1200	6841.37	6841.37	525.84	525.84	4076.34	4076.34	3396.95	3396.95	E	6841.37	6841.37	veterans affairs	ppo
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	2738.51	2738.51	veterans affairs	veterans affairs plan
Hydration infusion into a vein	cpt	96361	3931.6	3931.6	306.66	306.66	5644.92	5644.92	4704.1	4704.1	E	2738.51	2738.51	veterans affairs	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.85	5.85	veterans affairs	veterans affairs plan
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	5.85	5.85	veterans affairs	ppo
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	4.15	4.15	veterans affairs	veterans affairs plan
Lipase (fat enzyme) level	cpt	83690	91.53	91.53	4.15	4.15	150.12	150.12	125.1	125.1	O	4.15	4.15	veterans affairs	ppo
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	162.77	162.77	veterans affairs	veterans affairs plan
Hydration infusion into a vein 31 minutes to 1 hour	cpt	96360	3013.18	3013.18	162.77	162.77	3699.7	3699.7	3083.08	3083.08	E	162.77	162.77	veterans affairs	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	5050.15	5050.15	veterans affairs	veterans affairs plan
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	5050.15	5050.15	veterans affairs	ppo
"Removal of foreign body from tissue, accessed beneath the skin, simple"	cpt	10120	635.65	635.65	381.98	381.98	1477.88	1477.88	1231.57	1231.57	E	635.65	635.65	veterans affairs	veterans affairs plan
"Removal of foreign body from tissue, accessed beneath the skin, simple"	cpt	10120	635.65	635.65	381.98	381.98	1477.88	1477.88	1231.57	1231.57	E	635.65	635.65	veterans affairs	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	veterans affairs	veterans affairs plan
"Emergency department visit, low to moderately severe problem"	cpt	99282	195.33	195.33	103.55	103.55	297.65	297.65	248.04	248.04	E	113.36	113.36	veterans affairs	ppo
G6PD (enzyme) level	cpt	82955	9.7	9.7	5.84	5.84	103.2	103.2	86	86	O	5.84	5.84	veterans affairs	veterans affairs plan
G6PD (enzyme) level	cpt	82955	9.7	9.7	5.84	5.84	103.2	103.2	86	86	O	5.84	5.84	veterans affairs	ppo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	86.32	86.32	veterans affairs	veterans affairs plan
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	86.32	86.32	veterans affairs	ppo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	31.65	31.65	veterans affairs	veterans affairs plan
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	31.65	31.65	veterans affairs	ppo
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	227.85	227.85	veterans affairs	veterans affairs plan
MRI scan of brain before and after contrast	cpt	70553	2577.39	2577.39	216.51	216.51	4123.82	4123.82	3436.52	3436.52	O	227.85	227.85	veterans affairs	ppo
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	4.15	4.15	veterans affairs	veterans affairs plan
Lipase (fat enzyme) level	cpt	83690	135.92	135.92	4.15	4.15	159.12	159.12	132.6	132.6	E	4.15	4.15	veterans affairs	ppo
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	119.58	119.58	veterans affairs	veterans affairs plan
CT scan of neck with contrast	cpt	70491	408.55	408.55	111.96	111.96	1507.32	1507.32	1256.1	1256.1	O	119.58	119.58	veterans affairs	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	3.91	3.91	veterans affairs	veterans affairs plan
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	3.91	3.91	veterans affairs	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	7.51	7.51	veterans affairs	veterans affairs plan
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	7.51	7.51	veterans affairs	ppo
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	268.55	268.55	veterans affairs	veterans affairs plan
Respiratory inhaled aerosol treatment to relieve airway obstruction	cpt	94645	1914.89	1914.89	268.55	268.55	2726.81	2726.81	2272.34	2272.34	E	268.55	268.55	veterans affairs	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	17.9	17.9	veterans affairs	veterans affairs plan
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	17.9	17.9	veterans affairs	ppo
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	285.24	285.24	veterans affairs	veterans affairs plan
Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen	cpt	94640	11447.12	11447.12	268.55	268.55	4772.35	4772.35	3976.96	3976.96	E	285.24	285.24	veterans affairs	ppo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	10.21	10.21	veterans affairs	veterans affairs plan
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	10.21	10.21	veterans affairs	ppo
surgical supplies	cpt	A4649	9907.54	9907.54	2386.25	2386.25	23508.36	23508.36	19590.3	19590.3	O	9907.54	9907.54	veterans affairs	veterans affairs plan
surgical supplies	cpt	A4649	9907.54	9907.54	2386.25	2386.25	23508.36	23508.36	19590.3	19590.3	O	9907.54	9907.54	veterans affairs	ppo
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	6841.37	6841.37	veterans affairs	veterans affairs plan
inj heparin sodium per 10 u	cpt	J1642	6841.37	6841.37	541.93	541.93	4972.12	4972.12	4143.43	4143.43	E	6841.37	6841.37	veterans affairs	ppo
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	142.69	142.69	veterans affairs	veterans affairs plan
inj heparin sodium per 10 u	cpt	J1642	4844.02	4844.02	47.76	47.76	209.88	209.88	174.9	174.9	O	142.69	142.69	veterans affairs	ppo
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	1192.31	1192.31	veterans affairs	veterans affairs plan
mod sedat endo service >5yrs	cpt	G0500	3539.01	3539.01	682.87	682.87	4454.65	4454.65	3712.21	3712.21	O	1192.31	1192.31	veterans affairs	ppo
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	3.26	3.26	veterans affairs	veterans affairs plan
Blood creatinine level	cpt	82565	27.03	27.03	3.26	3.26	32.44	32.44	27.03	27.03	O	3.26	3.26	veterans affairs	ppo
"X-ray of wrist, 2 views"	cpt	73100	21.74	21.74	19.86	19.86	272.21	272.21	226.84	226.84	E	21.74	21.74	veterans affairs	veterans affairs plan
"X-ray of wrist, 2 views"	cpt	73100	21.74	21.74	19.86	19.86	272.21	272.21	226.84	226.84	E	21.74	21.74	veterans affairs	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	105.56	105.56	veterans affairs	veterans affairs plan
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	685.6	685.6	90.7	90.7	783.55	783.55	652.96	652.96	E	105.56	105.56	veterans affairs	ppo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	3863.24	3863.24	veterans affairs	veterans affairs plan
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	3863.24	3863.24	veterans affairs	ppo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	25.25	25.25	veterans affairs	veterans affairs plan
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	25.25	25.25	veterans affairs	ppo
other antepartum diagnoses without o.r. procedures with mcc	ms-drg	831	8473.81	8473.81	3236.69	3236.69	13886.92	13886.92	11572.43	11572.43	I	6746.45	6746.45	veterans affairs	veterans affairs plan
other antepartum diagnoses without o.r. procedures with mcc	ms-drg	831	8473.81	8473.81	3236.69	3236.69	13886.92	13886.92	11572.43	11572.43	I	6746.45	6746.45	veterans affairs	ppo
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	8.6	8.6	veterans affairs	veterans affairs plan
Hepatitis C antibody measurement	cpt	86803	76.32	76.32	8.6	8.6	122.11	122.11	101.76	101.76	O	8.6	8.6	veterans affairs	ppo
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	1860.14	1860.14	veterans affairs	veterans affairs plan
respiratory infections and inflammations with cc	ms-drg	178	17495.91	17495.91	1860.14	1860.14	21426.17	21426.17	17855.14	17855.14	I	1860.14	1860.14	veterans affairs	ppo
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	603.46	603.46	veterans affairs	veterans affairs plan
ketorolac tromethamine inj	cpt	J1885	1476.71	1476.71	268.55	268.55	2235.78	2235.78	1863.15	1863.15	E	603.46	603.46	veterans affairs	ppo
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	1.97	1.97	veterans affairs	veterans affairs plan
Blood glucose (sugar) test performed by hand-held instrument	cpt	82962	28.7	28.7	1.97	1.97	45.91	45.91	38.26	38.26	E	1.97	1.97	veterans affairs	ppo
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	12767.84	12767.84	veterans affairs	veterans affairs plan
ketorolac tromethamine inj	cpt	J1885	19270.59	19270.59	1409.32	1409.32	7004.59	7004.59	5837.16	5837.16	O	12767.84	12767.84	veterans affairs	ppo
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	12.71	12.71	veterans affairs	veterans affairs plan
Apolipoprotein level	cpt	82172	21.09	21.09	12.71	12.71	91.58	91.58	76.32	76.32	O	12.71	12.71	veterans affairs	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	1.63	1.63	veterans affairs	veterans affairs plan
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	1.63	1.63	veterans affairs	ppo
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	5352.8	5352.8	veterans affairs	veterans affairs plan
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	5352.8	5352.8	veterans affairs	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	23.34	23.34	veterans affairs	veterans affairs plan
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	23.34	23.34	veterans affairs	ppo
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	5183.36	5183.36	veterans affairs	veterans affairs plan
chronic obstructive pulmonary disease with mcc	ms-drg	190	9844.32	9844.32	5103.72	5103.72	26965.48	26965.48	22471.23	22471.23	I	5183.36	5183.36	veterans affairs	ppo
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	161.46	161.46	veterans affairs	veterans affairs plan
CT scan abdomen before and after contrast	cpt	74170	2071.58	2071.58	151.18	151.18	2755.15	2755.15	2295.96	2295.96	O	161.46	161.46	veterans affairs	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	101.81	101.81	veterans affairs	veterans affairs plan
CT scan of abdomen and pelvis	cpt	74176	1708.46	1708.46	95.33	95.33	2733.53	2733.53	2277.94	2277.94	E	101.81	101.81	veterans affairs	ppo
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	4803.96	4803.96	veterans affairs	veterans affairs plan
chronic obstructive pulmonary disease with cc	ms-drg	191	7503.57	7503.57	4026.99	4026.99	20630.96	20630.96	17192.47	17192.47	I	4803.96	4803.96	veterans affairs	ppo
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	33.24	33.24	veterans affairs	veterans affairs plan
"X-ray of both hips with pelvis, 3-4 views"	cpt	73522	102.22	102.22	29.49	29.49	382.87	382.87	319.06	319.06	O	33.24	33.24	veterans affairs	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	19.5	19.5	veterans affairs	veterans affairs plan
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	19.5	19.5	veterans affairs	ppo
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	3.02	3.02	veterans affairs	veterans affairs plan
"Bilirubin level, total"	cpt	82247	7.18	7.18	3.02	3.02	42	42	35	35	O	3.02	3.02	veterans affairs	ppo
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	12934.28	12934.28	veterans affairs	veterans affairs plan
Repair of hernia using an endoscope	cpt	49652	12934.28	12934.28	3941.19	3941.19	28555.19	28555.19	23795.99	23795.99	O	12934.28	12934.28	veterans affairs	ppo
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	214.42	214.42	veterans affairs	veterans affairs plan
CT scan head or brain	cpt	70450	1652.81	1652.81	61.66	61.66	2644.49	2644.49	2203.74	2203.74	E	214.42	214.42	veterans affairs	ppo
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	16572.45	16572.45	veterans affairs	veterans affairs plan
lorazepam injection	cpt	J2060	16572.45	16572.45	1486.86	1486.86	17302.45	17302.45	14418.71	14418.71	O	16572.45	16572.45	veterans affairs	ppo
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	3.19	3.19	veterans affairs	veterans affairs plan
"Liver enzyme (SGPT), level"	cpt	84460	6.41	6.41	3.19	3.19	31.8	31.8	26.5	26.5	O	3.19	3.19	veterans affairs	ppo
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	8375.59	8375.59	veterans affairs	veterans affairs plan
simple pneumonia and pleurisy with mcc	ms-drg	193	25007.97	25007.97	6197.57	6197.57	32692.73	32692.73	27243.94	27243.94	I	8375.59	8375.59	veterans affairs	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	193.58	193.58	veterans affairs	veterans affairs plan
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	193.58	193.58	veterans affairs	ppo
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	1192.31	1192.31	veterans affairs	veterans affairs plan
meperidine hydrochl /100 mg	cpt	J2175	4701.08	4701.08	1192.31	1192.31	11006.52	11006.52	9172.1	9172.1	O	1192.31	1192.31	veterans affairs	ppo
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	240.13	240.13	veterans affairs	veterans affairs plan
CT scan of abdomen and pelvis before and after contrast	cpt	74178	2547.88	2547.88	240.13	240.13	4935.36	4935.36	4112.8	4112.8	O	240.13	240.13	veterans affairs	ppo
meropenem	cpt	J2185	14120.9	14120.9	308.94	308.94	13886.69	13886.69	11572.24	11572.24	O	308.94	308.94	veterans affairs	veterans affairs plan
meropenem	cpt	J2185	14120.9	14120.9	308.94	308.94	13886.69	13886.69	11572.24	11572.24	O	308.94	308.94	veterans affairs	ppo
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	226.84	226.84	veterans affairs	veterans affairs plan
"X-ray of wrist, 2 views"	cpt	73100	226.84	226.84	19.86	19.86	272.21	272.21	226.84	226.84	O	226.84	226.84	veterans affairs	ppo
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	7492.06	7492.06	veterans affairs	veterans affairs plan
inj midazolam hydrochloride	cpt	J2250	15146.83	15146.83	2242.95	2242.95	19381.32	19381.32	16151.1	16151.1	O	7492.06	7492.06	veterans affairs	ppo
"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report"	cpt	93291	101.06	101.06	20.37	20.37	137.38	137.38	114.48	114.48	O	40.52	40.52	veterans affairs	veterans affairs plan
"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report"	cpt	93291	101.06	101.06	20.37	20.37	137.38	137.38	114.48	114.48	O	40.52	40.52	veterans affairs	ppo
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1899.34	1899.34	veterans affairs	veterans affairs plan
tc99m sestamibi	cpt	A9500	5421.31	5421.31	600.12	600.12	8770.91	8770.91	7309.09	7309.09	O	1899.34	1899.34	veterans affairs	ppo
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	688.83	688.83	veterans affairs	veterans affairs plan
morphine sulfate injection	cpt	J2270	5002.28	5002.28	688.83	688.83	7005.42	7005.42	5837.85	5837.85	E	688.83	688.83	veterans affairs	ppo
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	136.2	136.2	veterans affairs	veterans affairs plan
MRI scan of abdomen	cpt	74181	2589.58	2589.58	136.2	136.2	3107.5	3107.5	2589.58	2589.58	O	136.2	136.2	veterans affairs	ppo
Glucose (sugar) level on body fluid	cpt	82945	108.62	108.62	3.5	3.5	124.14	124.14	103.45	103.45	E	108.62	108.62	veterans affairs	veterans affairs plan
Glucose (sugar) level on body fluid	cpt	82945	108.62	108.62	3.5	3.5	124.14	124.14	103.45	103.45	E	108.62	108.62	veterans affairs	ppo
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	7.09	7.09	veterans affairs	veterans affairs plan
Hepatitis B core antibody (IgM) measurement	cpt	86705	23.03	23.03	7.09	7.09	107.86	107.86	89.88	89.88	O	7.09	7.09	veterans affairs	ppo
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	5747.5	5747.5	veterans affairs	veterans affairs plan
"other injury, poisoning and toxic effect diagnoses without mcc"	ms-drg	923	27632.25	27632.25	3062.32	3062.32	22082.47	22082.47	18402.06	18402.06	I	5747.5	5747.5	veterans affairs	ppo
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	361.33	361.33	veterans affairs	veterans affairs plan
Nuclear medicine study of vessels of heart using drugs or exercise multiple studies	cpt	78452	3752.4	3752.4	341.67	341.67	6003.84	6003.84	5003.2	5003.2	O	361.33	361.33	veterans affairs	ppo
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16677.02	16677.02	veterans affairs	veterans affairs plan
Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine	cpt	63030	16677.02	16677.02	5299.29	5299.29	27792.77	27792.77	23160.64	23160.64	O	16677.02	16677.02	veterans affairs	ppo
olanzapine long-acting inj	cpt	J2358	1013.4	1013.4	462.24	462.24	5260.78	5260.78	4383.98	4383.98	E	462.24	462.24	veterans affairs	veterans affairs plan
olanzapine long-acting inj	cpt	J2358	1013.4	1013.4	462.24	462.24	5260.78	5260.78	4383.98	4383.98	E	462.24	462.24	veterans affairs	ppo
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	197.85	197.85	veterans affairs	veterans affairs plan
orphenadrine injection	cpt	J2360	716.17	716.17	197.85	197.85	1354.74	1354.74	1128.95	1128.95	E	197.85	197.85	veterans affairs	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1895.64	1895.64	veterans affairs	veterans affairs plan
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	1895.64	1895.64	veterans affairs	ppo
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	6249.69	6249.69	veterans affairs	veterans affairs plan
bronchitis and asthma with cc/mcc	ms-drg	202	7954.58	7954.58	3549.64	3549.64	19951.51	19951.51	16626.26	16626.26	I	6249.69	6249.69	veterans affairs	ppo
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	431.63	431.63	veterans affairs	veterans affairs plan
"Established patient office or other outpatient, visit typically 25 minutes"	cpt	99214	2005.98	2005.98	79.71	79.71	2405.64	2405.64	2004.7	2004.7	O	431.63	431.63	veterans affairs	ppo
connective tissue disorders without cc/mcc	ms-drg	547	6345.37	6345.37	5540.41	5540.41	19645.06	19645.06	16370.88	16370.88	I	6345.37	6345.37	veterans affairs	veterans affairs plan
connective tissue disorders without cc/mcc	ms-drg	547	6345.37	6345.37	5540.41	5540.41	19645.06	19645.06	16370.88	16370.88	I	6345.37	6345.37	veterans affairs	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	64.14	64.14	veterans affairs	veterans affairs plan
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	118.72	118.72	5.35	5.35	142.46	142.46	118.72	118.72	E	64.14	64.14	veterans affairs	ppo
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6403.21	6403.21	veterans affairs	veterans affairs plan
phenylephrine hcl injection	cpt	J2370	23111.69	23111.69	1541.69	1541.69	25453.21	25453.21	21211.01	21211.01	O	6403.21	6403.21	veterans affairs	ppo
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	1190.95	1190.95	veterans affairs	veterans affairs plan
ondansetron hcl injection	cpt	J2405	5002.28	5002.28	679.31	679.31	6400.3	6400.3	5333.58	5333.58	E	1190.95	1190.95	veterans affairs	ppo
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	39.76	39.76	veterans affairs	veterans affairs plan
Lactic acid level	cpt	83605	62.54	62.54	10.29	10.29	77.59	77.59	64.66	64.66	E	39.76	39.76	veterans affairs	ppo
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	91.86	91.86	veterans affairs	veterans affairs plan
X-ray of upper digestive tract with double contrast	cpt	74246	326.2	326.2	91.86	91.86	521.92	521.92	434.93	434.93	O	91.86	91.86	veterans affairs	ppo
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	8699.8	8699.8	veterans affairs	veterans affairs plan
ondansetron hcl injection	cpt	J2405	19270.59	19270.59	2167.41	2167.41	18628.44	18628.44	15523.7	15523.7	O	8699.8	8699.8	veterans affairs	ppo
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	16677.02	16677.02	veterans affairs	veterans affairs plan
succinycholine chloride inj	cpt	J0330	23111.69	23111.69	3938.98	3938.98	25931.63	25931.63	21609.69	21609.69	O	16677.02	16677.02	veterans affairs	ppo
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	3.02	3.02	veterans affairs	veterans affairs plan
"Bilirubin level, direct"	cpt	82248	27.83	27.83	3.02	3.02	44.52	44.52	37.1	37.1	O	3.02	3.02	veterans affairs	ppo
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	5.27	5.27	veterans affairs	veterans affairs plan
Iron binding capacity	cpt	83550	71.63	71.63	5.27	5.27	114.6	114.6	95.5	95.5	O	5.27	5.27	veterans affairs	ppo
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	17378.1	17378.1	veterans affairs	veterans affairs plan
bone diseases and arthropathies with mcc	ms-drg	553	17378.1	17378.1	8579.22	8579.22	36360.38	36360.38	30300.32	30300.32	I	17378.1	17378.1	veterans affairs	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	veterans affairs	veterans affairs plan
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	8.37	8.37	veterans affairs	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	5.44	5.44	veterans affairs	veterans affairs plan
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	5.44	5.44	veterans affairs	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	7.73	7.73	veterans affairs	veterans affairs plan
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	1660.16	1660.16	7.73	7.73	1127.22	1127.22	939.35	939.35	O	7.73	7.73	veterans affairs	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	26.54	26.54	veterans affairs	veterans affairs plan
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	244.22	244.22	203.52	203.52	E	26.54	26.54	veterans affairs	ppo
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1367.16	1367.16	veterans affairs	veterans affairs plan
Fine needle aspiration of first lesion using ultrasound guidance	cpt	10005	1833.84	1833.84	96.87	96.87	2794.98	2794.98	2329.15	2329.15	O	1367.16	1367.16	veterans affairs	ppo
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	10179.39	10179.39	veterans affairs	veterans affairs plan
Infusion of chemotherapy into a vein up to 1 hour	cpt	96413	10179.39	10179.39	1052.17	1052.17	21878.4	21878.4	18232	18232	O	10179.39	10179.39	veterans affairs	ppo
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	6910.46	6910.46	veterans affairs	veterans affairs plan
"inj, propofol, 10 mg"	cpt	J2704	19270.59	19270.59	1379.67	1379.67	17082.98	17082.98	14235.82	14235.82	O	6910.46	6910.46	veterans affairs	ppo
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	285.24	285.24	veterans affairs	veterans affairs plan
Routine electrocardiogram (EKG) with tracing using at least 12 leads	cpt	93005	7986.58	7986.58	194.68	194.68	4684.98	4684.98	3904.15	3904.15	E	285.24	285.24	veterans affairs	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	311.64	311.64	veterans affairs	veterans affairs plan
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1130.86	1130.86	222.96	222.96	2240.83	2240.83	1867.36	1867.36	E	311.64	311.64	veterans affairs	ppo
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	14281.21	14281.21	veterans affairs	veterans affairs plan
neostigmine methylslfte inj	cpt	J2710	19270.59	19270.59	3941.08	3941.08	26610.96	26610.96	22175.8	22175.8	O	14281.21	14281.21	veterans affairs	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	49.49	49.49	veterans affairs	veterans affairs plan
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	49.49	49.49	veterans affairs	ppo
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware	cpt	25607	16572.45	16572.45	4897.01	4897.01	36409.4	36409.4	30341.17	30341.17	O	16572.45	16572.45	veterans affairs	veterans affairs plan
Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware	cpt	25607	16572.45	16572.45	4897.01	4897.01	36409.4	36409.4	30341.17	30341.17	O	16572.45	16572.45	veterans affairs	ppo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	11.2	11.2	veterans affairs	veterans affairs plan
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	11.2	11.2	veterans affairs	ppo
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	311.64	311.64	veterans affairs	veterans affairs plan
Administration of 1 vaccine	cpt	90471	1130.86	1130.86	222.96	222.96	2007.48	2007.48	1672.9	1672.9	E	311.64	311.64	veterans affairs	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	78.97	78.97	veterans affairs	veterans affairs plan
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	78.97	78.97	veterans affairs	ppo
Syphilis detection test	cpt	86592	4.77	4.77	2.99	2.99	132.29	132.29	110.24	110.24	E	2.99	2.99	veterans affairs	veterans affairs plan
Syphilis detection test	cpt	86592	4.77	4.77	2.99	2.99	132.29	132.29	110.24	110.24	E	2.99	2.99	veterans affairs	ppo
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	25835.23	25835.23	veterans affairs	veterans affairs plan
Spinal fusion	ms-drg	460	36305.41	36305.41	17839.3	17839.3	143767.9	143767.9	119806.58	119806.58	I	25835.23	25835.23	veterans affairs	ppo
Body fluid cell count with cell identification	cpt	89051	115.75	115.75	4.98	4.98	124.8	124.8	104	104	E	115.75	115.75	veterans affairs	veterans affairs plan
Body fluid cell count with cell identification	cpt	89051	115.75	115.75	4.98	4.98	124.8	124.8	104	104	E	115.75	115.75	veterans affairs	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	8156.09	8156.09	veterans affairs	veterans affairs plan
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	8156.09	8156.09	veterans affairs	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	48.23	48.23	veterans affairs	veterans affairs plan
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	48.23	48.23	veterans affairs	ppo
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1899.34	1899.34	veterans affairs	veterans affairs plan
regadenoson injection	cpt	J2785	5481.82	5481.82	603.67	603.67	8903.99	8903.99	7419.99	7419.99	O	1899.34	1899.34	veterans affairs	ppo
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	377.36	377.36	veterans affairs	veterans affairs plan
"Special stained specimen slides to examine tissue, initial procedure"	cpt	88342	377.36	377.36	58.37	58.37	452.83	452.83	377.36	377.36	O	377.36	377.36	veterans affairs	ppo
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	41.49	41.49	veterans affairs	veterans affairs plan
"Tuberculosis test, gamma interferon"	cpt	86480	236.12	236.12	33.45	33.45	377.78	377.78	314.82	314.82	O	41.49	41.49	veterans affairs	ppo
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	43.4	43.4	veterans affairs	veterans affairs plan
Preparation of tissue for examination by removing any calcium present	cpt	88311	43.4	43.4	7.48	7.48	49.61	49.61	41.34	41.34	O	43.4	43.4	veterans affairs	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	55.57	55.57	veterans affairs	veterans affairs plan
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	55.57	55.57	veterans affairs	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	88.01	88.01	veterans affairs	veterans affairs plan
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	122.23	122.23	13.39	13.39	190.8	190.8	159	159	E	88.01	88.01	veterans affairs	ppo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	226.84	226.84	veterans affairs	veterans affairs plan
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	226.84	226.84	veterans affairs	ppo
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	366.63	366.63	veterans affairs	veterans affairs plan
methylprednisolone injection	cpt	J2930	2087.31	2087.31	366.63	366.63	3352	3352	2793.33	2793.33	E	366.63	366.63	veterans affairs	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	8541.69	8541.69	veterans affairs	veterans affairs plan
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	8541.69	8541.69	veterans affairs	ppo
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	3.7	3.7	veterans affairs	veterans affairs plan
Rheumatoid factor analysis	cpt	86430	28.7	28.7	3.7	3.7	45.91	45.91	38.26	38.26	O	3.7	3.7	veterans affairs	ppo
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	6.95	6.95	veterans affairs	veterans affairs plan
Screening test for presence of antibody	cpt	86403	37.36	37.36	5.66	5.66	59.78	59.78	49.82	49.82	O	6.95	6.95	veterans affairs	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	195.57	195.57	veterans affairs	veterans affairs plan
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	195.57	195.57	veterans affairs	ppo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	2.64	2.64	veterans affairs	veterans affairs plan
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	2.64	2.64	veterans affairs	ppo
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	133.56	133.56	veterans affairs	veterans affairs plan
Pathology examination of tissue using a microscope	cpt	88302	133.56	133.56	20.05	20.05	160.27	160.27	133.56	133.56	O	133.56	133.56	veterans affairs	ppo
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	11420.91	11420.91	veterans affairs	veterans affairs plan
fentanyl citrate injection	cpt	J3010	19270.59	19270.59	2425.05	2425.05	22941.24	22941.24	19117.7	19117.7	O	11420.91	11420.91	veterans affairs	ppo
percutaneous cardiovascular procedures with non-drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	248	17786.09	17786.09	12684.86	12684.86	136939.61	136939.61	114116.34	114116.34	I	12684.86	12684.86	veterans affairs	veterans affairs plan
percutaneous cardiovascular procedures with non-drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	248	17786.09	17786.09	12684.86	12684.86	136939.61	136939.61	114116.34	114116.34	I	12684.86	12684.86	veterans affairs	ppo
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	44.52	44.52	veterans affairs	veterans affairs plan
"Pap test, evaluation of fine needle aspirate, immediate, each additional evaluation episode"	cpt	88177	52.53	52.53	4.01	4.01	53.42	53.42	44.52	44.52	O	44.52	44.52	veterans affairs	ppo
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	16475.95	16475.95	veterans affairs	veterans affairs plan
percutaneous cardiovascular procedures with non-drug-eluting stent without mcc	ms-drg	249	19270.14	19270.14	11166.95	11166.95	79497.7	79497.7	66248.08	66248.08	I	16475.95	16475.95	veterans affairs	ppo
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	98.58	98.58	veterans affairs	veterans affairs plan
Evaluation of fine needle aspirate with interpretation and report	cpt	88173	98.58	98.58	58.16	58.16	118.3	118.3	98.58	98.58	O	98.58	98.58	veterans affairs	ppo
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	374.18	374.18	veterans affairs	veterans affairs plan
Evaluation of fine needle aspirate	cpt	88172	374.18	374.18	16.56	16.56	449.02	449.02	374.18	374.18	O	374.18	374.18	veterans affairs	ppo
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	482.41	482.41	veterans affairs	veterans affairs plan
tc99m sulfur colloid	cpt	A9541	4483.23	4483.23	257.14	257.14	2003.39	2003.39	1669.49	1669.49	O	482.41	482.41	veterans affairs	ppo
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7417.71	7417.71	veterans affairs	veterans affairs plan
vancomycin hcl injection	cpt	J3370	8866.76	8866.76	216.34	216.34	10270.32	10270.32	8558.6	8558.6	O	7417.71	7417.71	veterans affairs	ppo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	29.37	29.37	veterans affairs	veterans affairs plan
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	29.37	29.37	veterans affairs	ppo
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	4.6	4.6	veterans affairs	veterans affairs plan
"Thyroxine (thyroid chemical), total"	cpt	84436	40.46	40.46	4.6	4.6	61.08	61.08	50.9	50.9	O	4.6	4.6	veterans affairs	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	158.13	158.13	veterans affairs	veterans affairs plan
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	158.13	158.13	veterans affairs	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	21.1	21.1	veterans affairs	veterans affairs plan
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	21.1	21.1	veterans affairs	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	16.03	16.03	veterans affairs	veterans affairs plan
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	16.03	16.03	veterans affairs	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	65.22	65.22	veterans affairs	veterans affairs plan
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	65.22	65.22	veterans affairs	ppo
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	9.74	9.74	veterans affairs	veterans affairs plan
Microsomal antibodies (autoantibody) measurement	cpt	86376	67.61	67.61	9.74	9.74	45.41	45.41	37.84	37.84	O	9.74	9.74	veterans affairs	ppo
Removal of tonsils patient age 12 or over	cpt	42826	7492.06	7492.06	2170.19	2170.19	19340.47	19340.47	16117.06	16117.06	O	7492.06	7492.06	veterans affairs	veterans affairs plan
Removal of tonsils patient age 12 or over	cpt	42826	7492.06	7492.06	2170.19	2170.19	19340.47	19340.47	16117.06	16117.06	O	7492.06	7492.06	veterans affairs	ppo
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	709.36	709.36	veterans affairs	veterans affairs plan
Drainage of abscess	cpt	10060	2311.63	2311.63	251.42	251.42	1139.56	1139.56	949.63	949.63	E	709.36	709.36	veterans affairs	ppo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	4656.83	4656.83	veterans affairs	veterans affairs plan
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	4656.83	4656.83	veterans affairs	ppo
"trauma to the skin, subcutaneous tissue and breast without mcc"	ms-drg	605	6119.32	6119.32	5709.83	5709.83	28864.31	28864.31	24053.59	24053.59	I	5709.83	5709.83	veterans affairs	veterans affairs plan
"trauma to the skin, subcutaneous tissue and breast without mcc"	ms-drg	605	6119.32	6119.32	5709.83	5709.83	28864.31	28864.31	24053.59	24053.59	I	5709.83	5709.83	veterans affairs	ppo
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	9.07	9.07	veterans affairs	veterans affairs plan
"Valproic acid level, total"	cpt	80164	47.79	47.79	9.07	9.07	132.16	132.16	110.13	110.13	O	9.07	9.07	veterans affairs	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	12.08	12.08	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	12.08	12.08	veterans affairs	ppo
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	609.71	609.71	veterans affairs	veterans affairs plan
drugs unclassified injection	cpt	J3490	4051.53	4051.53	429.12	429.12	14528.98	14528.98	12107.48	12107.48	O	609.71	609.71	veterans affairs	ppo
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	183.23	183.23	veterans affairs	veterans affairs plan
"tomosynthesis, mammo"	cpt	G0279	537.22	537.22	129.17	129.17	720	720	600	600	O	183.23	183.23	veterans affairs	ppo
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	23.49	23.49	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for Strep (Streptococcus, group A), amplified probe technique"	cpt	87651	100.97	100.97	23.49	23.49	161.54	161.54	134.62	134.62	E	23.49	23.49	veterans affairs	ppo
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	518.09	518.09	veterans affairs	veterans affairs plan
normal saline solution infus	cpt	J7030	5460.04	5460.04	306.66	306.66	6472.27	6472.27	5393.56	5393.56	E	518.09	518.09	veterans affairs	ppo
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	717.95	717.95	veterans affairs	veterans affairs plan
Injection of dye for X-ray imaging of shoulder joint	cpt	23350	1560.4	1560.4	665.72	665.72	5407.96	5407.96	4506.63	4506.63	O	717.95	717.95	veterans affairs	ppo
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	4.34	4.34	veterans affairs	veterans affairs plan
Glutamyltransferase (liver enzyme) level	cpt	82977	30.13	30.13	4.34	4.34	43.32	43.32	36.1	36.1	O	4.34	4.34	veterans affairs	ppo
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	81.62	81.62	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for Staphylococcus aureus, methicillin resistant (MRSA bacteria), amplified probe technique"	cpt	87641	81.62	81.62	26.28	26.28	102.84	102.84	85.7	85.7	O	81.62	81.62	veterans affairs	ppo
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	952.49	952.49	veterans affairs	veterans affairs plan
"gad-base mr contrast nos,1ml"	cpt	A9579	2833.93	2833.93	332.86	332.86	4399.94	4399.94	3666.62	3666.62	O	952.49	952.49	veterans affairs	ppo
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	118.72	118.72	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for Staphylococcus aureus (bacteria), amplified probe technique"	cpt	87640	118.72	118.72	31.21	31.21	142.46	142.46	118.72	118.72	O	118.72	118.72	veterans affairs	ppo
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1513.32	1513.32	veterans affairs	veterans affairs plan
normal saline solution infus	cpt	J7040	6865.24	6865.24	696.23	696.23	5102.34	5102.34	4251.95	4251.95	O	1513.32	1513.32	veterans affairs	ppo
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	10.8	10.8	veterans affairs	veterans affairs plan
"Measurement of antibody for assessment of autoimmune disorder, any method"	cpt	86235	29.53	29.53	8.28	8.28	44.57	44.57	37.14	37.14	O	10.8	10.8	veterans affairs	ppo
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	67.84	67.84	veterans affairs	veterans affairs plan
Opiates levels	cpt	80361	67.84	67.84	2.18	2.18	85.48	85.48	71.23	71.23	O	67.84	67.84	veterans affairs	ppo
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	7.8	7.8	veterans affairs	veterans affairs plan
Measurement of antibody for rheumatoid arthritis assessment	cpt	86200	169.34	169.34	7.8	7.8	270.94	270.94	225.78	225.78	O	7.8	7.8	veterans affairs	ppo
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	16.83	16.83	veterans affairs	veterans affairs plan
Estradiol (hormone) level	cpt	82670	112.1	112.1	16.83	16.83	179.35	179.35	149.46	149.46	O	16.83	16.83	veterans affairs	ppo
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	9907.54	9907.54	veterans affairs	veterans affairs plan
adrenalin epinephrine inject	cpt	J0171	12553.76	12553.76	2249.08	2249.08	22158.58	22158.58	18465.48	18465.48	O	9907.54	9907.54	veterans affairs	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	21.14	21.14	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	21.14	21.14	veterans affairs	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	21.14	21.14	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	21.14	21.14	veterans affairs	ppo
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	9907.54	9907.54	veterans affairs	veterans affairs plan
ringers lactate infusion	cpt	J7120	19270.59	19270.59	505.78	505.78	4101.9	4101.9	3418.25	3418.25	O	9907.54	9907.54	veterans affairs	ppo
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	14753.37	14753.37	veterans affairs	veterans affairs plan
"anchor/screw bn/bn,tis/bn"	cpt	C1713	26638.49	26638.49	3947.72	3947.72	36740.42	36740.42	30617.02	30617.02	O	14753.37	14753.37	veterans affairs	ppo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	23.98	23.98	veterans affairs	veterans affairs plan
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	23.98	23.98	veterans affairs	ppo
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	594.7	594.7	veterans affairs	veterans affairs plan
"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs"	cpt	12002	870.77	870.77	222.96	222.96	1583.29	1583.29	1319.41	1319.41	E	594.7	594.7	veterans affairs	ppo
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	228.27	228.27	veterans affairs	veterans affairs plan
prednisone ir or dr oral 1mg	cpt	J7512	2048.12	2048.12	228.27	228.27	2502.85	2502.85	2085.71	2085.71	E	228.27	228.27	veterans affairs	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	5.66	5.66	veterans affairs	veterans affairs plan
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	5.66	5.66	veterans affairs	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	5.66	5.66	veterans affairs	veterans affairs plan
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	238.4	238.4	5.66	5.66	272.46	272.46	227.05	227.05	E	5.66	5.66	veterans affairs	ppo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	28.68	28.68	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	28.68	28.68	veterans affairs	ppo
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	5771.8	5771.8	veterans affairs	veterans affairs plan
diabetes with cc	ms-drg	638	26280.06	26280.06	3900.52	3900.52	23211.72	23211.72	19343.1	19343.1	I	5771.8	5771.8	veterans affairs	ppo
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	15628.14	15628.14	veterans affairs	veterans affairs plan
Removal of gallbladder using an endoscope	cpt	47562	17009.14	17009.14	3939.77	3939.77	26379.84	26379.84	21983.2	21983.2	O	15628.14	15628.14	veterans affairs	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	12.08	12.08	veterans affairs	veterans affairs plan
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	12.08	12.08	veterans affairs	ppo
Blood sodium level	cpt	84295	4.81	4.81	3.22	3.22	40.44	40.44	33.7	33.7	O	3.22	3.22	veterans affairs	veterans affairs plan
Blood sodium level	cpt	84295	4.81	4.81	3.22	3.22	40.44	40.44	33.7	33.7	O	3.22	3.22	veterans affairs	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	7.71	7.71	veterans affairs	veterans affairs plan
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	7.71	7.71	236.59	236.59	197.16	197.16	E	7.71	7.71	veterans affairs	ppo
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7867.71	7867.71	veterans affairs	veterans affairs plan
"miscellaneous disorders of nutrition, metabolism, fluids and electrolytes with mcc"	ms-drg	640	10946.86	10946.86	5256.92	5256.92	24676.81	24676.81	20564.01	20564.01	I	7867.71	7867.71	veterans affairs	ppo
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	169.49	169.49	veterans affairs	veterans affairs plan
Screening digital tomography of both breasts	cpt	77063	169.49	169.49	21.93	21.93	198.43	198.43	165.36	165.36	O	169.49	169.49	veterans affairs	ppo
Obstetric blood test panel	cpt	80055	108.71	108.71	108.71	108.71	271.62	271.62	226.35	226.35	E	108.71	108.71	veterans affairs	veterans affairs plan
Obstetric blood test panel	cpt	80055	108.71	108.71	108.71	108.71	271.62	271.62	226.35	226.35	E	108.71	108.71	veterans affairs	ppo
Obstetric blood test panel	cpt	80055	89.99	89.99	89.99	89.99	107.64	107.64	89.7	89.7	O	89.99	89.99	veterans affairs	veterans affairs plan
Obstetric blood test panel	cpt	80055	89.99	89.99	89.99	89.99	107.64	107.64	89.7	89.7	O	89.99	89.99	veterans affairs	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	17.83	17.83	veterans affairs	veterans affairs plan
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	17.83	17.83	veterans affairs	ppo
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	13240	13240	veterans affairs	veterans affairs plan
slings	cpt	A4565	13240	13240	1472.77	1472.77	19034.96	19034.96	15862.47	15862.47	O	13240	13240	veterans affairs	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	10.22	10.22	veterans affairs	veterans affairs plan
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	10.22	10.22	veterans affairs	ppo
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	6.95	6.95	veterans affairs	veterans affairs plan
"Analysis of substance using immunoassay technique, multiple step method"	cpt	83516	34.58	34.58	6.95	6.95	55.33	55.33	46.11	46.11	O	6.95	6.95	veterans affairs	ppo
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	75.16	75.16	veterans affairs	veterans affairs plan
Radiological supervision and interpretation X-ray of shoulder joint	cpt	73040	380.33	380.33	75.16	75.16	1431	1431	1192.5	1192.5	O	75.16	75.16	veterans affairs	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	22.45	22.45	veterans affairs	veterans affairs plan
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	22.45	22.45	veterans affairs	ppo
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	197.85	197.85	veterans affairs	veterans affairs plan
Collection of blood specimen from central or peripheral venous catheter	cpt	36592	2110.35	2110.35	197.85	197.85	5696.08	5696.08	4746.73	4746.73	E	197.85	197.85	veterans affairs	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	37.26	37.26	veterans affairs	veterans affairs plan
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	37.26	37.26	veterans affairs	ppo
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1513.32	1513.32	veterans affairs	veterans affairs plan
Biopsy of the large bowel using an endoscope (colonoscopy)	cpt	45380	3589.03	3589.03	889.62	889.62	4667.93	4667.93	3889.94	3889.94	O	1513.32	1513.32	veterans affairs	ppo
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1071.04	1071.04	veterans affairs	veterans affairs plan
Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk	cpt	45378	2708.94	2708.94	665.88	665.88	3770.44	3770.44	3142.03	3142.03	O	1071.04	1071.04	veterans affairs	ppo
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	3.12	3.12	veterans affairs	veterans affairs plan
Measurement C-reactive protein for detection of infection or inflammation	cpt	86140	45.55	45.55	3.12	3.12	72.88	72.88	60.73	60.73	O	3.12	3.12	veterans affairs	ppo
"Total protein level, body fluid"	cpt	84157	120.42	120.42	3.56	3.56	129.84	129.84	108.2	108.2	E	120.42	120.42	veterans affairs	veterans affairs plan
"Total protein level, body fluid"	cpt	84157	120.42	120.42	3.56	3.56	129.84	129.84	108.2	108.2	E	120.42	120.42	veterans affairs	ppo
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	9.85	9.85	veterans affairs	veterans affairs plan
"Folic acid level, serum"	cpt	82746	58.51	58.51	9.85	9.85	70.21	70.21	58.51	58.51	O	9.85	9.85	veterans affairs	ppo
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10179.39	10179.39	veterans affairs	veterans affairs plan
inj pembrolizumab	cpt	J9271	26265.21	26265.21	7502.28	7502.28	42024.34	42024.34	35020.28	35020.28	O	10179.39	10179.39	veterans affairs	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	8.06	8.06	veterans affairs	veterans affairs plan
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	8.06	8.06	veterans affairs	ppo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	5810.53	5810.53	veterans affairs	veterans affairs plan
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	5810.53	5810.53	veterans affairs	ppo
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	49.49	49.49	veterans affairs	veterans affairs plan
"X-ray of chest, 1 view"	cpt	71045	151.85	151.85	13.77	13.77	242.95	242.95	202.46	202.46	E	49.49	49.49	veterans affairs	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	128.65	128.65	veterans affairs	veterans affairs plan
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	128.65	128.65	veterans affairs	ppo
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2411.66	2411.66	veterans affairs	veterans affairs plan
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43239	3539.01	3539.01	696.23	696.23	4804.01	4804.01	4003.34	4003.34	O	2411.66	2411.66	veterans affairs	ppo
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	7.58	7.58	veterans affairs	veterans affairs plan
Haptoglobin (serum protein) level	cpt	83010	12.63	12.63	7.58	7.58	91.58	91.58	76.32	76.32	O	7.58	7.58	veterans affairs	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	12.08	12.08	veterans affairs	veterans affairs plan
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	12.08	12.08	veterans affairs	ppo
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	330.05	330.05	veterans affairs	veterans affairs plan
drug test def 1-7 classes	cpt	G0480	5714.16	5714.16	330.05	330.05	4392.84	4392.84	3660.7	3660.7	E	330.05	330.05	veterans affairs	ppo
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	7.22	7.22	veterans affairs	veterans affairs plan
Detection test by immunoassay technique for bacteria toxin (shiga-like toxin)	cpt	87427	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	7.22	7.22	veterans affairs	ppo
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	9642.9	9642.9	veterans affairs	veterans affairs plan
renal failure with mcc	ms-drg	682	14766.63	14766.63	7096.73	7096.73	29039.57	29039.57	24199.64	24199.64	I	9642.9	9642.9	veterans affairs	ppo
laparoscopic cholecystectomy without c.d.e. with mcc	ms-drg	417	13810.6	13810.6	10906.98	10906.98	46700.2	46700.2	38916.83	38916.83	I	12596.22	12596.22	veterans affairs	veterans affairs plan
laparoscopic cholecystectomy without c.d.e. with mcc	ms-drg	417	13810.6	13810.6	10906.98	10906.98	46700.2	46700.2	38916.83	38916.83	I	12596.22	12596.22	veterans affairs	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	9.8	9.8	veterans affairs	veterans affairs plan
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	9.8	9.8	veterans affairs	ppo
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6019.26	6019.26	veterans affairs	veterans affairs plan
renal failure with cc	ms-drg	683	8376.57	8376.57	4149.28	4149.28	20393.95	20393.95	16994.96	16994.96	I	6019.26	6019.26	veterans affairs	ppo
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1010.54	1010.54	veterans affairs	veterans affairs plan
"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope"	cpt	43235	1810.27	1810.27	696.23	696.23	3668.42	3668.42	3057.02	3057.02	O	1010.54	1010.54	veterans affairs	ppo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	14.51	14.51	veterans affairs	veterans affairs plan
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	14.51	14.51	veterans affairs	ppo
adenosine inj 1mg	cpt	J0153	1952.13	1952.13	162.77	162.77	6062.33	6062.33	5051.94	5051.94	E	162.77	162.77	veterans affairs	veterans affairs plan
adenosine inj 1mg	cpt	J0153	1952.13	1952.13	162.77	162.77	6062.33	6062.33	5051.94	5051.94	E	162.77	162.77	veterans affairs	ppo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	12.57	12.57	veterans affairs	veterans affairs plan
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	12.57	12.57	veterans affairs	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	23.34	23.34	veterans affairs	veterans affairs plan
"X-ray of hand, minimum of 3 views"	cpt	73130	221.81	221.81	20.77	20.77	354.89	354.89	295.74	295.74	E	23.34	23.34	veterans affairs	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	8.66	8.66	veterans affairs	veterans affairs plan
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	8.66	8.66	veterans affairs	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	veterans affairs	veterans affairs plan
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	88.57	88.57	veterans affairs	ppo
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	1.36	1.36	veterans affairs	veterans affairs plan
Automated urinalysis test	cpt	81003	37.84	37.84	1.36	1.36	43.25	43.25	36.04	36.04	E	1.36	1.36	veterans affairs	ppo
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	2.65	2.65	veterans affairs	veterans affairs plan
"Urea nitrogen level to assess kidney function, quantitative"	cpt	84520	8.36	8.36	2.65	2.65	43.25	43.25	36.04	36.04	O	2.65	2.65	veterans affairs	ppo
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	213.69	213.69	veterans affairs	veterans affairs plan
"X-ray of spine, 1 view"	cpt	72020	213.69	213.69	12.95	12.95	244.22	244.22	203.52	203.52	O	213.69	213.69	veterans affairs	ppo
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	274.65	274.65	veterans affairs	veterans affairs plan
Stomach emptying study	cpt	78264	756.88	756.88	257.14	257.14	1658.69	1658.69	1382.24	1382.24	O	274.65	274.65	veterans affairs	ppo
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2796.74	2796.74	veterans affairs	veterans affairs plan
Puncture of skin for collection of blood sample	cpt	36416	2796.74	2796.74	32.13	32.13	5087.64	5087.64	4239.7	4239.7	O	2796.74	2796.74	veterans affairs	ppo
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	107.03	107.03	veterans affairs	veterans affairs plan
Diagnostic mammography of both breasts	cpt	77066	208.15	208.15	100.44	100.44	304.01	304.01	253.34	253.34	O	107.03	107.03	veterans affairs	ppo
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	7.22	7.22	veterans affairs	veterans affairs plan
Detection test by immunoassay technique for adenovirus enteric types 40/41	cpt	87301	40.46	40.46	7.22	7.22	64.74	64.74	53.95	53.95	O	7.22	7.22	veterans affairs	ppo
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	87.67	87.67	veterans affairs	veterans affairs plan
"Evaluation of occupational therapy, typically 45 minutes"	cpt	97166	3567.98	3567.98	82.09	82.09	1782.07	1782.07	1485.06	1485.06	O	87.67	87.67	veterans affairs	ppo
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	3.08	3.08	veterans affairs	veterans affairs plan
Blood potassium level	cpt	84132	11.42	11.42	3.08	3.08	31.8	31.8	26.5	26.5	O	3.08	3.08	veterans affairs	ppo
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	1445.9	1445.9	veterans affairs	veterans affairs plan
Puncture of skin for collection of blood sample	cpt	36416	4642.21	4642.21	716.5	716.5	7116.65	7116.65	5930.54	5930.54	E	1445.9	1445.9	veterans affairs	ppo
Blood chloride level	cpt	82435	3.08	3.08	3.08	3.08	29.26	29.26	24.38	24.38	O	3.08	3.08	veterans affairs	veterans affairs plan
Blood chloride level	cpt	82435	3.08	3.08	3.08	3.08	29.26	29.26	24.38	24.38	O	3.08	3.08	veterans affairs	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	1.36	1.36	veterans affairs	veterans affairs plan
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	1.36	1.36	veterans affairs	ppo
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	19.83	19.83	veterans affairs	veterans affairs plan
"X-ray of elbow, minimum of 3 views"	cpt	73080	164.17	164.17	17.76	17.76	318	318	265	265	E	19.83	19.83	veterans affairs	ppo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	4256.51	4256.51	veterans affairs	veterans affairs plan
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	4256.51	4256.51	veterans affairs	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	242.53	242.53	veterans affairs	veterans affairs plan
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	242.53	242.53	veterans affairs	ppo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	133.32	133.32	veterans affairs	veterans affairs plan
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	133.32	133.32	veterans affairs	ppo
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	10.37	10.37	veterans affairs	veterans affairs plan
"Cortisol (hormone) measurement, total"	cpt	82533	18.64	18.64	10.37	10.37	120.84	120.84	100.7	100.7	O	10.37	10.37	veterans affairs	ppo
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	717.95	717.95	veterans affairs	veterans affairs plan
"locm 100-199mg/ml iodine,1ml"	cpt	Q9965	877.03	877.03	228.19	228.19	3466.87	3466.87	2889.06	2889.06	O	717.95	717.95	veterans affairs	ppo
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	3.9	3.9	veterans affairs	veterans affairs plan
Iron level	cpt	83540	27.83	27.83	3.9	3.9	44.52	44.52	37.1	37.1	O	3.9	3.9	veterans affairs	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.42	52.42	webtpa	ppo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.42	52.42	webtpa	epo
"Pap test, automated thin layer preparation; automated system and manual rescreening"	cpt	88175	65.52	65.52	16.03	16.03	89.86	89.86	74.88	74.88	O	52.42	52.42	webtpa	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	41.29	41.29	webtpa	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	41.29	41.29	webtpa	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	78.71	78.71	6.69	6.69	72.5	72.5	60.42	60.42	O	41.29	41.29	webtpa	pos
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.11	9.11	webtpa	ppo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.11	9.11	webtpa	epo
Automated urinalysis test	cpt	81003	9.3	9.3	1.36	1.36	14.88	14.88	12.4	12.4	O	9.11	9.11	webtpa	pos
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	137.88	137.88	webtpa	ppo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	137.88	137.88	webtpa	epo
Acute hepatitis panel	cpt	80074	144.13	144.13	29.37	29.37	230.6	230.6	192.17	192.17	O	137.88	137.88	webtpa	pos
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	11251.17	11251.17	webtpa	ppo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	11251.17	11251.17	webtpa	epo
cardiac arrhythmia and conduction disorders without cc/mcc	ms-drg	310	11251.17	11251.17	2923.72	2923.72	16099.55	16099.55	13416.29	13416.29	I	11251.17	11251.17	webtpa	pos
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	21.52	21.52	webtpa	ppo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	21.52	21.52	webtpa	epo
Stool analysis for blood to screen for colon tumors	cpt	82270	21.52	21.52	2.64	2.64	32.44	32.44	27.03	27.03	O	21.52	21.52	webtpa	pos
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	3144.74	3144.74	webtpa	ppo
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	3144.74	3144.74	webtpa	epo
General	revCode	350	3144.74	3144.74	1916.73	1916.73	6914.77	6914.77	5762.31	5762.31	O	3144.74	3144.74	webtpa	pos
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	46683.8	46683.8	webtpa	ppo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	46683.8	46683.8	webtpa	epo
cervical spinal fusion with cc	ms-drg	472	50054.52	50054.52	13410.03	13410.03	74958.38	74958.38	62465.32	62465.32	I	46683.8	46683.8	webtpa	pos
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.5	208.5	webtpa	ppo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.5	208.5	webtpa	epo
Screening mammography of both breasts	cpt	77067	301.25	301.25	83	83	357.43	357.43	297.86	297.86	O	208.5	208.5	webtpa	pos
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1903.34	1903.34	webtpa	ppo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1903.34	1903.34	webtpa	epo
MRI scan of arm	cpt	73218	1903.34	1903.34	206.45	206.45	3107.5	3107.5	2589.58	2589.58	O	1903.34	1903.34	webtpa	pos
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	217.36	217.36	webtpa	ppo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	217.36	217.36	webtpa	epo
"X-ray of hand, minimum of 3 views"	cpt	73130	232.89	232.89	20.77	20.77	334.8	334.8	279	279	O	217.36	217.36	webtpa	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	95.38	95.38	webtpa	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	95.38	95.38	webtpa	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), amplified probe technique"	cpt	87661	95.38	95.38	31.21	31.21	163.5	163.5	136.25	136.25	O	95.38	95.38	webtpa	pos
General	revCode	920	2756	2756	2756	2756	4457.16	4457.16	3714.3	3714.3	O	2756	2756	webtpa	ppo
General	revCode	920	2756	2756	2756	2756	4457.16	4457.16	3714.3	3714.3	O	2756	2756	webtpa	epo
General	revCode	920	2756	2756	2756	2756	4457.16	4457.16	3714.3	3714.3	O	2756	2756	webtpa	pos
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	4588.22	4588.22	webtpa	ppo
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	4588.22	4588.22	webtpa	epo
vaginal delivery with o.r. procedures except sterilization and/or d&c	ms-drg	768	9464.17	9464.17	2050.49	2050.49	12508.94	12508.94	10424.12	10424.12	I	4588.22	4588.22	webtpa	pos
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	71.97	71.97	webtpa	ppo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	71.97	71.97	webtpa	epo
"Detection test by nucleic acid for Trichomonas vaginalis (genital parasite), direct probe technique"	cpt	87660	77.12	77.12	12.08	12.08	123.38	123.38	102.82	102.82	O	71.97	71.97	webtpa	pos
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	149.46	149.46	webtpa	ppo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	149.46	149.46	webtpa	epo
Gonadotropin (reproductive hormone) analysis	cpt	84703	149.46	149.46	6.69	6.69	147.04	147.04	122.53	122.53	E	149.46	149.46	webtpa	pos
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	40.96	40.96	webtpa	ppo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	40.96	40.96	webtpa	epo
"Bacterial culture, any other source except urine, blood or stool, aerobic"	cpt	87070	43.88	43.88	5.77	5.77	70.21	70.21	58.51	58.51	O	40.96	40.96	webtpa	pos
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	5003.5	5003.5	webtpa	ppo
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	5003.5	5003.5	webtpa	epo
Diagnostic radiopharmaceuticals	revCode	343	5003.5	5003.5	3200.73	3200.73	18038.66	18038.66	15032.22	15032.22	O	5003.5	5003.5	webtpa	pos
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	166.73	166.73	webtpa	ppo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	166.73	166.73	webtpa	epo
"X-ray of shoulder, minimum of 2 views"	cpt	73030	178.64	178.64	19.75	19.75	256.8	256.8	214	214	O	166.73	166.73	webtpa	pos
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.67	67.67	webtpa	ppo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.67	67.67	webtpa	epo
"Detection test for candida species (yeast), direct probe technique"	cpt	87480	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.67	67.67	webtpa	pos
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3148.29	3148.29	webtpa	ppo
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3148.29	3148.29	webtpa	epo
Diagnostic	revCode	341	3200.73	3200.73	3148.29	3148.29	15974.16	15974.16	13311.8	13311.8	O	3148.29	3148.29	webtpa	pos
minor skin disorders without mcc	ms-drg	607	5526.24	5526.24	2222.6	2222.6	11361.04	11361.04	9467.53	9467.53	I	3934.49	3934.49	webtpa	ppo
minor skin disorders without mcc	ms-drg	607	5526.24	5526.24	2222.6	2222.6	11361.04	11361.04	9467.53	9467.53	I	3934.49	3934.49	webtpa	epo
minor skin disorders without mcc	ms-drg	607	5526.24	5526.24	2222.6	2222.6	11361.04	11361.04	9467.53	9467.53	I	3934.49	3934.49	webtpa	pos
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	796.91	796.91	webtpa	ppo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	796.91	796.91	webtpa	epo
CT scan of arm	cpt	73200	1195.36	1195.36	97.7	97.7	1366.13	1366.13	1138.44	1138.44	O	796.91	796.91	webtpa	pos
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.13	57.13	webtpa	ppo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.13	57.13	webtpa	epo
"Immunologic analysis for detection of tumor antigen, quantitative; CA 15-3"	cpt	86300	77.89	77.89	18.51	18.51	97.94	97.94	81.62	81.62	O	57.13	57.13	webtpa	pos
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	10759.16	10759.16	webtpa	ppo
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	10759.16	10759.16	webtpa	epo
Chemotherapy administration	revCode	335	10759.16	10759.16	3913.9	3913.9	19348.8	19348.8	16124	16124	O	10759.16	10759.16	webtpa	pos
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1903.34	1903.34	webtpa	ppo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1903.34	1903.34	webtpa	epo
MRI scan of middle spinal canal	cpt	72146	1933.28	1933.28	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1903.34	1903.34	webtpa	pos
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	403.57	403.57	webtpa	ppo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	403.57	403.57	webtpa	epo
"Ultrasound re-evaluation of pregnant uterus, per fetus"	cpt	76816	411.81	411.81	59.85	59.85	658.9	658.9	549.08	549.08	O	403.57	403.57	webtpa	pos
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	15507.2	15507.2	webtpa	ppo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	15507.2	15507.2	webtpa	epo
"esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc"	ms-drg	392	15507.2	15507.2	2961.25	2961.25	20252.21	20252.21	16876.84	16876.84	I	15507.2	15507.2	webtpa	pos
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	10826.07	10826.07	webtpa	ppo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	10826.07	10826.07	webtpa	epo
Observation hours	revCode	762	10826.07	10826.07	1775.61	1775.61	17738.81	17738.81	14782.34	14782.34	O	10826.07	10826.07	webtpa	pos
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	43.35	43.35	webtpa	ppo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	43.35	43.35	webtpa	epo
"Gonadotropin, chorionic (reproductive hormone) level"	cpt	84702	60.42	60.42	13.39	13.39	72.5	72.5	60.42	60.42	O	43.35	43.35	webtpa	pos
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	48.3	48.3	webtpa	ppo
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	48.3	48.3	webtpa	epo
Infrared analysis of stone	cpt	82365	48.3	48.3	11.47	11.47	78.86	78.86	65.72	65.72	O	48.3	48.3	webtpa	pos
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	349.02	349.02	webtpa	ppo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	349.02	349.02	webtpa	epo
"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes"	cpt	97113	3812.03	3812.03	349.02	349.02	2948.4	2948.4	2457	2457	O	349.02	349.02	webtpa	pos
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	20.67	20.67	webtpa	ppo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	20.67	20.67	webtpa	epo
"Hemoglobin analysis and measurement, chromatography"	cpt	83021	88.25	88.25	15.73	15.73	141.19	141.19	117.66	117.66	O	20.67	20.67	webtpa	pos
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	625.93	625.93	webtpa	ppo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	625.93	625.93	webtpa	epo
"Ultrasound of abdomen, complete"	cpt	76700	654.29	654.29	68.57	68.57	1046.86	1046.86	872.38	872.38	O	625.93	625.93	webtpa	pos
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	117942.4	117942.4	webtpa	ppo
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	117942.4	117942.4	webtpa	epo
revision of hip or knee replacement with cc	ms-drg	467	117942.4	117942.4	14037.35	14037.35	102567.41	102567.41	85472.84	85472.84	I	117942.4	117942.4	webtpa	pos
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	1794.6	1794.6	webtpa	ppo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	1794.6	1794.6	webtpa	epo
MRI scan brain	cpt	70551	2039.29	2039.29	128.4	128.4	3107.5	3107.5	2589.58	2589.58	O	1794.6	1794.6	webtpa	pos
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	145.43	145.43	webtpa	ppo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	145.43	145.43	webtpa	epo
"X-ray of knee, 1 or 2 views"	cpt	73560	145.43	145.43	20.17	20.17	116	116	96.67	96.67	O	145.43	145.43	webtpa	pos
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	85.33	85.33	webtpa	ppo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	85.33	85.33	webtpa	epo
"Testosterone (hormone) level, total"	cpt	84403	91.43	91.43	22.96	22.96	146.28	146.28	121.9	121.9	O	85.33	85.33	webtpa	pos
postoperative or post-traumatic infections with o.r. procedures with cc	ms-drg	857	17726.82	17726.82	10988.1	10988.1	68981.11	68981.11	57484.26	57484.26	I	17726.82	17726.82	webtpa	ppo
postoperative or post-traumatic infections with o.r. procedures with cc	ms-drg	857	17726.82	17726.82	10988.1	10988.1	68981.11	68981.11	57484.26	57484.26	I	17726.82	17726.82	webtpa	epo
postoperative or post-traumatic infections with o.r. procedures with cc	ms-drg	857	17726.82	17726.82	10988.1	10988.1	68981.11	68981.11	57484.26	57484.26	I	17726.82	17726.82	webtpa	pos
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	862.92	862.92	webtpa	ppo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	862.92	862.92	webtpa	epo
Treatment room	revCode	761	3117.13	3117.13	687.71	687.71	14934.65	14934.65	12445.54	12445.54	O	862.92	862.92	webtpa	pos
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2750.19	2750.19	webtpa	ppo
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2750.19	2750.19	webtpa	epo
General	revCode	750	2750.19	2750.19	2204.19	2204.19	4701.28	4701.28	3917.73	3917.73	O	2750.19	2750.19	webtpa	pos
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	3272.23	3272.23	webtpa	ppo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	3272.23	3272.23	webtpa	epo
Radiation therapy	revCode	333	3272.23	3272.23	139.32	139.32	14353.2	14353.2	11961	11961	O	3272.23	3272.23	webtpa	pos
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	149.58	149.58	webtpa	ppo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	149.58	149.58	webtpa	epo
"X-ray of fingers, minimum of 2 views"	cpt	73140	149.58	149.58	23.94	23.94	230.4	230.4	192	192	O	149.58	149.58	webtpa	pos
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	7446.82	7446.82	webtpa	ppo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	7446.82	7446.82	webtpa	epo
vaginal delivery without sterilization or d&c with cc	ms-drg	806	8080.24	8080.24	2095.72	2095.72	14659.54	14659.54	12216.28	12216.28	I	7446.82	7446.82	webtpa	pos
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	490.46	490.46	webtpa	ppo
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	490.46	490.46	webtpa	epo
General	revCode	740	4124.85	4124.85	490.46	490.46	19972.24	19972.24	16643.53	16643.53	O	490.46	490.46	webtpa	pos
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	109.07	109.07	webtpa	ppo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	109.07	109.07	webtpa	epo
lactation class	cpt	S9443	111.3	111.3	87.35	87.35	178.08	178.08	148.4	148.4	O	109.07	109.07	webtpa	pos
Holter monitor	revCode	731	331.88	331.88	331.88	331.88	541.87	541.87	451.56	451.56	O	331.88	331.88	webtpa	ppo
Holter monitor	revCode	731	331.88	331.88	331.88	331.88	541.87	541.87	451.56	451.56	O	331.88	331.88	webtpa	epo
Holter monitor	revCode	731	331.88	331.88	331.88	331.88	541.87	541.87	451.56	451.56	O	331.88	331.88	webtpa	pos
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	10349.74	10349.74	webtpa	ppo
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	10349.74	10349.74	webtpa	epo
cesarean section without sterilization with cc	ms-drg	787	10349.74	10349.74	3346.6	3346.6	16357.43	16357.43	13631.19	13631.19	I	10349.74	10349.74	webtpa	pos
urinary stones without mcc	ms-drg	694	5014.21	5014.21	2963.72	2963.72	12824.16	12824.16	10686.8	10686.8	I	4873.85	4873.85	webtpa	ppo
urinary stones without mcc	ms-drg	694	5014.21	5014.21	2963.72	2963.72	12824.16	12824.16	10686.8	10686.8	I	4873.85	4873.85	webtpa	epo
urinary stones without mcc	ms-drg	694	5014.21	5014.21	2963.72	2963.72	12824.16	12824.16	10686.8	10686.8	I	4873.85	4873.85	webtpa	pos
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	212.19	212.19	webtpa	ppo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	212.19	212.19	webtpa	epo
"X-ray of wrist, minimum of 3 views"	cpt	73110	232.89	232.89	25.14	25.14	116	116	96.67	96.67	O	212.19	212.19	webtpa	pos
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	380.69	380.69	webtpa	ppo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	380.69	380.69	webtpa	epo
General	revCode	730	2685.64	2685.64	380.69	380.69	11463.71	11463.71	9553.09	9553.09	O	380.69	380.69	webtpa	pos
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	395.78	395.78	webtpa	ppo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	395.78	395.78	webtpa	epo
"Radiation treatment devices, design and construction, complex"	cpt	77334	403.86	403.86	57.75	57.75	646.18	646.18	538.48	538.48	O	395.78	395.78	webtpa	pos
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	43	43	webtpa	ppo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	43	43	webtpa	epo
Magnesium level	cpt	83735	46.07	46.07	4.04	4.04	70.21	70.21	58.51	58.51	O	43	43	webtpa	pos
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	348.64	348.64	webtpa	ppo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	348.64	348.64	webtpa	epo
Insertion of needle into vein for collection of blood sample	cpt	36415	2685.64	2685.64	23.2	23.2	498.73	498.73	415.61	415.61	O	348.64	348.64	webtpa	pos
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	232.95	232.95	webtpa	ppo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	232.95	232.95	webtpa	epo
"Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine)"	cpt	77080	237.71	237.71	9.8	9.8	380.33	380.33	316.94	316.94	O	232.95	232.95	webtpa	pos
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	46.27	46.27	webtpa	ppo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	46.27	46.27	webtpa	epo
Liver function blood test panel	cpt	80076	47.22	47.22	7.27	7.27	75.55	75.55	62.96	62.96	O	46.27	46.27	webtpa	pos
"thyroid, parathyroid and thyroglossal procedures without cc/mcc"	ms-drg	627	15314.08	15314.08	15314.08	15314.08	26252.7	26252.7	21877.25	21877.25	I	15314.08	15314.08	webtpa	ppo
"thyroid, parathyroid and thyroglossal procedures without cc/mcc"	ms-drg	627	15314.08	15314.08	15314.08	15314.08	26252.7	26252.7	21877.25	21877.25	I	15314.08	15314.08	webtpa	epo
"thyroid, parathyroid and thyroglossal procedures without cc/mcc"	ms-drg	627	15314.08	15314.08	15314.08	15314.08	26252.7	26252.7	21877.25	21877.25	I	15314.08	15314.08	webtpa	pos
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	5458.16	5458.16	webtpa	ppo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	5458.16	5458.16	webtpa	epo
heart failure and shock with mcc	ms-drg	291	21478.52	21478.52	5458.16	5458.16	29935.93	29935.93	24946.61	24946.61	I	5458.16	5458.16	webtpa	pos
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	73.54	73.54	webtpa	ppo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	73.54	73.54	webtpa	epo
Screening test for autoimmune disorder	cpt	86038	75.05	75.05	7.28	7.28	113.28	113.28	94.4	94.4	O	73.54	73.54	webtpa	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	221.43	221.43	webtpa	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	221.43	221.43	webtpa	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	232.5	232.5	6.91	6.91	265.72	265.72	221.43	221.43	E	221.43	221.43	webtpa	pos
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	664.19	664.19	webtpa	ppo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	664.19	664.19	webtpa	epo
Drugs requiring detailed coding	revCode	636	5378.65	5378.65	129.14	129.14	22408.99	22408.99	18674.16	18674.16	O	664.19	664.19	webtpa	pos
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3168.72	3168.72	webtpa	ppo
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3168.72	3168.72	webtpa	epo
Chemotherapy administration	revCode	331	3576.75	3576.75	3168.72	3168.72	18152.71	18152.71	15127.26	15127.26	O	3168.72	3168.72	webtpa	pos
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	68.24	68.24	webtpa	ppo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	68.24	68.24	webtpa	epo
"Detection test by nucleic acid for human papillomavirus (hpv), high-risk types"	cpt	87624	97.48	97.48	21.14	21.14	116.98	116.98	97.48	97.48	O	68.24	68.24	webtpa	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	77.09	77.09	webtpa	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	77.09	77.09	webtpa	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	82.6	82.6	9.05	9.05	132.16	132.16	110.13	110.13	O	77.09	77.09	webtpa	pos
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.36	384.36	webtpa	ppo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.36	384.36	webtpa	epo
Vaginal ultrasound of pregnant uterus	cpt	76817	411.81	411.81	49.63	49.63	658.9	658.9	549.08	549.08	O	384.36	384.36	webtpa	pos
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	385.84	385.84	webtpa	ppo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	385.84	385.84	webtpa	epo
"X-ray of upper spine, 4 or 5 views"	cpt	72050	413.4	413.4	30.83	30.83	661.44	661.44	551.2	551.2	O	385.84	385.84	webtpa	pos
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	3068.09	3068.09	webtpa	ppo
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	3068.09	3068.09	webtpa	epo
Spinal cord/spine	revCode	612	5297.03	5297.03	3068.09	3068.09	6214.99	6214.99	5179.16	5179.16	O	3068.09	3068.09	webtpa	pos
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	224.08	224.08	webtpa	ppo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	224.08	224.08	webtpa	epo
"X-ray of middle spine, 3 views"	cpt	72072	224.08	224.08	22.45	22.45	384.14	384.14	320.12	320.12	O	224.08	224.08	webtpa	pos
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	85.33	85.33	webtpa	ppo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	85.33	85.33	webtpa	epo
"PSA (prostate specific antigen) measurement, free"	cpt	84154	85.33	85.33	16.63	16.63	146.28	146.28	121.9	121.9	O	85.33	85.33	webtpa	pos
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	2644.18	2644.18	webtpa	ppo
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	2644.18	2644.18	webtpa	epo
Brain/brain stem	revCode	611	3393.18	3393.18	2644.18	2644.18	14004	14004	11670	11670	O	2644.18	2644.18	webtpa	pos
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	10252.42	10252.42	webtpa	ppo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	10252.42	10252.42	webtpa	epo
heart failure and shock with cc	ms-drg	292	22045.55	22045.55	4447.05	4447.05	22970.14	22970.14	19141.78	19141.78	I	10252.42	10252.42	webtpa	pos
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	2922	2922	webtpa	ppo
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	2922	2922	webtpa	epo
General	revCode	610	3269.92	3269.92	2922	2922	4211.08	4211.08	3509.23	3509.23	O	2922	2922	webtpa	pos
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	92.82	92.82	webtpa	ppo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	92.82	92.82	webtpa	epo
"Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique"	cpt	87591	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	92.82	92.82	webtpa	pos
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	331.01	331.01	webtpa	ppo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	331.01	331.01	webtpa	epo
psa screening	cpt	G0103	424.12	424.12	29.78	29.78	591.17	591.17	492.64	492.64	O	331.01	331.01	webtpa	pos
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	156.54	156.54	webtpa	ppo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	156.54	156.54	webtpa	epo
General	revCode	250	16775.47	16775.47	156.54	156.54	19999.5	19999.5	16666.25	16666.25	O	156.54	156.54	webtpa	pos
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	1039.72	1039.72	webtpa	ppo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	1039.72	1039.72	webtpa	epo
Chest X	revCode	324	2899.33	2899.33	993.32	993.32	14709.6	14709.6	12258	12258	O	1039.72	1039.72	webtpa	pos
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	67	67	webtpa	ppo
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	67	67	webtpa	epo
"Insulin measurement, total"	cpt	83525	68.37	68.37	10.17	10.17	109.39	109.39	91.16	91.16	O	67	67	webtpa	pos
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	13482.64	13482.64	webtpa	ppo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	13482.64	13482.64	webtpa	epo
vaginal delivery without sterilization or d&c with mcc	ms-drg	805	13482.64	13482.64	2649.69	2649.69	19194.61	19194.61	15995.51	15995.51	I	13482.64	13482.64	webtpa	pos
Urgent care clinic	revCode	516	58.62	58.62	58.62	58.62	100.49	100.49	83.74	83.74	O	58.62	58.62	webtpa	ppo
Urgent care clinic	revCode	516	58.62	58.62	58.62	58.62	100.49	100.49	83.74	83.74	O	58.62	58.62	webtpa	epo
Urgent care clinic	revCode	516	58.62	58.62	58.62	58.62	100.49	100.49	83.74	83.74	O	58.62	58.62	webtpa	pos
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	100.5	100.5	webtpa	ppo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	100.5	100.5	webtpa	epo
Analysis for antibody to Rubeola (measles virus)	cpt	86765	100.5	100.5	11.46	11.46	53.93	53.93	44.94	44.94	O	100.5	100.5	webtpa	pos
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	60.3	60.3	webtpa	ppo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	60.3	60.3	webtpa	epo
"PSA (prostate specific antigen) measurement, total"	cpt	84153	61.53	61.53	16.36	16.36	98.45	98.45	82.04	82.04	O	60.3	60.3	webtpa	pos
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	12287.03	12287.03	webtpa	ppo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	12287.03	12287.03	webtpa	epo
intracranial hemorrhage or cerebral infarction with cc or tpa in 24 hours	ms-drg	65	21865.72	21865.72	6193.89	6193.89	17014.63	17014.63	14178.86	14178.86	I	12287.03	12287.03	webtpa	pos
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1674.28	1674.28	webtpa	ppo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1674.28	1674.28	webtpa	epo
CT scan of abdomen and pelvis	cpt	74176	1708.45	1708.45	203.15	203.15	2733.53	2733.53	2277.94	2277.94	O	1674.28	1674.28	webtpa	pos
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	24.49	24.49	webtpa	ppo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	24.49	24.49	webtpa	epo
"Red blood cell sedimentation rate, to detect inflammation, automated"	cpt	85652	26.24	26.24	1.63	1.63	41.98	41.98	34.98	34.98	O	24.49	24.49	webtpa	pos
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	61.55	61.55	webtpa	ppo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	61.55	61.55	webtpa	epo
General	revCode	510	3561.8	3561.8	61.55	61.55	2348.4	2348.4	1957	1957	O	61.55	61.55	webtpa	pos
back and neck procedures except spinal fusion with cc	ms-drg	519	36370.92	36370.92	10756.98	10756.98	60402.74	60402.74	50335.62	50335.62	I	36370.92	36370.92	webtpa	ppo
back and neck procedures except spinal fusion with cc	ms-drg	519	36370.92	36370.92	10756.98	10756.98	60402.74	60402.74	50335.62	50335.62	I	36370.92	36370.92	webtpa	epo
back and neck procedures except spinal fusion with cc	ms-drg	519	36370.92	36370.92	10756.98	10756.98	60402.74	60402.74	50335.62	50335.62	I	36370.92	36370.92	webtpa	pos
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.25	278.25	webtpa	ppo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.25	278.25	webtpa	epo
Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus	cpt	76805	298.13	298.13	90.7	90.7	477	477	397.5	397.5	O	278.25	278.25	webtpa	pos
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	27750.28	27750.28	webtpa	ppo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	27750.28	27750.28	webtpa	epo
General	revCode	480	27750.28	27750.28	2685.64	2685.64	26808.52	26808.52	22340.43	22340.43	O	27750.28	27750.28	webtpa	pos
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	149.58	149.58	webtpa	ppo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	149.58	149.58	webtpa	epo
"X-ray of knee, 3 views"	cpt	73562	160.27	160.27	24.84	24.84	230.4	230.4	192	192	O	149.58	149.58	webtpa	pos
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.07	44.07	webtpa	ppo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.07	44.07	webtpa	epo
"Blood test, basic group of blood chemicals (Calcium, total)"	cpt	80048	49.58	49.58	5.66	5.66	75.55	75.55	62.96	62.96	O	44.07	44.07	webtpa	pos
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1184.97	1184.97	webtpa	ppo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1184.97	1184.97	webtpa	epo
"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function"	cpt	93306	1269.62	1269.62	113.16	113.16	2031.38	2031.38	1692.82	1692.82	O	1184.97	1184.97	webtpa	pos
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	469.79	469.79	webtpa	ppo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	469.79	469.79	webtpa	epo
Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck	cpt	93880	479.39	479.39	188.57	188.57	767.02	767.02	639.18	639.18	O	469.79	469.79	webtpa	pos
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	247.09	247.09	webtpa	ppo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	247.09	247.09	webtpa	epo
Ultrasound of fetus	cpt	76819	411.81	411.81	42.11	42.11	658.9	658.9	549.08	549.08	O	247.09	247.09	webtpa	pos
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.03	33.03	webtpa	ppo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.03	33.03	webtpa	epo
Analysis for antibody to Rubella (German measles virus)	cpt	86762	33.71	33.71	6.66	6.66	53.93	53.93	44.94	44.94	O	33.03	33.03	webtpa	pos
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	812.7	812.7	webtpa	ppo
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	812.7	812.7	webtpa	epo
General	revCode	460	6950.29	6950.29	812.7	812.7	36595.54	36595.54	30496.28	30496.28	O	812.7	812.7	webtpa	pos
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	webtpa	ppo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	webtpa	epo
cesarean section without sterilization with mcc	ms-drg	786	17092.44	17092.44	4451.94	4451.94	27347.9	27347.9	22789.92	22789.92	I	8998.11	8998.11	webtpa	pos
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	185.5	185.5	webtpa	ppo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	185.5	185.5	webtpa	epo
"Established patient office or other outpatient visit, typically 15 minutes"	cpt	99213	320.9	320.9	46.39	46.39	1045.49	1045.49	871.24	871.24	O	185.5	185.5	webtpa	pos
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	37.77	37.77	webtpa	ppo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	37.77	37.77	webtpa	epo
"Thyroid hormone, T3 measurement, total"	cpt	84480	40.46	40.46	12.61	12.61	64.74	64.74	53.95	53.95	O	37.77	37.77	webtpa	pos
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	13099.97	13099.97	webtpa	ppo
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	13099.97	13099.97	webtpa	epo
pulmonary edema and respiratory failure	ms-drg	189	13099.97	13099.97	3622.47	3622.47	35491.31	35491.31	29576.09	29576.09	I	13099.97	13099.97	webtpa	pos
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited	cpt	93882	365.06	365.06	98.5	98.5	505.94	505.94	421.62	421.62	O	365.06	365.06	webtpa	ppo
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited	cpt	93882	365.06	365.06	98.5	98.5	505.94	505.94	421.62	421.62	O	365.06	365.06	webtpa	epo
Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited	cpt	93882	365.06	365.06	98.5	98.5	505.94	505.94	421.62	421.62	O	365.06	365.06	webtpa	pos
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	ppo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	epo
MRI scan of arm joint	cpt	73221	2039.29	2039.29	146.62	146.62	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	pos
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	468.5	468.5	webtpa	ppo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	468.5	468.5	webtpa	epo
Ultrasound study of arteries and arterial grafts of both legs	cpt	93925	468.5	468.5	184.36	184.36	783.55	783.55	652.96	652.96	O	468.5	468.5	webtpa	pos
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	33.03	33.03	webtpa	ppo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	33.03	33.03	webtpa	epo
"Uric acid level, blood"	cpt	84550	78.7	78.7	2.87	2.87	53.93	53.93	44.94	44.94	O	33.03	33.03	webtpa	pos
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	33.5	33.5	webtpa	ppo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	33.5	33.5	webtpa	epo
"Coagulation assessment blood test, plasma or whole blood"	cpt	85730	35.04	35.04	5.35	5.35	54.7	54.7	45.58	45.58	O	33.5	33.5	webtpa	pos
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1714.61	1714.61	webtpa	ppo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1714.61	1714.61	webtpa	epo
General	revCode	450	2685.64	2685.64	663.01	663.01	5685.82	5685.82	4738.18	4738.18	O	1714.61	1714.61	webtpa	pos
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	326.44	326.44	webtpa	ppo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	326.44	326.44	webtpa	epo
"Detection test by nucleic acid for Hepatitis C virus, quantification"	cpt	87522	326.44	326.44	28.68	28.68	532.97	532.97	444.14	444.14	O	326.44	326.44	webtpa	pos
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	60.85	60.85	webtpa	ppo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	60.85	60.85	webtpa	epo
Hepatitis B surface antibody measurement	cpt	86706	63.6	63.6	9.55	9.55	101.76	101.76	84.8	84.8	O	60.85	60.85	webtpa	pos
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	16405.35	16405.35	webtpa	ppo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	16405.35	16405.35	webtpa	epo
diabetes with mcc	ms-drg	637	17801.06	17801.06	6598.2	6598.2	39138.23	39138.23	32615.19	32615.19	I	16405.35	16405.35	webtpa	pos
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	349.03	349.03	webtpa	ppo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	349.03	349.03	webtpa	epo
Ultrasound of scrotum	cpt	76870	356.16	356.16	61.67	61.67	569.86	569.86	474.88	474.88	O	349.03	349.03	webtpa	pos
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	108.33	108.33	webtpa	ppo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	108.33	108.33	webtpa	epo
Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days	cpt	93270	124.38	124.38	7.84	7.84	185.71	185.71	154.76	154.76	O	108.33	108.33	webtpa	pos
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	6218.17	6218.17	webtpa	ppo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	6218.17	6218.17	webtpa	epo
respiratory infections and inflammations with mcc	ms-drg	177	20820.38	20820.38	6218.17	6218.17	37441.16	37441.16	31200.97	31200.97	I	6218.17	6218.17	webtpa	pos
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	46.75	46.75	webtpa	ppo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	46.75	46.75	webtpa	epo
"Testosterone (hormone) level, free"	cpt	84402	47.7	47.7	16.99	16.99	76.32	76.32	63.6	63.6	O	46.75	46.75	webtpa	pos
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	ppo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	epo
MRI scan of leg joint	cpt	73721	1986.81	1986.81	139.24	139.24	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	pos
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.14	17.14	webtpa	ppo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.14	17.14	webtpa	epo
"Identification of organisms by immunologic analysis, other than immunofluorescence method"	cpt	87147	17.49	17.49	3.46	3.46	27.98	27.98	23.32	23.32	O	17.14	17.14	webtpa	pos
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.23	48.23	webtpa	ppo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.23	48.23	webtpa	epo
Hemoglobin A1C level	cpt	83036	68.9	68.9	5.72	5.72	82.68	82.68	68.9	68.9	O	48.23	48.23	webtpa	pos
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	249.46	249.46	webtpa	ppo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	249.46	249.46	webtpa	epo
"X-ray of abdomen, minimum of 3 views"	cpt	74021	249.46	249.46	23.65	23.65	417.22	417.22	347.68	347.68	O	249.46	249.46	webtpa	pos
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	298.28	298.28	webtpa	ppo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	298.28	298.28	webtpa	epo
Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring	cpt	93017	5285.79	5285.79	224.22	224.22	8449.04	8449.04	7040.87	7040.87	O	298.28	298.28	webtpa	pos
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	66.92	66.92	webtpa	ppo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	66.92	66.92	webtpa	epo
Vitamin D-3 level	cpt	82306	68.29	68.29	17.83	17.83	109.26	109.26	91.05	91.05	O	66.92	66.92	webtpa	pos
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	687.83	687.83	webtpa	ppo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	687.83	687.83	webtpa	epo
Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers	cpt	93970	773.81	773.81	136.54	136.54	1129.54	1129.54	941.28	941.28	O	687.83	687.83	webtpa	pos
"Ultrasound of pelvis, complete, not pregnancy related"	cpt	76856	430.84	430.84	63.46	63.46	703.42	703.42	586.18	586.18	O	430.84	430.84	webtpa	ppo
"Ultrasound of pelvis, complete, not pregnancy related"	cpt	76856	430.84	430.84	63.46	63.46	703.42	703.42	586.18	586.18	O	430.84	430.84	webtpa	epo
"Ultrasound of pelvis, complete, not pregnancy related"	cpt	76856	430.84	430.84	63.46	63.46	703.42	703.42	586.18	586.18	O	430.84	430.84	webtpa	pos
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	37.47	37.47	webtpa	ppo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	37.47	37.47	webtpa	epo
"Immunologic analysis for autoimmune disease, A, B, or C, single antigen"	cpt	86812	63.9	63.9	17.59	17.59	109.39	109.39	91.16	91.16	O	37.47	37.47	webtpa	pos
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	1092.29	1092.29	webtpa	ppo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	1092.29	1092.29	webtpa	epo
CT scan of lower spine	cpt	72131	1092.29	1092.29	99.29	99.29	1783.34	1783.34	1486.12	1486.12	O	1092.29	1092.29	webtpa	pos
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	63.74	63.74	webtpa	ppo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	63.74	63.74	webtpa	epo
Detection test by immunoassay technique for HIV-1 and HIV-2	cpt	87389	84.6	84.6	14.51	14.51	109.26	109.26	91.05	91.05	O	63.74	63.74	webtpa	pos
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	23.28	23.28	webtpa	ppo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	23.28	23.28	webtpa	epo
Screening test for pathogenic organisms	cpt	87081	30.37	30.37	5.9	5.9	48.59	48.59	40.49	40.49	O	23.28	23.28	webtpa	pos
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	13113.91	13113.91	webtpa	ppo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	13113.91	13113.91	webtpa	epo
pulmonary embolism without mcc	ms-drg	176	13113.91	13113.91	3391.36	3391.36	21706.12	21706.12	18088.43	18088.43	I	13113.91	13113.91	webtpa	pos
"shoulder, elbow or forearm procedures, except major joint procedures with cc"	ms-drg	511	41222.33	41222.33	12029.58	12029.58	70758.94	70758.94	58965.78	58965.78	I	41222.33	41222.33	webtpa	ppo
"shoulder, elbow or forearm procedures, except major joint procedures with cc"	ms-drg	511	41222.33	41222.33	12029.58	12029.58	70758.94	70758.94	58965.78	58965.78	I	41222.33	41222.33	webtpa	epo
"shoulder, elbow or forearm procedures, except major joint procedures with cc"	ms-drg	511	41222.33	41222.33	12029.58	12029.58	70758.94	70758.94	58965.78	58965.78	I	41222.33	41222.33	webtpa	pos
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	1066.29	1066.29	webtpa	ppo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	1066.29	1066.29	webtpa	epo
CT scan chest	cpt	71250	1066.29	1066.29	97.4	97.4	1783.34	1783.34	1486.12	1486.12	O	1066.29	1066.29	webtpa	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	258.42	258.42	webtpa	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	258.42	258.42	webtpa	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	415.61	415.61	9.39	9.39	310.1	310.1	258.42	258.42	E	258.42	258.42	webtpa	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.39	35.39	webtpa	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.39	35.39	webtpa	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test"	cpt	85027	50.56	50.56	5.75	5.75	60.67	60.67	50.56	50.56	O	35.39	35.39	webtpa	pos
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	444.09	444.09	webtpa	ppo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	444.09	444.09	webtpa	epo
"New patient office or other outpatient visit, typically 45 minutes"	cpt	99204	1368.51	1368.51	147.84	147.84	1456.69	1456.69	1213.91	1213.91	O	444.09	444.09	webtpa	pos
other antepartum diagnoses without o.r. procedures with mcc	ms-drg	831	8473.81	8473.81	3236.69	3236.69	13886.92	13886.92	11572.43	11572.43	I	8473.81	8473.81	webtpa	ppo
other antepartum diagnoses without o.r. procedures with mcc	ms-drg	831	8473.81	8473.81	3236.69	3236.69	13886.92	13886.92	11572.43	11572.43	I	8473.81	8473.81	webtpa	epo
other antepartum diagnoses without o.r. procedures with mcc	ms-drg	831	8473.81	8473.81	3236.69	3236.69	13886.92	13886.92	11572.43	11572.43	I	8473.81	8473.81	webtpa	pos
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	71.9	71.9	webtpa	ppo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	71.9	71.9	webtpa	epo
"Thyroid hormone, T3 measurement, free"	cpt	84481	73.37	73.37	10.21	10.21	117.4	117.4	97.83	97.83	O	71.9	71.9	webtpa	pos
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	79.4	79.4	webtpa	ppo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	79.4	79.4	webtpa	epo
"Analysis for antibody to Herpes simplex virus, type 2"	cpt	86696	204.66	204.66	17.21	17.21	136.1	136.1	113.42	113.42	O	79.4	79.4	webtpa	pos
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	18279.29	18279.29	webtpa	ppo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	18279.29	18279.29	webtpa	epo
disorders of pancreas except malignancy with cc	ms-drg	439	18279.29	18279.29	4142.79	4142.79	19675.4	19675.4	16396.17	16396.17	I	18279.29	18279.29	webtpa	pos
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	479.92	479.92	webtpa	ppo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	479.92	479.92	webtpa	epo
Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers	cpt	93971	515.96	515.96	90.7	90.7	783.55	783.55	652.96	652.96	O	479.92	479.92	webtpa	pos
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	216.66	216.66	webtpa	ppo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	216.66	216.66	webtpa	epo
"X-ray of chest, 2 views"	cpt	71046	232.14	232.14	18.26	18.26	371.42	371.42	309.52	309.52	O	216.66	216.66	webtpa	pos
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1977.77	1977.77	webtpa	ppo
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1977.77	1977.77	webtpa	epo
Visit charge	revCode	431	1977.77	1977.77	138.67	138.67	4487.62	4487.62	3739.68	3739.68	O	1977.77	1977.77	webtpa	pos
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	50462.72	50462.72	webtpa	ppo
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	50462.72	50462.72	webtpa	epo
pulmonary embolism with mcc or acute cor pulmonale	ms-drg	175	50462.72	50462.72	7416.41	7416.41	41944.68	41944.68	34953.9	34953.9	I	50462.72	50462.72	webtpa	pos
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	224.08	224.08	webtpa	ppo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	224.08	224.08	webtpa	epo
"X-ray of ribs on one side of body including the chest, minimum of 3 views"	cpt	71101	224.08	224.08	21.67	21.67	384.14	384.14	320.12	320.12	O	224.08	224.08	webtpa	pos
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	263	263	webtpa	ppo
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	263	263	webtpa	epo
Evaluation or reevaluation	revCode	424	1044.94	1044.94	136.89	136.89	2814.5	2814.5	2345.42	2345.42	O	263	263	webtpa	pos
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	7.08	7.08	webtpa	ppo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	7.08	7.08	webtpa	epo
Red blood cell concentration measurement	cpt	85014	30.21	30.21	2.11	2.11	45.6	45.6	38	38	O	7.08	7.08	webtpa	pos
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	60.3	60.3	webtpa	ppo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	60.3	60.3	webtpa	epo
"Blood test, comprehensive group of blood chemicals"	cpt	80053	61.53	61.53	9.39	9.39	98.45	98.45	82.04	82.04	O	60.3	60.3	webtpa	pos
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	32467.31	32467.31	webtpa	ppo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	32467.31	32467.31	webtpa	epo
major small and large bowel procedures with cc	ms-drg	330	59746.02	59746.02	14048.11	14048.11	67900.68	67900.68	56583.9	56583.9	I	32467.31	32467.31	webtpa	pos
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	177.63	177.63	webtpa	ppo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	177.63	177.63	webtpa	epo
"X-ray of abdomen, 1 view"	cpt	74018	181.26	181.26	16.26	16.26	290.02	290.02	241.68	241.68	O	177.63	177.63	webtpa	pos
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	85116	85116	webtpa	ppo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	85116	85116	webtpa	epo
respiratory system diagnosis with ventilator support >96 hours	ms-drg	207	173837.62	173837.62	912.58	912.58	169745.27	169745.27	141454.39	141454.39	I	85116	85116	webtpa	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	24.15	24.15	webtpa	ppo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	24.15	24.15	webtpa	epo
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	24.15	24.15	webtpa	pos
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.67	67.67	webtpa	ppo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.67	67.67	webtpa	epo
"Detection test for gardnerella vaginalis (bacteria), direct probe technique"	cpt	87510	72.5	72.5	12.08	12.08	116	116	96.67	96.67	O	67.67	67.67	webtpa	pos
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	39.92	39.92	webtpa	ppo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	39.92	39.92	webtpa	epo
Progesterone (reproductive hormone) level	cpt	84144	68.37	68.37	12.57	12.57	109.39	109.39	91.16	91.16	O	39.92	39.92	webtpa	pos
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	3.17	3.17	webtpa	ppo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	3.17	3.17	webtpa	epo
"Red blood cell count, automated test"	cpt	85041	13.52	13.52	2.27	2.27	21.62	21.62	18.02	18.02	O	3.17	3.17	webtpa	pos
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	574	574	webtpa	ppo
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	574	574	webtpa	epo
Peripheral vascular lab	revCode	921	2997.13	2997.13	489.26	489.26	14875.3	14875.3	12396.08	12396.08	O	574	574	webtpa	pos
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	2253.92	2253.92	webtpa	ppo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	2253.92	2253.92	webtpa	epo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	2253.92	2253.92	webtpa	pos
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	238.92	238.92	webtpa	ppo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	238.92	238.92	webtpa	epo
Complete ultrasound of arm or leg	cpt	76881	282.79	282.79	39.56	39.56	409.58	409.58	341.32	341.32	O	238.92	238.92	webtpa	pos
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3778.97	3778.97	webtpa	ppo
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3778.97	3778.97	webtpa	epo
General	revCode	420	3778.97	3778.97	3098.67	3098.67	6602.4	6602.4	5502	5502	O	3778.97	3778.97	webtpa	pos
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	9053.89	9053.89	webtpa	ppo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	9053.89	9053.89	webtpa	epo
septicemia or severe sepsis without mv >96 hours with mcc	ms-drg	871	18280.29	18280.29	8156.09	8156.09	43218.12	43218.12	36015.1	36015.1	I	9053.89	9053.89	webtpa	pos
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5825.61	5825.61	webtpa	ppo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5825.61	5825.61	webtpa	epo
gastrointestinal obstruction with cc	ms-drg	389	16489.31	16489.31	3863.24	3863.24	20166.95	20166.95	16805.79	16805.79	I	5825.61	5825.61	webtpa	pos
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	56.39	56.39	webtpa	ppo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	56.39	56.39	webtpa	epo
"Analysis for antibody to Herpes simplex virus, type 1"	cpt	86695	56.39	56.39	11.73	11.73	96.67	96.67	80.56	80.56	O	56.39	56.39	webtpa	pos
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	836.75	836.75	webtpa	ppo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	836.75	836.75	webtpa	epo
CT scan of cranial cavity	cpt	70480	836.75	836.75	94.12	94.12	1366.13	1366.13	1138.44	1138.44	O	836.75	836.75	webtpa	pos
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.9	19.9	webtpa	ppo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.9	19.9	webtpa	epo
Blood group typing (ABO)	cpt	86900	96.59	96.59	2.66	2.66	136.1	136.1	113.42	113.42	O	19.9	19.9	webtpa	pos
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	908.35	908.35	webtpa	ppo
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	908.35	908.35	webtpa	epo
MRI scan of leg	cpt	73718	978.69	978.69	183.82	183.82	3107.5	3107.5	2589.58	2589.58	O	908.35	908.35	webtpa	pos
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	138.01	138.01	webtpa	ppo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	138.01	138.01	webtpa	epo
Detection test by nucleic acid for multiple types influenza virus	cpt	87502	147.87	147.87	44.91	44.91	236.59	236.59	197.16	197.16	O	138.01	138.01	webtpa	pos
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	77.91	77.91	webtpa	ppo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	77.91	77.91	webtpa	epo
Virus isolation	cpt	87255	77.91	77.91	30.12	30.12	133.56	133.56	111.3	111.3	O	77.91	77.91	webtpa	pos
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	14541.21	14541.21	webtpa	ppo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	14541.21	14541.21	webtpa	epo
poisoning and toxic effects of drugs with mcc	ms-drg	917	24671.23	24671.23	6543.47	6543.47	34428.73	34428.73	28690.61	28690.61	I	14541.21	14541.21	webtpa	pos
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	158.47	158.47	webtpa	ppo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	158.47	158.47	webtpa	epo
"Troponin (protein) analysis, quantitative"	cpt	84484	166.39	166.39	7.51	7.51	190.16	190.16	158.47	158.47	E	158.47	158.47	webtpa	pos
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	439.5	439.5	webtpa	ppo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	439.5	439.5	webtpa	epo
CT scan leg	cpt	73700	482.16	482.16	93.83	93.83	1504.78	1504.78	1253.98	1253.98	O	439.5	439.5	webtpa	pos
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.22	13.22	webtpa	ppo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.22	13.22	webtpa	epo
Blood typing for Rh (D) antigen	cpt	86901	70.1	70.1	2.66	2.66	90.31	90.31	75.26	75.26	O	13.22	13.22	webtpa	pos
inguinal and femoral hernia procedures with cc	ms-drg	351	51566.74	51566.74	7816.79	7816.79	39829.91	39829.91	33191.59	33191.59	I	51566.74	51566.74	webtpa	ppo
inguinal and femoral hernia procedures with cc	ms-drg	351	51566.74	51566.74	7816.79	7816.79	39829.91	39829.91	33191.59	33191.59	I	51566.74	51566.74	webtpa	epo
inguinal and femoral hernia procedures with cc	ms-drg	351	51566.74	51566.74	7816.79	7816.79	39829.91	39829.91	33191.59	33191.59	I	51566.74	51566.74	webtpa	pos
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	149.07	149.07	webtpa	ppo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	149.07	149.07	webtpa	epo
"X-ray of toes, minimum of 2 views"	cpt	73660	149.07	149.07	17.96	17.96	249.31	249.31	207.76	207.76	O	149.07	149.07	webtpa	pos
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	46942.95	46942.95	webtpa	ppo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	46942.95	46942.95	webtpa	epo
cardiac valve and other major cardiothoracic procedures without cardiac catheterization with cc	ms-drg	220	54699.55	54699.55	626.2	626.2	182875.63	182875.63	152396.36	152396.36	I	46942.95	46942.95	webtpa	pos
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	24554.04	24554.04	webtpa	ppo
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	24554.04	24554.04	webtpa	epo
vaginal delivery with sterilization and/or d&c without cc/mcc	ms-drg	798	24554.04	24554.04	2940.28	2940.28	31170.52	31170.52	25975.43	25975.43	I	24554.04	24554.04	webtpa	pos
Screening mammography	revCode	403	340.46	340.46	340.46	340.46	555.86	555.86	463.22	463.22	O	340.46	340.46	webtpa	ppo
Screening mammography	revCode	403	340.46	340.46	340.46	340.46	555.86	555.86	463.22	463.22	O	340.46	340.46	webtpa	epo
Screening mammography	revCode	403	340.46	340.46	340.46	340.46	555.86	555.86	463.22	463.22	O	340.46	340.46	webtpa	pos
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	6556.08	6556.08	webtpa	ppo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	6556.08	6556.08	webtpa	epo
Normal delivery of baby	ms-drg	807	8071.15	8071.15	1850.9	1850.9	13314.88	13314.88	11095.73	11095.73	I	6556.08	6556.08	webtpa	pos
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	2884.88	2884.88	webtpa	ppo
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	2884.88	2884.88	webtpa	epo
Stereotactic body radiation therapy 1 or more lesions using imaging guidance	cpt	77373	2884.88	2884.88	1536.3	1536.3	4710	4710	3925	3925	O	2884.88	2884.88	webtpa	pos
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	173.63	173.63	webtpa	ppo
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	173.63	173.63	webtpa	epo
"Emergency department visit, low to moderately severe problem"	cpt	99282	370.1	370.1	173.63	173.63	297.65	297.65	248.04	248.04	O	173.63	173.63	webtpa	pos
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	185.01	185.01	webtpa	ppo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	185.01	185.01	webtpa	epo
"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older"	cpt	90714	1474.83	1474.83	185.01	185.01	1691.47	1691.47	1409.56	1409.56	O	185.01	185.01	webtpa	pos
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	695.73	695.73	webtpa	ppo
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	695.73	695.73	webtpa	epo
Ultrasound	revCode	402	1775.61	1775.61	695.73	695.73	1999.38	1999.38	1666.15	1666.15	O	695.73	695.73	webtpa	pos
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	7690.39	7690.39	webtpa	ppo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	7690.39	7690.39	webtpa	epo
C-Section delivery of baby	ms-drg	788	9709.02	9709.02	3004.94	3004.94	15976.34	15976.34	13313.62	13313.62	I	7690.39	7690.39	webtpa	pos
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	34.74	34.74	webtpa	ppo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	34.74	34.74	webtpa	epo
"Thyroxine (thyroid chemical), free"	cpt	84439	35.45	35.45	5.44	5.44	56.72	56.72	47.27	47.27	O	34.74	34.74	webtpa	pos
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	275.28	275.28	webtpa	ppo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	275.28	275.28	webtpa	epo
"New patient office or other outpatient visit, typically 30 minutes"	cpt	99203	6873.58	6873.58	205.95	205.95	1423.62	1423.62	1186.35	1186.35	O	275.28	275.28	webtpa	pos
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	9682.72	9682.72	webtpa	ppo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	9682.72	9682.72	webtpa	epo
cardiac arrhythmia and conduction disorders with cc	ms-drg	309	9682.72	9682.72	3142.55	3142.55	21946.09	21946.09	18288.41	18288.41	I	9682.72	9682.72	webtpa	pos
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	385.84	385.84	webtpa	ppo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	385.84	385.84	webtpa	epo
"X-ray of lower and sacral spine, minimum of 4 views"	cpt	72110	423.74	423.74	29.79	29.79	661.44	661.44	551.2	551.2	O	385.84	385.84	webtpa	pos
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	79.46	79.46	webtpa	ppo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	79.46	79.46	webtpa	epo
"Blood test, thyroid stimulating hormone (TSH)"	cpt	84443	81.09	81.09	14.94	14.94	129.74	129.74	108.12	108.12	O	79.46	79.46	webtpa	pos
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	31.91	31.91	webtpa	ppo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	31.91	31.91	webtpa	epo
Amylase (enzyme) level	cpt	82150	34.19	34.19	3.91	3.91	54.7	54.7	45.58	45.58	O	31.91	31.91	webtpa	pos
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	25.23	25.23	webtpa	ppo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	25.23	25.23	webtpa	epo
Syphilis detection test	cpt	86592	27.03	27.03	3.8	3.8	43.25	43.25	36.04	36.04	O	25.23	25.23	webtpa	pos
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	110.13	110.13	webtpa	ppo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	110.13	110.13	webtpa	epo
"Coagulation function measurement, D-dimer; quantitative"	cpt	85379	115.63	115.63	9.05	9.05	132.16	132.16	110.13	110.13	E	110.13	110.13	webtpa	pos
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	185.01	185.01	webtpa	ppo
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	185.01	185.01	webtpa	epo
Administration of 1 vaccine	cpt	90471	1474.83	1474.83	185.01	185.01	1605.23	1605.23	1337.69	1337.69	O	185.01	185.01	webtpa	pos
pt education noc individ	cpt	S9445	69.75	69.75	58.24	58.24	119.57	119.57	99.64	99.64	O	69.75	69.75	webtpa	ppo
pt education noc individ	cpt	S9445	69.75	69.75	58.24	58.24	119.57	119.57	99.64	99.64	O	69.75	69.75	webtpa	epo
pt education noc individ	cpt	S9445	69.75	69.75	58.24	58.24	119.57	119.57	99.64	99.64	O	69.75	69.75	webtpa	pos
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	217.36	217.36	webtpa	ppo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	217.36	217.36	webtpa	epo
"X-ray of foot, minimum of 3 views"	cpt	73630	221.81	221.81	20.35	20.35	354.89	354.89	295.74	295.74	O	217.36	217.36	webtpa	pos
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	14989.29	14989.29	webtpa	ppo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	14989.29	14989.29	webtpa	epo
septicemia or severe sepsis without mv >96 hours without mcc	ms-drg	872	15942.66	15942.66	4743.96	4743.96	25384.62	25384.62	21153.85	21153.85	I	14989.29	14989.29	webtpa	pos
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	309.41	309.41	webtpa	ppo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	309.41	309.41	webtpa	epo
Ultrasound of head and neck	cpt	76536	331.52	331.52	73.94	73.94	530.42	530.42	442.02	442.02	O	309.41	309.41	webtpa	pos
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	322.77	322.77	webtpa	ppo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	322.77	322.77	webtpa	epo
"Testing for presence of drug, read by instrument assisted observation"	cpt	80306	345.82	345.82	10.33	10.33	553.32	553.32	461.1	461.1	O	322.77	322.77	webtpa	pos
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	292.91	292.91	webtpa	ppo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	292.91	292.91	webtpa	epo
General	revCode	300	3043.23	3043.23	34.73	34.73	10533.8	10533.8	8778.17	8778.17	O	292.91	292.91	webtpa	pos
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	701.96	701.96	webtpa	ppo
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	701.96	701.96	webtpa	epo
General	revCode	320	6718.4	6718.4	701.96	701.96	4716.83	4716.83	3930.69	3930.69	O	701.96	701.96	webtpa	pos
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	157.3	157.3	webtpa	ppo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	157.3	157.3	webtpa	epo
"Gonadotropin, luteinizing (reproductive hormone) level"	cpt	83002	168.54	168.54	11.16	11.16	269.66	269.66	224.72	224.72	O	157.3	157.3	webtpa	pos
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	49183.7	49183.7	webtpa	ppo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	49183.7	49183.7	webtpa	epo
Major joint replacement (Hip/Knee)	ms-drg	470	51283.25	51283.25	9155.37	9155.37	77641.55	77641.55	64701.29	64701.29	I	49183.7	49183.7	webtpa	pos
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	8768.28	8768.28	webtpa	ppo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	8768.28	8768.28	webtpa	epo
red blood cell disorders with mcc	ms-drg	811	15107.34	15107.34	6276.26	6276.26	29647.03	29647.03	24705.86	24705.86	I	8768.28	8768.28	webtpa	pos
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	58.66	58.66	webtpa	ppo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	58.66	58.66	webtpa	epo
"Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count"	cpt	85025	59.86	59.86	6.91	6.91	95.77	95.77	79.81	79.81	O	58.66	58.66	webtpa	pos
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	246.97	246.97	webtpa	ppo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	246.97	246.97	webtpa	epo
Radiation therapy total body port plan	cpt	77321	316.47	316.47	246.97	246.97	403.22	403.22	336.02	336.02	O	246.97	246.97	webtpa	pos
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	171.92	171.92	webtpa	ppo
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	171.92	171.92	webtpa	epo
Chemistry	revCode	301	3532.41	3532.41	171.92	171.92	11030.75	11030.75	9192.29	9192.29	O	171.92	171.92	webtpa	pos
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	65.3	65.3	webtpa	ppo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	65.3	65.3	webtpa	epo
"Gonadotropin, follicle stimulating (reproductive hormone) level"	cpt	83001	69.96	69.96	11.2	11.2	111.94	111.94	93.28	93.28	O	65.3	65.3	webtpa	pos
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	343.58	343.58	webtpa	ppo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	343.58	343.58	webtpa	epo
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes"	cpt	97110	2994.51	2994.51	343.58	343.58	5002.78	5002.78	4168.98	4168.98	O	343.58	343.58	webtpa	pos
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	796.91	796.91	webtpa	ppo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	796.91	796.91	webtpa	epo
CT scan of face	cpt	70486	875.18	875.18	81.02	81.02	1366.13	1366.13	1138.44	1138.44	O	796.91	796.91	webtpa	pos
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.26	45.26	webtpa	ppo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.26	45.26	webtpa	epo
"Bacterial colony count, urine"	cpt	87086	48.5	48.5	4.86	4.86	77.59	77.59	64.66	64.66	O	45.26	45.26	webtpa	pos
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	14050.94	14050.94	webtpa	ppo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	14050.94	14050.94	webtpa	epo
hypertension without mcc	ms-drg	305	18810.66	18810.66	3377.11	3377.11	19962.74	19962.74	16635.62	16635.62	I	14050.94	14050.94	webtpa	pos
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	18.21	18.21	webtpa	ppo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	18.21	18.21	webtpa	epo
"Measurement of antibody (IgE) to allergic substance, crude allergen extract, each"	cpt	86003	29.21	29.21	5.22	5.22	42.88	42.88	35.73	35.73	O	18.21	18.21	webtpa	pos
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	537.58	537.58	webtpa	ppo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	537.58	537.58	webtpa	epo
X-ray lower and sacral spine including bending views minimum 6 views	cpt	72114	575.98	575.98	37.12	37.12	877.68	877.68	731.4	731.4	O	537.58	537.58	webtpa	pos
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	192.18	192.18	webtpa	ppo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	192.18	192.18	webtpa	epo
"Ultrasound of one breast, limited"	cpt	76642	216.32	216.32	45.12	45.12	329.45	329.45	274.54	274.54	O	192.18	192.18	webtpa	pos
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4856.9	4856.9	webtpa	ppo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4856.9	4856.9	webtpa	epo
"alcohol, drug abuse or dependence without rehabilitation therapy without mcc"	ms-drg	897	5814.25	5814.25	1891.86	1891.86	16430.57	16430.57	13692.14	13692.14	I	4856.9	4856.9	webtpa	pos
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	217.36	217.36	webtpa	ppo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	217.36	217.36	webtpa	epo
"X-ray of ankle, minimum of 3 views"	cpt	73610	232.89	232.89	21.85	21.85	334.8	334.8	279	279	O	217.36	217.36	webtpa	pos
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	66.06	66.06	webtpa	ppo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	66.06	66.06	webtpa	epo
"Detection test by nucleic acid for clostridium difficile, amplified probe technique"	cpt	87493	67.41	67.41	13.82	13.82	107.86	107.86	89.88	89.88	O	66.06	66.06	webtpa	pos
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1805.42	1805.42	webtpa	ppo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1805.42	1805.42	webtpa	epo
MRI scan of upper spinal canal	cpt	72141	1942.19	1942.19	123.29	123.29	3107.5	3107.5	2589.58	2589.58	O	1805.42	1805.42	webtpa	pos
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	185.01	185.01	webtpa	ppo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	185.01	185.01	webtpa	epo
"Emergency department visit, moderately severe problem"	cpt	99283	702.39	702.39	185.01	185.01	1224.94	1224.94	1020.78	1020.78	O	185.01	185.01	webtpa	pos
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	185.01	185.01	webtpa	ppo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	185.01	185.01	webtpa	epo
"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes"	cpt	12011	1652.17	1652.17	185.01	185.01	4586.89	4586.89	3822.41	3822.41	O	185.01	185.01	webtpa	pos
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	117.6	117.6	webtpa	ppo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	117.6	117.6	webtpa	epo
SARS-COV-2 COVID-19 AMP PRB	cpt	87635	1660.16	1660.16	51.31	51.31	201.6	201.6	168	168	O	117.6	117.6	webtpa	pos
Minor surgery	revCode	361	2031.56	2031.56	2031.56	2031.56	5049.49	5049.49	4207.91	4207.91	O	2031.56	2031.56	webtpa	ppo
Minor surgery	revCode	361	2031.56	2031.56	2031.56	2031.56	5049.49	5049.49	4207.91	4207.91	O	2031.56	2031.56	webtpa	epo
Minor surgery	revCode	361	2031.56	2031.56	2031.56	2031.56	5049.49	5049.49	4207.91	4207.91	O	2031.56	2031.56	webtpa	pos
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	102531.45	102531.45	webtpa	ppo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	102531.45	102531.45	webtpa	epo
percutaneous cardiovascular procedures with drug-eluting stent with mcc or 4+ arteries or stents	ms-drg	246	102531.45	102531.45	16056.72	16056.72	120967.27	120967.27	100806.06	100806.06	I	102531.45	102531.45	webtpa	pos
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	445.64	445.64	webtpa	ppo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	445.64	445.64	webtpa	epo
"X-ray of both hips with pelvis, minimum of 5 views"	cpt	73523	445.64	445.64	36.22	36.22	727.58	727.58	606.32	606.32	O	445.64	445.64	webtpa	pos
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	208.5	208.5	webtpa	ppo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	208.5	208.5	webtpa	epo
ldct for lung ca screen	cpt	G0297	312.75	312.75	69.29	69.29	357.43	357.43	297.86	297.86	O	208.5	208.5	webtpa	pos
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	13935.82	13935.82	webtpa	ppo
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	13935.82	13935.82	webtpa	epo
General	revCode	360	13935.82	13935.82	8642.34	8642.34	28909.84	28909.84	24091.53	24091.53	O	13935.82	13935.82	webtpa	pos
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	241.2	241.2	webtpa	ppo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	241.2	241.2	webtpa	epo
"Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method"	cpt	87338	246.13	246.13	8.66	8.66	393.8	393.8	328.17	328.17	O	241.2	241.2	webtpa	pos
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	309.52	309.52	webtpa	ppo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	309.52	309.52	webtpa	epo
"X-ray of chest, 2 views"	cpt	71046	309.52	309.52	17.46	17.46	371.42	371.42	309.52	309.52	E	309.52	309.52	webtpa	pos
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.45	46.45	webtpa	ppo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.45	46.45	webtpa	epo
Cyanocobalamin (vitamin B-12) level	cpt	82607	49.76	49.76	9.08	9.08	79.62	79.62	66.35	66.35	O	46.45	46.45	webtpa	pos
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	14535.84	14535.84	webtpa	ppo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	14535.84	14535.84	webtpa	epo
Other implants	revCode	278	14535.84	14535.84	7453.01	7453.01	66615.74	66615.74	55513.12	55513.12	O	14535.84	14535.84	webtpa	pos
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.42	53.42	webtpa	ppo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.42	53.42	webtpa	epo
Ferritin (blood protein) level	cpt	82728	58.67	58.67	12.12	12.12	91.58	91.58	76.32	76.32	O	53.42	53.42	webtpa	pos
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	158.79	158.79	webtpa	ppo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	158.79	158.79	webtpa	epo
"Pathology examination of tissue using a microscope, intermediate complexity"	cpt	88305	226.84	226.84	26.64	26.64	272.21	272.21	226.84	226.84	O	158.79	158.79	webtpa	pos
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	ppo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	epo
MRI scan of lower spinal canal	cpt	72148	1942.19	1942.19	123.59	123.59	3107.5	3107.5	2589.58	2589.58	O	1812.71	1812.71	webtpa	pos
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	133.56	133.56	webtpa	ppo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	133.56	133.56	webtpa	epo
"Pathology examination of tissue using a microscope, moderately low complexity"	cpt	88304	195.57	195.57	24.37	24.37	228.96	228.96	190.8	190.8	O	133.56	133.56	webtpa	pos
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	446.68	446.68	webtpa	ppo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	446.68	446.68	webtpa	epo
"Ultrasound of abdomen, limited"	cpt	76705	478.59	478.59	52.09	52.09	765.74	765.74	638.12	638.12	O	446.68	446.68	webtpa	pos
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	500.11	500.11	webtpa	ppo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	500.11	500.11	webtpa	epo
Ultrasound pelvis through vagina	cpt	76830	535.83	535.83	73.68	73.68	857.33	857.33	714.44	714.44	O	500.11	500.11	webtpa	pos
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2018.99	2018.99	webtpa	ppo
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2018.99	2018.99	webtpa	epo
als 1	cpt	A0426	2862	2862	763.59	763.59	3265.2	3265.2	2721	2721	O	2018.99	2018.99	webtpa	pos
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	95.27	95.27	webtpa	ppo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	95.27	95.27	webtpa	epo
"Blood test, lipids (cholesterol and triglycerides)"	cpt	80061	102.07	102.07	8.06	8.06	127.4	127.4	106.17	106.17	O	95.27	95.27	webtpa	pos
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	46211.54	46211.54	webtpa	ppo
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	46211.54	46211.54	webtpa	epo
cervical spinal fusion with mcc	ms-drg	471	46211.54	46211.54	27832.43	27832.43	101079.62	101079.62	84233.02	84233.02	I	46211.54	46211.54	webtpa	pos
"Estrogen analysis, fractionated"	cpt	82671	274.54	274.54	28.73	28.73	457.32	457.32	381.1	381.1	O	274.54	274.54	webtpa	ppo
"Estrogen analysis, fractionated"	cpt	82671	274.54	274.54	28.73	28.73	457.32	457.32	381.1	381.1	O	274.54	274.54	webtpa	epo
"Estrogen analysis, fractionated"	cpt	82671	274.54	274.54	28.73	28.73	457.32	457.32	381.1	381.1	O	274.54	274.54	webtpa	pos
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	7.27	7.27	webtpa	ppo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	7.27	7.27	webtpa	epo
"Blood count, hemoglobin"	cpt	85018	31.01	31.01	2.11	2.11	46.8	46.8	39	39	O	7.27	7.27	webtpa	pos
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	1846.98	1846.98	webtpa	ppo
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	1846.98	1846.98	webtpa	epo
Body scan	revCode	352	2997.13	2997.13	1846.98	1846.98	12378.82	12378.82	10315.68	10315.68	O	1846.98	1846.98	webtpa	pos
non-extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	987	39092.28	39092.28	19983.77	19983.77	81264.44	81264.44	67720.37	67720.37	I	39092.28	39092.28	webtpa	ppo
non-extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	987	39092.28	39092.28	19983.77	19983.77	81264.44	81264.44	67720.37	67720.37	I	39092.28	39092.28	webtpa	epo
non-extensive o.r. procedures unrelated to principal diagnosis with mcc	ms-drg	987	39092.28	39092.28	19983.77	19983.77	81264.44	81264.44	67720.37	67720.37	I	39092.28	39092.28	webtpa	pos
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	64931.69	64931.69	webtpa	ppo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	64931.69	64931.69	webtpa	epo
percutaneous cardiovascular procedures with drug-eluting stent without mcc	ms-drg	247	64931.69	64931.69	8541.69	8541.69	88718.5	88718.5	73932.08	73932.08	I	64931.69	64931.69	webtpa	pos
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	170.66	170.66	webtpa	ppo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	170.66	170.66	webtpa	epo
Diagnostic mammography of one breast	cpt	77065	197.59	197.59	78.49	78.49	292.56	292.56	243.8	243.8	O	170.66	170.66	webtpa	pos
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	92.82	92.82	webtpa	ppo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	92.82	92.82	webtpa	epo
"Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique"	cpt	87491	99.45	99.45	21.14	21.14	159.12	159.12	132.6	132.6	O	92.82	92.82	webtpa	pos
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	493.95	493.95	webtpa	ppo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	493.95	493.95	webtpa	epo
Ultrasound behind abdominal cavity	cpt	76770	493.95	493.95	64.36	64.36	806.45	806.45	672.04	672.04	O	493.95	493.95	webtpa	pos
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	40.96	40.96	webtpa	ppo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	40.96	40.96	webtpa	epo
Fungal culture (mold or yeast)	cpt	87102	43.88	43.88	7.48	7.48	70.21	70.21	58.51	58.51	O	40.96	40.96	webtpa	pos
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	1442.37	1442.37	webtpa	ppo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	1442.37	1442.37	webtpa	epo
Head scan	revCode	351	2909.63	2909.63	1442.37	1442.37	14535.66	14535.66	12113.05	12113.05	O	1442.37	1442.37	webtpa	pos
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	43	43	webtpa	ppo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	43	43	webtpa	epo
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)"	cpt	80051	43	43	6.34	6.34	73.72	73.72	61.43	61.43	O	43	43	webtpa	pos
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	62.48	62.48	webtpa	ppo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	62.48	62.48	webtpa	epo
ANTIBODY SARS-COV-2 COVID-19	cpt	86769	4492.48	4492.48	62.48	62.48	9187.27	9187.27	7656.06	7656.06	O	62.48	62.48	webtpa	pos
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	224.08	224.08	webtpa	ppo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	224.08	224.08	webtpa	epo
"X-ray of knee, 4 or more views"	cpt	73564	240.09	240.09	27.24	27.24	362.4	362.4	302	302	O	224.08	224.08	webtpa	pos
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	594.34	594.34	webtpa	ppo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	594.34	594.34	webtpa	epo
"Emergency department visit, problem of high severity"	cpt	99284	2959.28	2959.28	594.34	594.34	4740.01	4740.01	3950.01	3950.01	O	594.34	594.34	webtpa	pos
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	17445.39	17445.39	webtpa	ppo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	17445.39	17445.39	webtpa	epo
other kidney and urinary tract diagnoses with mcc	ms-drg	698	18781.88	18781.88	2628.54	2628.54	33701.81	33701.81	28084.84	28084.84	I	17445.39	17445.39	webtpa	pos
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	13701.94	13701.94	webtpa	ppo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	13701.94	13701.94	webtpa	epo
kidney and urinary tract infections without mcc	ms-drg	690	13701.94	13701.94	2894.21	2894.21	18878.44	18878.44	15732.03	15732.03	I	13701.94	13701.94	webtpa	pos
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	23726.76	23726.76	webtpa	ppo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	23726.76	23726.76	webtpa	epo
laparoscopic cholecystectomy without c.d.e. without cc/mcc	ms-drg	419	23726.76	23726.76	5653.63	5653.63	40773.58	40773.58	33977.98	33977.98	I	23726.76	23726.76	webtpa	pos
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	141.02	141.02	webtpa	ppo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	141.02	141.02	webtpa	epo
"X-ray of hip with pelvis, 2-3 views"	cpt	73502	141.02	141.02	28.44	28.44	217.2	217.2	181	181	O	141.02	141.02	webtpa	pos
Cardiac rehabilitation	revCode	943	689.04	689.04	689.04	689.04	1124.93	1124.93	937.44	937.44	O	689.04	689.04	webtpa	ppo
Cardiac rehabilitation	revCode	943	689.04	689.04	689.04	689.04	1124.93	1124.93	937.44	937.44	O	689.04	689.04	webtpa	epo
Cardiac rehabilitation	revCode	943	689.04	689.04	689.04	689.04	1124.93	1124.93	937.44	937.44	O	689.04	689.04	webtpa	pos
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	238.18	238.18	webtpa	ppo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	238.18	238.18	webtpa	epo
Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus	cpt	76801	261.58	261.58	61.35	61.35	408.31	408.31	340.26	340.26	O	238.18	238.18	webtpa	pos
Education/training	revCode	942	117.93	117.93	117.93	117.93	186.34	186.34	155.28	155.28	O	117.93	117.93	webtpa	ppo
Education/training	revCode	942	117.93	117.93	117.93	117.93	186.34	186.34	155.28	155.28	O	117.93	117.93	webtpa	epo
Education/training	revCode	942	117.93	117.93	117.93	117.93	186.34	186.34	155.28	155.28	O	117.93	117.93	webtpa	pos
Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report	cpt	93010	24.15	24.15	6.96	6.96	39.43	39.43	32.86	32.86	O	23	23	webtpa medicare advantage	ppo
Visit charge	revCode	421	2253.92	2253.92	92.46	92.46	4980	4980	4150	4150	O	1420.17	1420.17	workers comp	workers comp