47-2059580_Fairview-Regional-Medical-Center_standardcharges.csv

Machine Downloadable file

hospital_name Fairview Regional Medical Center Authority
last_updated_on 1/1/2025
version 2.0.0
hospital_location Fairview Regional Medical Center
hospital_address 523 E State Road Fairview, OK 73737
license_number| OK 2248

**To the best of its knowledge and belief, Fairview Regional Medical Center has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.

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hospital_name	last_updated_on	version		hospital_location	hospital_address	license_number|OK	To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.
Fairview Regional Medical Center Authority	1/1/2025	2.0.0		Fairview Regional Medical Center	523 E State Road Fairview, OK 73737	2248	TRUE
description	code|[i]	code|[i]|type	setting	drug_unit_of_measurement	drug_type_of_measurement	standard_charge|gross	standard_charge|discounted_cash	payer_name	plan_name	modifiers	standard_charge|negotiated_dollar	standard_charge|negotiated_percentage	standard_charge|negotiated_algorithm	estimated_amount	standard_charge|min	standard_charge|max	standard_charge|methodology	additional_generic_notes
HC THER EXERCISE EA 15 MIN PT	97110		Both			$96.00	$57.60	AETNA			$20.68			999999999	$20.68	$77.05	Fee schedule
HC THER EXERCISE EA 15 MIN PT	97110		Both			$96.00	$57.60	BCBS			$77.05			999999999	$20.68	$77.05	Fee schedule
HC THER EXERCISE EA 15 MIN PT	97110		Both			$96.00	$57.60	HEALTHCHOICE			$35.59			999999999	$20.68	$77.05	Fee schedule
HC THER EXERCISE EA 15 MIN PT	97110		Both			$96.00	$57.60	Medicaid			$26.34			999999999	$20.68	$77.05	Fee schedule
HC THER EXERCISE EA 15 MIN PT	97110		Both			$96.00	$57.60	Medicare			$54.81			999999999	$20.68	$77.05	Per diem
HC GAIT TRAINING EA 15 MIN PT	97116		Both			$80.00	$48.00	AETNA			$18.26			999999999	$18.26	$77.05	Fee schedule
HC GAIT TRAINING EA 15 MIN PT	97116		Both			$80.00	$48.00	BCBS			$77.05			999999999	$18.26	$77.05	Fee schedule
HC GAIT TRAINING EA 15 MIN PT	97116		Both			$80.00	$48.00	HEALTHCHOICE			$35.21			999999999	$18.26	$77.05	Fee schedule
HC GAIT TRAINING EA 15 MIN PT	97116		Both			$80.00	$48.00	Medicaid			$26.34			999999999	$18.26	$77.05	Fee schedule
HC GAIT TRAINING EA 15 MIN PT	97116		Both			$80.00	$48.00	Medicare			$45.68			999999999	$18.26	$77.05	Per diem
LCHG CBC W AUTO DIFFERENTIAL	85025		Both			$49.00	$29.40	AETNA			$7.48			999999999	$7.48	$33.51	Fee schedule
LCHG CBC W AUTO DIFFERENTIAL	85025		Both			$49.00	$29.40	BCBS			$33.51			999999999	$7.48	$33.51	Fee schedule
LCHG CBC W AUTO DIFFERENTIAL	85025		Both			$49.00	$29.40	HEALTHCHOICE			$9.32			999999999	$7.48	$33.51	Fee schedule
LCHG CBC W AUTO DIFFERENTIAL	85025		Both			$49.00	$29.40	Medicaid			$26.34			999999999	$7.48	$33.51	Fee schedule
LCHG CBC W AUTO DIFFERENTIAL	85025		Both			$49.00	$29.40	Medicare			$27.95			999999999	$7.48	$33.51	Per diem
LCHG CBC W/O AUTO DIFFERENTIAL	85027		Both			$45.00	$27.00	AETNA			$6.22			999999999	$5.75	$33.51	Fee schedule
LCHG CBC W/O AUTO DIFFERENTIAL	85027		Both			$45.00	$27.00	BCBS			$33.51			999999999	$5.75	$33.51	Fee schedule
LCHG CBC W/O AUTO DIFFERENTIAL	85027		Both			$45.00	$27.00	HEALTHCHOICE			$7.76			999999999	$5.75	$33.51	Fee schedule
LCHG CBC W/O AUTO DIFFERENTIAL	85027		Both			$45.00	$27.00	Medicaid			$5.75			999999999	$5.75	$33.51	Fee schedule
LCHG CBC W/O AUTO DIFFERENTIAL	85027		Both			$45.00	$27.00	Medicare			$25.58			999999999	$5.75	$33.51	Per diem
LCHG D-DIMER QUANTITATIVE	85379		Both			$150.00	$90.00	AETNA			$9.79			999999999	$9.05	$90.00	Fee schedule
LCHG D-DIMER QUANTITATIVE	85379		Both			$150.00	$90.00	BCBS			$57.42			999999999	$9.05	$90.00	Fee schedule
LCHG D-DIMER QUANTITATIVE	85379		Both			$150.00	$90.00	HEALTHCHOICE			$12.22			999999999	$9.05	$90.00	Fee schedule
LCHG D-DIMER QUANTITATIVE	85379		Both			$150.00	$90.00	Medicaid			$9.05			999999999	$9.05	$90.00	Fee schedule
LCHG D-DIMER QUANTITATIVE	85379		Both			$150.00	$90.00	Medicare			$85.26			999999999	$9.05	$90.00	Per diem
LCHG PTH INTACT	83970		Both			$259.00	$155.40	AETNA			$39.72			999999999	$36.72	$155.40	Fee schedule
LCHG PTH INTACT	83970		Both			$259.00	$155.40	BCBS			$98.66			999999999	$36.72	$155.40	Fee schedule
LCHG PTH INTACT	83970		Both			$259.00	$155.40	HEALTHCHOICE			$49.54			999999999	$36.72	$155.40	Fee schedule
LCHG PTH INTACT	83970		Both			$259.00	$155.40	Medicaid			$36.72			999999999	$36.72	$155.40	Fee schedule
LCHG PTH INTACT	83970		Both			$259.00	$155.40	Medicare			$147.50			999999999	$36.72	$155.40	Per diem
LCHG PHOSPHORUS BLOOD	84100		Both			$45.00	$27.00	AETNA			$4.56			999999999	$4.22	$27.00	Fee schedule
LCHG PHOSPHORUS BLOOD	84100		Both			$45.00	$27.00	BCBS			$23.81			999999999	$4.22	$27.00	Fee schedule
LCHG PHOSPHORUS BLOOD	84100		Both			$45.00	$27.00	HEALTHCHOICE			$5.69			999999999	$4.22	$27.00	Fee schedule
LCHG PHOSPHORUS BLOOD	84100		Both			$45.00	$27.00	Medicaid			$4.22			999999999	$4.22	$27.00	Fee schedule
LCHG PHOSPHORUS BLOOD	84100		Both			$45.00	$27.00	Medicare			$25.58			999999999	$4.22	$27.00	Per diem
LCHG PROGESTERONE	84144		Both			$60.00	$36.00	AETNA			$20.08			999999999	$18.55	$74.32	Fee schedule
LCHG PROGESTERONE	84144		Both			$60.00	$36.00	BCBS			$74.32			999999999	$18.55	$74.32	Fee schedule
LCHG PROGESTERONE	84144		Both			$60.00	$36.00	HEALTHCHOICE			$25.03			999999999	$18.55	$74.32	Fee schedule
LCHG PROGESTERONE	84144		Both			$60.00	$36.00	Medicaid			$18.55			999999999	$18.55	$74.32	Fee schedule
LCHG PROGESTERONE	84144		Both			$60.00	$36.00	Medicare			$34.10			999999999	$18.55	$74.32	Per diem
LCHG PROLACTIN	84146		Both			$132.00	$79.20	AETNA			$18.65			999999999	$17.24	$98.66	Fee schedule
LCHG PROLACTIN	84146		Both			$132.00	$79.20	BCBS			$98.66			999999999	$17.24	$98.66	Fee schedule
LCHG PROLACTIN	84146		Both			$132.00	$79.20	HEALTHCHOICE			$23.26			999999999	$17.24	$98.66	Fee schedule
LCHG PROLACTIN	84146		Both			$132.00	$79.20	Medicaid			$17.24			999999999	$17.24	$98.66	Fee schedule
LCHG PROLACTIN	84146		Both			$132.00	$79.20	Medicare			$75.03			999999999	$17.24	$98.66	Per diem
PR IMPLANT,HORMONE,SUBCUTANEOUS	11980		Both			$375.00	$225.00	AETNA			$93.22			999999999	$0.00	$225.00	Fee schedule
PR IMPLANT,HORMONE,SUBCUTANEOUS	11980		Both			$375.00	$225.00	BCBS			789..29			999999999	$0.00	$225.00	Fee schedule
PR IMPLANT,HORMONE,SUBCUTANEOUS	11980		Both			$375.00	$225.00	HEALTHCHOICE			$0.00			999999999	$0.00	$225.00	Fee schedule
PR IMPLANT,HORMONE,SUBCUTANEOUS	11980		Both			$375.00	$225.00	Medicaid			$82.78			999999999	$0.00	$225.00	Fee schedule
PR IMPLANT,HORMONE,SUBCUTANEOUS	11980		Both			$375.00	$225.00	Medicare			$213.15			999999999	$0.00	$225.00	Per diem
HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	12001		Both			$283.00	$169.80	AETNA			$41.14			999999999	$41.14	$789.29	Fee schedule
HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	12001		Both			$283.00	$169.80	BCBS			$789.29			999999999	$41.14	$789.29	Fee schedule
HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	12001		Both			$283.00	$169.80	HEALTHCHOICE			$62.00			999999999	$41.14	$789.29	Fee schedule
HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	12001		Both			$283.00	$169.80	Medicaid			$82.12			999999999	$41.14	$789.29	Fee schedule
HC ED RPR SCLP/TRNK/EXTRM SMPL <= 2.5CM	12001		Both			$283.00	$169.80	Medicare			$160.78			999999999	$41.14	$789.29	Per diem
HC ED RPR FACE EAR SMPL <=2.5CM	12011		Both			$339.00	$203.40	AETNA			$99.12			999999999	$77.82	$789.29	Fee schedule
HC ED RPR FACE EAR SMPL <=2.5CM	12011		Both			$339.00	$203.40	BCBS			$789.29			999999999	$77.82	$789.29	Fee schedule
HC ED RPR FACE EAR SMPL <=2.5CM	12011		Both			$339.00	$203.40	HEALTHCHOICE			$77.82			999999999	$77.82	$789.29	Fee schedule
HC ED RPR FACE EAR SMPL <=2.5CM	12011		Both			$339.00	$203.40	Medicaid			$98.33			999999999	$77.82	$789.29	Fee schedule
HC ED RPR FACE EAR SMPL <=2.5CM	12011		Both			$339.00	$203.40	Medicare			$192.93			999999999	$77.82	$789.29	Per diem
PR DESTROY PREMALIG LESION, 1ST LESION	17000		Both			$94.00	$56.40	AETNA			$72.72			999999999	$53.29	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 1ST LESION	17000		Both			$94.00	$56.40	BCBS			$647.49			999999999	$53.29	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 1ST LESION	17000		Both			$94.00	$56.40	HEALTHCHOICE			$70.92			999999999	$53.29	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 1ST LESION	17000		Both			$94.00	$56.40	Medicaid			$58.54			999999999	$53.29	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 1ST LESION	17000		Both			$94.00	$56.40	Medicare			$53.29			999999999	$53.29	$647.49	Per diem
PR DESTROY PREMALIG LESION, 2-14	17003		Both			$24.00	$14.40	AETNA			$6.00			999999999	$2.87	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 2-14	17003		Both			$24.00	$14.40	BCBS			$647.49			999999999	$2.87	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 2-14	17003		Both			$24.00	$14.40	HEALTHCHOICE			$2.87			999999999	$2.87	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 2-14	17003		Both			$24.00	$14.40	Medicaid			$5.77			999999999	$2.87	$647.49	Fee schedule
PR DESTROY PREMALIG LESION, 2-14	17003		Both			$24.00	$14.40	Medicare			$13.70			999999999	$2.87	$647.49	Per diem
PR DESTRUCT BENIGN LESION, 1-14	17110		Both			$102.00	$61.20	AETNA			$98.93			999999999	$57.86	$759.33	Fee schedule
PR DESTRUCT BENIGN LESION, 1-14	17110		Both			$102.00	$61.20	BCBS			$759.33			999999999	$57.86	$759.33	Fee schedule
PR DESTRUCT BENIGN LESION, 1-14	17110		Both			$102.00	$61.20	HEALTHCHOICE			$88.18			999999999	$57.86	$759.33	Fee schedule
PR DESTRUCT BENIGN LESION, 1-14	17110		Both			$102.00	$61.20	Medicaid			$98.20			999999999	$57.86	$759.33	Fee schedule
PR DESTRUCT BENIGN LESION, 1-14	17110		Both			$102.00	$61.20	Medicare			$57.86			999999999	$57.86	$759.33	Per diem
REMOVAL OF BREAST GROWTH, OPEN	19120		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF BREAST GROWTH, OPEN	19120		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF BREAST GROWTH, OPEN	19120		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF BREAST GROWTH, OPEN	19120		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF BREAST GROWTH, OPEN	19120		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
PR DRAIN/INJECT LARGE JOINT/BURSA	20610		Both			$165.00	$99.00	AETNA			$60.73			999999999	$56.78	$1,073.44	Fee schedule
PR DRAIN/INJECT LARGE JOINT/BURSA	20610		Both			$165.00	$99.00	BCBS			$1,073.44			999999999	$56.78	$1,073.44	Fee schedule
PR DRAIN/INJECT LARGE JOINT/BURSA	20610		Both			$165.00	$99.00	HEALTHCHOICE			$62.62			999999999	$56.78	$1,073.44	Fee schedule
PR DRAIN/INJECT LARGE JOINT/BURSA	20610		Both			$165.00	$99.00	Medicaid			$56.78			999999999	$56.78	$1,073.44	Fee schedule
PR DRAIN/INJECT LARGE JOINT/BURSA	20610		Both			$165.00	$99.00	Medicare			$93.63			999999999	$56.78	$1,073.44	Per diem
HC ED STRAPPING ANKLE/FOOT	29540		Both			$120.00	$72.00	AETNA			$37.52			999999999	$24.69	$617.93	Fee schedule
HC ED STRAPPING ANKLE/FOOT	29540		Both			$120.00	$72.00	BCBS			$617.93			999999999	$24.69	$617.93	Fee schedule
HC ED STRAPPING ANKLE/FOOT	29540		Both			$120.00	$72.00	HEALTHCHOICE			$24.69			999999999	$24.69	$617.93	Fee schedule
HC ED STRAPPING ANKLE/FOOT	29540		Both			$120.00	$72.00	Medicaid			$24.91			999999999	$24.69	$617.93	Fee schedule
HC ED STRAPPING ANKLE/FOOT	29540		Both			$120.00	$72.00	Medicare			$68.21			999999999	$24.69	$617.93	Per diem
SHAVING OF SHOULDER BONE, ENDOSCOPE	29826		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
SHAVING OF SHOULDER BONE, ENDOSCOPE	29826		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
SHAVING OF SHOULDER BONE, ENDOSCOPE	29826		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
SHAVING OF SHOULDER BONE, ENDOSCOPE	29826		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
SHAVING OF SHOULDER BONE, ENDOSCOPE	29826		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
REMOVAL OF KNEE CARTILAGE, ENDOSCOPE	29881		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF KNEE CARTILAGE, ENDOSCOPE	29881		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF KNEE CARTILAGE, ENDOSCOPE	29881		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF KNEE CARTILAGE, ENDOSCOPE	29881		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF KNEE CARTILAGE, ENDOSCOPE	29881		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
LCHG BLOOD DRAW	36415		Both			$13.00	$7.80	AETNA			$3.12			999999999	$0.00	$7.85	Fee schedule
LCHG BLOOD DRAW	36415		Both			$13.00	$7.80	BCBS			$0.00			999999999	$0.00	$7.85	Fee schedule
LCHG BLOOD DRAW	36415		Both			$13.00	$7.80	HEALTHCHOICE			$4.14			999999999	$0.00	$7.85	Fee schedule
LCHG BLOOD DRAW	36415		Both			$13.00	$7.80	Medicaid			$7.85			999999999	$0.00	$7.85	Fee schedule
LCHG BLOOD DRAW	36415		Both			$13.00	$7.80	Medicare			$7.67			999999999	$0.00	$7.85	Per diem
LCHG TRANSFUSION SERVICE FEE	36430		Both			$955.00	$573.00	AETNA			$30.85			999999999	$30.85	$2,683.30	Fee schedule
LCHG TRANSFUSION SERVICE FEE	36430		Both			$955.00	$573.00	BCBS			$2,683.30			999999999	$30.85	$2,683.30	Fee schedule
LCHG TRANSFUSION SERVICE FEE	36430		Both			$955.00	$573.00	HEALTHCHOICE			$43.66			999999999	$30.85	$2,683.30	Fee schedule
LCHG TRANSFUSION SERVICE FEE	36430		Both			$955.00	$573.00	Medicaid			$32.83			999999999	$30.85	$2,683.30	Fee schedule
LCHG TRANSFUSION SERVICE FEE	36430		Both			$955.00	$573.00	Medicare			$543.11			999999999	$30.85	$2,683.30	Per diem
REMOVAL OF TONSILS AND ADENOIDS YOUNGER THAN 12	42820		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF TONSILS AND ADENOIDS YOUNGER THAN 12	42820		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF TONSILS AND ADENOIDS YOUNGER THAN 12	42820		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF TONSILS AND ADENOIDS YOUNGER THAN 12	42820		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF TONSILS AND ADENOIDS YOUNGER THAN 12	42820		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL ENDOSCOPE	43235		Both			$0.00	$0.00	AETNA			$282.49			999999999	$0.00	$1,927.03	Fee schedule
DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL ENDOSCOPE	43235		Both			$0.00	$0.00	BCBS			$1,927.03			999999999	$0.00	$1,927.03	Fee schedule
DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL ENDOSCOPE	43235		Both			$0.00	$0.00	HEALTHCHOICE			$167.84			999999999	$0.00	$1,927.03	Fee schedule
DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL ENDOSCOPE	43235		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$1,927.03	Fee schedule
DIAGNOSTIC EXAM OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL ENDOSCOPE	43235		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$1,927.03	Per diem
BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL, ENDOSCOPE	43239		Both			$5,107.00	$3,064.20	AETNA			$326.26			999999999	$189.38	$3,064.20	Fee schedule
BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL, ENDOSCOPE	43239		Both			$5,107.00	$3,064.20	BCBS			$1,927.03			999999999	$189.38	$3,064.20	Fee schedule
BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL, ENDOSCOPE	43239		Both			$5,107.00	$3,064.20	HEALTHCHOICE			$189.38			999999999	$189.38	$3,064.20	Fee schedule
BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL, ENDOSCOPE	43239		Both			$5,107.00	$3,064.20	Medicaid			$326.62			999999999	$189.38	$3,064.20	Fee schedule
BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL, ENDOSCOPE	43239		Both			$5,107.00	$3,064.20	Medicare			$2,904.08			999999999	$189.38	$3,064.20	Per diem
DIAGNOSIC EXAM OF LARGE BOWEL, ENDOSCOPE	45378		Both			$0.00	$0.00	AETNA			$374.50			999999999	$0.00	$2,007.01	Fee schedule
DIAGNOSIC EXAM OF LARGE BOWEL, ENDOSCOPE	45378		Both			$0.00	$0.00	BCBS			$2,007.01			999999999	$0.00	$2,007.01	Fee schedule
DIAGNOSIC EXAM OF LARGE BOWEL, ENDOSCOPE	45378		Both			$0.00	$0.00	HEALTHCHOICE			$254.21			999999999	$0.00	$2,007.01	Fee schedule
DIAGNOSIC EXAM OF LARGE BOWEL, ENDOSCOPE	45378		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$2,007.01	Fee schedule
DIAGNOSIC EXAM OF LARGE BOWEL, ENDOSCOPE	45378		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$2,007.01	Per diem
BIOPSY OF LARGE BOWEL, ENDOSCOPE	45380		Both			$4,688.00	$2,812.80	AETNA			$446.46			999999999	$275.34	$2,812.80	Fee schedule
BIOPSY OF LARGE BOWEL, ENDOSCOPE	45380		Both			$4,688.00	$2,812.80	BCBS			$2,007.01			999999999	$275.34	$2,812.80	Fee schedule
BIOPSY OF LARGE BOWEL, ENDOSCOPE	45380		Both			$4,688.00	$2,812.80	HEALTHCHOICE			$275.34			999999999	$275.34	$2,812.80	Fee schedule
BIOPSY OF LARGE BOWEL, ENDOSCOPE	45380		Both			$4,688.00	$2,812.80	Medicaid			$378.22			999999999	$275.34	$2,812.80	Fee schedule
BIOPSY OF LARGE BOWEL, ENDOSCOPE	45380		Both			$4,688.00	$2,812.80	Medicare			$2,665.72			999999999	$275.34	$2,812.80	Per diem
REMOVAL OF POLYPS OR GROWTHS LARGE BOWEL, ENDOSCOPE	45385		Both			$4,757.00	$2,854.20	AETNA			$503.74			999999999	$349.80	$3,263.41	Fee schedule
REMOVAL OF POLYPS OR GROWTHS LARGE BOWEL, ENDOSCOPE	45385		Both			$4,757.00	$2,854.20	BCBS			$3,263.41			999999999	$349.80	$3,263.41	Fee schedule
REMOVAL OF POLYPS OR GROWTHS LARGE BOWEL, ENDOSCOPE	45385		Both			$4,757.00	$2,854.20	HEALTHCHOICE			$349.80			999999999	$349.80	$3,263.41	Fee schedule
REMOVAL OF POLYPS OR GROWTHS LARGE BOWEL, ENDOSCOPE	45385		Both			$4,757.00	$2,854.20	Medicaid			$397.59			999999999	$349.80	$3,263.41	Fee schedule
REMOVAL OF POLYPS OR GROWTHS LARGE BOWEL, ENDOSCOPE	45385		Both			$4,757.00	$2,854.20	Medicare			$2,705.08			999999999	$349.80	$3,263.41	Per diem
ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL, ENDOSCOPE	45391		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$1,654.68	Fee schedule
ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL, ENDOSCOPE	45391		Both			$0.00	$0.00	BCBS			$1,654.68			999999999	$0.00	$1,654.68	Fee schedule
ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL, ENDOSCOPE	45391		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$1,654.68	Fee schedule
ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL, ENDOSCOPE	45391		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$1,654.68	Fee schedule
ULTRASOUND EXAMINATION OF LOWER LARGE BOWEL, ENDOSCOPE	45391		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$1,654.68	Per diem
REMOVAL OF GALLBLADDER, ENDOSCOPE	47562		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF GALLBLADDER, ENDOSCOPE	47562		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF GALLBLADDER, ENDOSCOPE	47562		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF GALLBLADDER, ENDOSCOPE	47562		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF GALLBLADDER, ENDOSCOPE	47562		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
REPAIR OF GROIN HERNIA PATIENT 5 OR OLDER	49505		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
REPAIR OF GROIN HERNIA PATIENT 5 OR OLDER	49505		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
REPAIR OF GROIN HERNIA PATIENT 5 OR OLDER	49505		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
REPAIR OF GROIN HERNIA PATIENT 5 OR OLDER	49505		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
REPAIR OF GROIN HERNIA PATIENT 5 OR OLDER	49505		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
HC ED INSERT CATH TEMP INDWELL BLADDER SMPL	51702		Both			$219.00	$131.40	AETNA			$77.35			999999999	$35.44	$214.05	Fee schedule
HC ED INSERT CATH TEMP INDWELL BLADDER SMPL	51702		Both			$219.00	$131.40	BCBS			$214.05			999999999	$35.44	$214.05	Fee schedule
HC ED INSERT CATH TEMP INDWELL BLADDER SMPL	51702		Both			$219.00	$131.40	HEALTHCHOICE			$35.44			999999999	$35.44	$214.05	Fee schedule
HC ED INSERT CATH TEMP INDWELL BLADDER SMPL	51702		Both			$219.00	$131.40	Medicaid			$53.37			999999999	$35.44	$214.05	Fee schedule
HC ED INSERT CATH TEMP INDWELL BLADDER SMPL	51702		Both			$219.00	$131.40	Medicare			$124.72			999999999	$35.44	$214.05	Per diem
BIOPSY OF PROSTATE GLAND	55700		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
BIOPSY OF PROSTATE GLAND	55700		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
BIOPSY OF PROSTATE GLAND	55700		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
BIOPSY OF PROSTATE GLAND	55700		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
BIOPSY OF PROSTATE GLAND	55700		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
REMOVAL OF PROSTATE AND LYMPH NODES, ENDOSCOPE	55866		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF PROSTATE AND LYMPH NODES, ENDOSCOPE	55866		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF PROSTATE AND LYMPH NODES, ENDOSCOPE	55866		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF PROSTATE AND LYMPH NODES, ENDOSCOPE	55866		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
REMOVAL OF PROSTATE AND LYMPH NODES, ENDOSCOPE	55866		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59400		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59400		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59400		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59400		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59400		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
ROUTINE OBSTETRIC CARE FOR CESAREAN DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59510		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$2,348.39	Fee schedule
ROUTINE OBSTETRIC CARE FOR CESAREAN DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59510		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$2,348.39	Fee schedule
ROUTINE OBSTETRIC CARE FOR CESAREAN DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59510		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$2,348.39	Fee schedule
ROUTINE OBSTETRIC CARE FOR CESAREAN DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59510		Both			$0.00	$0.00	Medicaid			$2,348.39			999999999	$0.00	$2,348.39	Fee schedule
ROUTINE OBSTETRIC CARE FOR CESAREAN DELIVERY, INCLUDING PRE-AND POST-DELIVERY CARE	59510		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$2,348.39	Per diem
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY AFTER PRIOR CESAREAN DELIERY INCLUDING PRE-AND POST-DELIVERY CARE	59610		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY AFTER PRIOR CESAREAN DELIERY INCLUDING PRE-AND POST-DELIVERY CARE	59610		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY AFTER PRIOR CESAREAN DELIERY INCLUDING PRE-AND POST-DELIVERY CARE	59610		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY AFTER PRIOR CESAREAN DELIERY INCLUDING PRE-AND POST-DELIVERY CARE	59610		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
ROUTINE OBSTETRIC CARE FOR VAG DELIVERY AFTER PRIOR CESAREAN DELIERY INCLUDING PRE-AND POST-DELIVERY CARE	59610		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
INJ OF SUB INTO SPINAL CANAL USING GUIDANCE	62322		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF SUB INTO SPINAL CANAL USING GUIDANCE	62322		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF SUB INTO SPINAL CANAL USING GUIDANCE	62322		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF SUB INTO SPINAL CANAL USING GUIDANCE	62322		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF SUB INTO SPINAL CANAL USING GUIDANCE	62322		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
INJ OF ANESTHETIC INTO SPINE USING IMAGING GUIDANCE	64483		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF ANESTHETIC INTO SPINE USING IMAGING GUIDANCE	64483		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF ANESTHETIC INTO SPINE USING IMAGING GUIDANCE	64483		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF ANESTHETIC INTO SPINE USING IMAGING GUIDANCE	64483		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
INJ OF ANESTHETIC INTO SPINE USING IMAGING GUIDANCE	64483		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
REMOVAL OF RECURRING CATARACT IN LENS CAPSULE	66821		Both			$0.00	$0.00	AETNA			$300.57			999999999	$0.00	$1,193.54	Fee schedule
REMOVAL OF RECURRING CATARACT IN LENS CAPSULE	66821		Both			$0.00	$0.00	BCBS			$1,193.54			999999999	$0.00	$1,193.54	Fee schedule
REMOVAL OF RECURRING CATARACT IN LENS CAPSULE	66821		Both			$0.00	$0.00	HEALTHCHOICE			$407.93			999999999	$0.00	$1,193.54	Fee schedule
REMOVAL OF RECURRING CATARACT IN LENS CAPSULE	66821		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$1,193.54	Fee schedule
REMOVAL OF RECURRING CATARACT IN LENS CAPSULE	66821		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$1,193.54	Per diem
HC CT HEAD NON CONTRAST	70450		Both			$1,746.00	$1,047.60	AETNA			$184.06			999999999	$95.42	$1,047.60	Fee schedule
HC CT HEAD NON CONTRAST	70450		Both			$1,746.00	$1,047.60	BCBS			$335.21			999999999	$95.42	$1,047.60	Fee schedule
HC CT HEAD NON CONTRAST	70450		Both			$1,746.00	$1,047.60	HEALTHCHOICE			$161.07			999999999	$95.42	$1,047.60	Fee schedule
HC CT HEAD NON CONTRAST	70450		Both			$1,746.00	$1,047.60	Medicaid			$95.42			999999999	$95.42	$1,047.60	Fee schedule
HC CT HEAD NON CONTRAST	70450		Both			$1,746.00	$1,047.60	Medicare			$992.67			999999999	$95.42	$1,047.60	Per diem
HC CT SINUS FACIAL BONES NON CONTRAST	70486		Both			$1,746.00	$1,047.60	AETNA			$251.31			999999999	$114.82	$1,047.60	Fee schedule
HC CT SINUS FACIAL BONES NON CONTRAST	70486		Both			$1,746.00	$1,047.60	BCBS			$602.69			999999999	$114.82	$1,047.60	Fee schedule
HC CT SINUS FACIAL BONES NON CONTRAST	70486		Both			$1,746.00	$1,047.60	HEALTHCHOICE			$193.20			999999999	$114.82	$1,047.60	Fee schedule
HC CT SINUS FACIAL BONES NON CONTRAST	70486		Both			$1,746.00	$1,047.60	Medicaid			$114.82			999999999	$114.82	$1,047.60	Fee schedule
HC CT SINUS FACIAL BONES NON CONTRAST	70486		Both			$1,746.00	$1,047.60	Medicare			$992.67			999999999	$114.82	$1,047.60	Per diem
HC MRI BRAIN WITH & WITHOUT CONTRAST	70553		Both			$3,427.00	$2,056.20	AETNA			$625.64			999999999	$287.83	$2,056.20	Fee schedule
HC MRI BRAIN WITH & WITHOUT CONTRAST	70553		Both			$3,427.00	$2,056.20	BCBS			$1,190.12			999999999	$287.83	$2,056.20	Fee schedule
HC MRI BRAIN WITH & WITHOUT CONTRAST	70553		Both			$3,427.00	$2,056.20	HEALTHCHOICE			$506.58			999999999	$287.83	$2,056.20	Fee schedule
HC MRI BRAIN WITH & WITHOUT CONTRAST	70553		Both			$3,427.00	$2,056.20	Medicaid			$287.83			999999999	$287.83	$2,056.20	Fee schedule
HC MRI BRAIN WITH & WITHOUT CONTRAST	70553		Both			$3,427.00	$2,056.20	Medicare			$1,948.80			999999999	$287.83	$2,056.20	Per diem
HC XRAY CHEST 1 VIEW	71045		Both			$121.00	$72.60	AETNA			$15.69			999999999	$15.69	$99.99	Fee schedule
HC XRAY CHEST 1 VIEW	71045		Both			$121.00	$72.60	BCBS			$99.99			999999999	$15.69	$99.99	Fee schedule
HC XRAY CHEST 1 VIEW	71045		Both			$121.00	$72.60	HEALTHCHOICE			$35.63			999999999	$15.69	$99.99	Fee schedule
HC XRAY CHEST 1 VIEW	71045		Both			$121.00	$72.60	Medicaid			$22.52			999999999	$15.69	$99.99	Fee schedule
HC XRAY CHEST 1 VIEW	71045		Both			$121.00	$72.60	Medicare			$91.01			999999999	$15.69	$99.99	Per diem
HC XRAY CHEST 2 VIEWS	71046		Both			$223.00	$133.80	AETNA			$23.96			999999999	$23.96	$168.46	Fee schedule
HC XRAY CHEST 2 VIEWS	71046		Both			$223.00	$133.80	BCBS			$99.99			999999999	$23.96	$168.46	Fee schedule
HC XRAY CHEST 2 VIEWS	71046		Both			$223.00	$133.80	HEALTHCHOICE			$45.47			999999999	$23.96	$168.46	Fee schedule
HC XRAY CHEST 2 VIEWS	71046		Both			$223.00	$133.80	Medicaid			$29.13			999999999	$23.96	$168.46	Fee schedule
HC XRAY CHEST 2 VIEWS	71046		Both			$223.00	$133.80	Medicare			$168.46			999999999	$23.96	$168.46	Per diem
HC RIBS UNILATERAL 2 VW	71100		Both			$325.00	$195.00	AETNA			$25.11			999999999	$25.11	$246.04	Fee schedule
HC RIBS UNILATERAL 2 VW	71100		Both			$325.00	$195.00	BCBS			$99.99			999999999	$25.11	$246.04	Fee schedule
HC RIBS UNILATERAL 2 VW	71100		Both			$325.00	$195.00	HEALTHCHOICE			$49.30			999999999	$25.11	$246.04	Fee schedule
HC RIBS UNILATERAL 2 VW	71100		Both			$325.00	$195.00	Medicaid			$31.94			999999999	$25.11	$246.04	Fee schedule
HC RIBS UNILATERAL 2 VW	71100		Both			$325.00	$195.00	Medicare			$246.04			999999999	$25.11	$246.04	Per diem
HC CT CHEST NON CONTRAST	71250		Both			$1,746.00	$1,047.60	AETNA			$233.83			999999999	$119.81	$1,047.60	Fee schedule
HC CT CHEST NON CONTRAST	71250		Both			$1,746.00	$1,047.60	BCBS			$706.79			999999999	$119.81	$1,047.60	Fee schedule
HC CT CHEST NON CONTRAST	71250		Both			$1,746.00	$1,047.60	HEALTHCHOICE			$220.53			999999999	$119.81	$1,047.60	Fee schedule
HC CT CHEST NON CONTRAST	71250		Both			$1,746.00	$1,047.60	Medicaid			$119.81			999999999	$119.81	$1,047.60	Fee schedule
HC CT CHEST NON CONTRAST	71250		Both			$1,746.00	$1,047.60	Medicare			$992.67			999999999	$119.81	$1,047.60	Per diem
HC CT CHEST WITH CONTRAST	71260		Both			$2,695.00	$1,617.00	AETNA			$292.23			999999999	$149.59	$1,617.00	Fee schedule
HC CT CHEST WITH CONTRAST	71260		Both			$2,695.00	$1,617.00	BCBS			$706.79			999999999	$149.59	$1,617.00	Fee schedule
HC CT CHEST WITH CONTRAST	71260		Both			$2,695.00	$1,617.00	HEALTHCHOICE			$272.34			999999999	$149.59	$1,617.00	Fee schedule
HC CT CHEST WITH CONTRAST	71260		Both			$2,695.00	$1,617.00	Medicaid			$149.59			999999999	$149.59	$1,617.00	Fee schedule
HC CT CHEST WITH CONTRAST	71260		Both			$2,695.00	$1,617.00	Medicare			$1,532.24			999999999	$149.59	$1,617.00	Per diem
HC CT ANGIO CHEST W/WO CONTRAST	71275		Both			$3,007.00	$1,804.20	AETNA			$449.45			999999999	$220.35	$1,804.20	Fee schedule
HC CT ANGIO CHEST W/WO CONTRAST	71275		Both			$3,007.00	$1,804.20	BCBS			$813.48			999999999	$220.35	$1,804.20	Fee schedule
HC CT ANGIO CHEST W/WO CONTRAST	71275		Both			$3,007.00	$1,804.20	HEALTHCHOICE			$377.08			999999999	$220.35	$1,804.20	Fee schedule
HC CT ANGIO CHEST W/WO CONTRAST	71275		Both			$3,007.00	$1,804.20	Medicaid			$220.35			999999999	$220.35	$1,804.20	Fee schedule
HC CT ANGIO CHEST W/WO CONTRAST	71275		Both			$3,007.00	$1,804.20	Medicare			$1,710.07			999999999	$220.35	$1,804.20	Per diem
HC CERVICAL SPINE 2 OR 3 VW	72040		Both			$325.00	$195.00	AETNA			$27.51			999999999	$27.51	$246.04	Fee schedule
HC CERVICAL SPINE 2 OR 3 VW	72040		Both			$325.00	$195.00	BCBS			$99.99			999999999	$27.51	$246.04	Fee schedule
HC CERVICAL SPINE 2 OR 3 VW	72040		Both			$325.00	$195.00	HEALTHCHOICE			$52.66			999999999	$27.51	$246.04	Fee schedule
HC CERVICAL SPINE 2 OR 3 VW	72040		Both			$325.00	$195.00	Medicaid			$34.19			999999999	$27.51	$246.04	Fee schedule
HC CERVICAL SPINE 2 OR 3 VW	72040		Both			$325.00	$195.00	Medicare			$246.04			999999999	$27.51	$246.04	Per diem
HC THORACIC SPINE 3 VW	72072		Both			$325.00	$195.00	AETNA			$28.57			999999999	$28.57	$246.04	Fee schedule
HC THORACIC SPINE 3 VW	72072		Both			$325.00	$195.00	BCBS			$99.99			999999999	$28.57	$246.04	Fee schedule
HC THORACIC SPINE 3 VW	72072		Both			$325.00	$195.00	HEALTHCHOICE			$53.20			999999999	$28.57	$246.04	Fee schedule
HC THORACIC SPINE 3 VW	72072		Both			$325.00	$195.00	Medicaid			$33.95			999999999	$28.57	$246.04	Fee schedule
HC THORACIC SPINE 3 VW	72072		Both			$325.00	$195.00	Medicare			$246.04			999999999	$28.57	$246.04	Per diem
HC LUMBAR SPINE 2 OR 3 VW	72100		Both			$325.00	$195.00	AETNA			$27.76			999999999	$27.76	$246.04	Fee schedule
HC LUMBAR SPINE 2 OR 3 VW	72100		Both			$325.00	$195.00	BCBS			$99.99			999999999	$27.76	$246.04	Fee schedule
HC LUMBAR SPINE 2 OR 3 VW	72100		Both			$325.00	$195.00	HEALTHCHOICE			$52.66			999999999	$27.76	$246.04	Fee schedule
HC LUMBAR SPINE 2 OR 3 VW	72100		Both			$325.00	$195.00	Medicaid			$34.47			999999999	$27.76	$246.04	Fee schedule
HC LUMBAR SPINE 2 OR 3 VW	72100		Both			$325.00	$195.00	Medicare			$246.04			999999999	$27.76	$246.04	Per diem
HC LUMBAR SPINE 4+ VW	72110		Both			$434.00	$260.40	AETNA			$37.79			999999999	$37.79	$328.86	Fee schedule
HC LUMBAR SPINE 4+ VW	72110		Both			$434.00	$260.40	BCBS			$99.99			999999999	$37.79	$328.86	Fee schedule
HC LUMBAR SPINE 4+ VW	72110		Both			$434.00	$260.40	HEALTHCHOICE			$66.81			999999999	$37.79	$328.86	Fee schedule
HC LUMBAR SPINE 4+ VW	72110		Both			$434.00	$260.40	Medicaid			$44.18			999999999	$37.79	$328.86	Fee schedule
HC LUMBAR SPINE 4+ VW	72110		Both			$434.00	$260.40	Medicare			$328.86			999999999	$37.79	$328.86	Per diem
HC CT CERVICAL SPINE NON CONTRAST	72125		Both			$1,746.00	$1,047.60	AETNA			$239.23			999999999	$116.49	$1,047.60	Fee schedule
HC CT CERVICAL SPINE NON CONTRAST	72125		Both			$1,746.00	$1,047.60	BCBS			$487.56			999999999	$116.49	$1,047.60	Fee schedule
HC CT CERVICAL SPINE NON CONTRAST	72125		Both			$1,746.00	$1,047.60	HEALTHCHOICE			$216.19			999999999	$116.49	$1,047.60	Fee schedule
HC CT CERVICAL SPINE NON CONTRAST	72125		Both			$1,746.00	$1,047.60	Medicaid			$116.49			999999999	$116.49	$1,047.60	Fee schedule
HC CT CERVICAL SPINE NON CONTRAST	72125		Both			$1,746.00	$1,047.60	Medicare			$992.67			999999999	$116.49	$1,047.60	Per diem
HC MRI SPINE CERVICAL NON CONTRAST	72141		Both			$2,206.00	$1,323.60	AETNA			$423.51			999999999	$172.06	$1,323.60	Fee schedule
HC MRI SPINE CERVICAL NON CONTRAST	72141		Both			$2,206.00	$1,323.60	BCBS			$572.63			999999999	$172.06	$1,323.60	Fee schedule
HC MRI SPINE CERVICAL NON CONTRAST	72141		Both			$2,206.00	$1,323.60	HEALTHCHOICE			$302.10			999999999	$172.06	$1,323.60	Fee schedule
HC MRI SPINE CERVICAL NON CONTRAST	72141		Both			$2,206.00	$1,323.60	Medicaid			$172.06			999999999	$172.06	$1,323.60	Fee schedule
HC MRI SPINE CERVICAL NON CONTRAST	72141		Both			$2,206.00	$1,323.60	Medicare			$1,254.54			999999999	$172.06	$1,323.60	Per diem
HC MRI SPINE LUMBAR NON CONTRAST	72148		Both			$2,206.00	$1,323.60	AETNA			$417.32			999999999	$172.62	$1,323.60	Fee schedule
HC MRI SPINE LUMBAR NON CONTRAST	72148		Both			$2,206.00	$1,323.60	BCBS			$671.54			999999999	$172.62	$1,323.60	Fee schedule
HC MRI SPINE LUMBAR NON CONTRAST	72148		Both			$2,206.00	$1,323.60	HEALTHCHOICE			$302.58			999999999	$172.62	$1,323.60	Fee schedule
HC MRI SPINE LUMBAR NON CONTRAST	72148		Both			$2,206.00	$1,323.60	Medicaid			$172.62			999999999	$172.62	$1,323.60	Fee schedule
HC MRI SPINE LUMBAR NON CONTRAST	72148		Both			$2,206.00	$1,323.60	Medicare			$1,254.54			999999999	$172.62	$1,323.60	Per diem
HC PELVIS 1 OR 2 VW	72170		Both			$325.00	$195.00	AETNA			$22.35			999999999	$22.35	$246.04	Fee schedule
HC PELVIS 1 OR 2 VW	72170		Both			$325.00	$195.00	BCBS			$99.99			999999999	$22.35	$246.04	Fee schedule
HC PELVIS 1 OR 2 VW	72170		Both			$325.00	$195.00	HEALTHCHOICE			$39.41			999999999	$22.35	$246.04	Fee schedule
HC PELVIS 1 OR 2 VW	72170		Both			$325.00	$195.00	Medicaid			$24.17			999999999	$22.35	$246.04	Fee schedule
HC PELVIS 1 OR 2 VW	72170		Both			$325.00	$195.00	Medicare			$246.04			999999999	$22.35	$246.04	Per diem
CT SCAN, PELVIS W/CONTRAST	72193		Both			$0.00	$0.00	AETNA			$304.11			999999999	$0.00	$868.04	Fee schedule
CT SCAN, PELVIS W/CONTRAST	72193		Both			$0.00	$0.00	BCBS			$868.04			999999999	$0.00	$868.04	Fee schedule
CT SCAN, PELVIS W/CONTRAST	72193		Both			$0.00	$0.00	HEALTHCHOICE			$327.98			999999999	$0.00	$868.04	Fee schedule
CT SCAN, PELVIS W/CONTRAST	72193		Both			$0.00	$0.00	Medicaid			$192.78			999999999	$0.00	$868.04	Fee schedule
CT SCAN, PELVIS W/CONTRAST	72193		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$868.04	Per diem
HC SHOULDER 2+ VW	73030		Both			$325.00	$195.00	AETNA			$23.88			999999999	$23.88	$246.04	Fee schedule
HC SHOULDER 2+ VW	73030		Both			$325.00	$195.00	BCBS			$99.99			999999999	$23.88	$246.04	Fee schedule
HC SHOULDER 2+ VW	73030		Both			$325.00	$195.00	HEALTHCHOICE			$45.69			999999999	$23.88	$246.04	Fee schedule
HC SHOULDER 2+ VW	73030		Both			$325.00	$195.00	Medicaid			$29.83			999999999	$23.88	$246.04	Fee schedule
HC SHOULDER 2+ VW	73030		Both			$325.00	$195.00	Medicare			$246.04			999999999	$23.88	$246.04	Per diem
HC HUMERUS 2+ VW	73060		Both			$325.00	$195.00	AETNA			$22.42			999999999	$22.42	$246.04	Fee schedule
HC HUMERUS 2+ VW	73060		Both			$325.00	$195.00	BCBS			$99.99			999999999	$22.42	$246.04	Fee schedule
HC HUMERUS 2+ VW	73060		Both			$325.00	$195.00	HEALTHCHOICE			$43.17			999999999	$22.42	$246.04	Fee schedule
HC HUMERUS 2+ VW	73060		Both			$325.00	$195.00	Medicaid			$27.79			999999999	$22.42	$246.04	Fee schedule
HC HUMERUS 2+ VW	73060		Both			$325.00	$195.00	Medicare			$246.04			999999999	$22.42	$246.04	Per diem
HC ELBOW 2 VW	73070		Both			$325.00	$195.00	AETNA			$22.09			999999999	$22.09	$246.04	Fee schedule
HC ELBOW 2 VW	73070		Both			$325.00	$195.00	BCBS			$99.99			999999999	$22.09	$246.04	Fee schedule
HC ELBOW 2 VW	73070		Both			$325.00	$195.00	HEALTHCHOICE			$39.34			999999999	$22.09	$246.04	Fee schedule
HC ELBOW 2 VW	73070		Both			$325.00	$195.00	Medicaid			$25.26			999999999	$22.09	$246.04	Fee schedule
HC ELBOW 2 VW	73070		Both			$325.00	$195.00	Medicare			$246.04			999999999	$22.09	$246.04	Per diem
HC FOREARM 2 VW	73090		Both			$325.00	$195.00	AETNA			$21.64			999999999	$21.64	$246.04	Fee schedule
HC FOREARM 2 VW	73090		Both			$325.00	$195.00	BCBS			$99.99			999999999	$21.64	$246.04	Fee schedule
HC FOREARM 2 VW	73090		Both			$325.00	$195.00	HEALTHCHOICE			$39.83			999999999	$21.64	$246.04	Fee schedule
HC FOREARM 2 VW	73090		Both			$325.00	$195.00	Medicaid			$25.26			999999999	$21.64	$246.04	Fee schedule
HC FOREARM 2 VW	73090		Both			$325.00	$195.00	Medicare			$246.04			999999999	$21.64	$246.04	Per diem
HC WRIST 3+ VW	73110		Both			$325.00	$195.00	AETNA			$29.11			999999999	$29.11	$246.04	Fee schedule
HC WRIST 3+ VW	73110		Both			$325.00	$195.00	BCBS			$99.99			999999999	$29.11	$246.04	Fee schedule
HC WRIST 3+ VW	73110		Both			$325.00	$195.00	HEALTHCHOICE			$53.31			999999999	$29.11	$246.04	Fee schedule
HC WRIST 3+ VW	73110		Both			$325.00	$195.00	Medicaid			$35.14			999999999	$29.11	$246.04	Fee schedule
HC WRIST 3+ VW	73110		Both			$325.00	$195.00	Medicare			$246.04			999999999	$29.11	$246.04	Per diem
HC HAND 3+ VW	73130		Both			$325.00	$195.00	AETNA			$25.14			999999999	$25.14	$246.04	Fee schedule
HC HAND 3+ VW	73130		Both			$325.00	$195.00	BCBS			$99.99			999999999	$25.14	$246.04	Fee schedule
HC HAND 3+ VW	73130		Both			$325.00	$195.00	HEALTHCHOICE			$48.03			999999999	$25.14	$246.04	Fee schedule
HC HAND 3+ VW	73130		Both			$325.00	$195.00	Medicaid			$31.76			999999999	$25.14	$246.04	Fee schedule
HC HAND 3+ VW	73130		Both			$325.00	$195.00	Medicare			$246.04			999999999	$25.14	$246.04	Per diem
HC FINGERS (MULTIPLE)	73140		Both			$325.00	$195.00	AETNA			$25.97			999999999	$25.97	$246.04	Fee schedule
HC FINGERS (MULTIPLE)	73140		Both			$325.00	$195.00	BCBS			$99.99			999999999	$25.97	$246.04	Fee schedule
HC FINGERS (MULTIPLE)	73140		Both			$325.00	$195.00	HEALTHCHOICE			$48.75			999999999	$25.97	$246.04	Fee schedule
HC FINGERS (MULTIPLE)	73140		Both			$325.00	$195.00	Medicaid			$32.46			999999999	$25.97	$246.04	Fee schedule
HC FINGERS (MULTIPLE)	73140		Both			$325.00	$195.00	Medicare			$246.04			999999999	$25.97	$246.04	Per diem
HC XRAY HIP UNILAT 2-3 VIEWS	73502		Both			$325.00	$195.00	AETNA			$31.62			999999999	$31.62	$246.04	Fee schedule
HC XRAY HIP UNILAT 2-3 VIEWS	73502		Both			$325.00	$195.00	BCBS			$99.99			999999999	$31.62	$246.04	Fee schedule
HC XRAY HIP UNILAT 2-3 VIEWS	73502		Both			$325.00	$195.00	HEALTHCHOICE			$62.25			999999999	$31.62	$246.04	Fee schedule
HC XRAY HIP UNILAT 2-3 VIEWS	73502		Both			$325.00	$195.00	Medicaid			$40.38			999999999	$31.62	$246.04	Fee schedule
HC XRAY HIP UNILAT 2-3 VIEWS	73502		Both			$325.00	$195.00	Medicare			$246.04			999999999	$31.62	$246.04	Per diem
HC KNEE 1 OR 2 VW	73560		Both			$325.00	$195.00	AETNA			$24.08			999999999	$24.08	$246.04	Fee schedule
HC KNEE 1 OR 2 VW	73560		Both			$325.00	$195.00	BCBS			$99.99			999999999	$24.08	$246.04	Fee schedule
HC KNEE 1 OR 2 VW	73560		Both			$325.00	$195.00	HEALTHCHOICE			$46.05			999999999	$24.08	$246.04	Fee schedule
HC KNEE 1 OR 2 VW	73560		Both			$325.00	$195.00	Medicaid			$29.48			999999999	$24.08	$246.04	Fee schedule
HC KNEE 1 OR 2 VW	73560		Both			$325.00	$195.00	Medicare			$246.04			999999999	$24.08	$246.04	Per diem
HC KNEE 3 VW	73562		Both			$325.00	$195.00	AETNA			$29.08			999999999	$29.08	$246.04	Fee schedule
HC KNEE 3 VW	73562		Both			$325.00	$195.00	BCBS			$99.99			999999999	$29.08	$246.04	Fee schedule
HC KNEE 3 VW	73562		Both			$325.00	$195.00	HEALTHCHOICE			$53.85			999999999	$29.08	$246.04	Fee schedule
HC KNEE 3 VW	73562		Both			$325.00	$195.00	Medicaid			$34.89			999999999	$29.08	$246.04	Fee schedule
HC KNEE 3 VW	73562		Both			$325.00	$195.00	Medicare			$246.04			999999999	$29.08	$246.04	Per diem
HC TIBIA AND FIBULA 2 VW	73590		Both			$325.00	$195.00	AETNA			$21.43			999999999	$21.43	$246.04	Fee schedule
HC TIBIA AND FIBULA 2 VW	73590		Both			$325.00	$195.00	BCBS			$99.99			999999999	$21.43	$246.04	Fee schedule
HC TIBIA AND FIBULA 2 VW	73590		Both			$325.00	$195.00	HEALTHCHOICE			$42.21			999999999	$21.43	$246.04	Fee schedule
HC TIBIA AND FIBULA 2 VW	73590		Both			$325.00	$195.00	Medicaid			$27.33			999999999	$21.43	$246.04	Fee schedule
HC TIBIA AND FIBULA 2 VW	73590		Both			$325.00	$195.00	Medicare			$246.04			999999999	$21.43	$246.04	Per diem
HC ANKLE 3+ VW	73610		Both			$325.00	$195.00	AETNA			$25.89			999999999	$25.89	$246.04	Fee schedule
HC ANKLE 3+ VW	73610		Both			$325.00	$195.00	BCBS			$99.99			999999999	$25.89	$246.04	Fee schedule
HC ANKLE 3+ VW	73610		Both			$325.00	$195.00	HEALTHCHOICE			$48.03			999999999	$25.89	$246.04	Fee schedule
HC ANKLE 3+ VW	73610		Both			$325.00	$195.00	Medicaid			$31.76			999999999	$25.89	$246.04	Fee schedule
HC ANKLE 3+ VW	73610		Both			$325.00	$195.00	Medicare			$246.04			999999999	$25.89	$246.04	Per diem
HC FOOT 3+ VW	73630		Both			$325.00	$195.00	AETNA			$24.40			999999999	$24.40	$246.04	Fee schedule
HC FOOT 3+ VW	73630		Both			$325.00	$195.00	BCBS			$99.99			999999999	$24.40	$246.04	Fee schedule
HC FOOT 3+ VW	73630		Both			$325.00	$195.00	HEALTHCHOICE			$45.15			999999999	$24.40	$246.04	Fee schedule
HC FOOT 3+ VW	73630		Both			$325.00	$195.00	Medicaid			$29.51			999999999	$24.40	$246.04	Fee schedule
HC FOOT 3+ VW	73630		Both			$325.00	$195.00	Medicare			$246.04			999999999	$24.40	$246.04	Per diem
HC CT LOWER EXTREMITY NON CONTRAST	73700		Both			$1,746.00	$1,047.60	AETNA			$233.24			999999999	$116.21	$1,047.60	Fee schedule
HC CT LOWER EXTREMITY NON CONTRAST	73700		Both			$1,746.00	$1,047.60	BCBS			$602.69			999999999	$116.21	$1,047.60	Fee schedule
HC CT LOWER EXTREMITY NON CONTRAST	73700		Both			$1,746.00	$1,047.60	HEALTHCHOICE			$215.24			999999999	$116.21	$1,047.60	Fee schedule
HC CT LOWER EXTREMITY NON CONTRAST	73700		Both			$1,746.00	$1,047.60	Medicaid			$116.21			999999999	$116.21	$1,047.60	Fee schedule
HC CT LOWER EXTREMITY NON CONTRAST	73700		Both			$1,746.00	$1,047.60	Medicare			$992.67			999999999	$116.21	$1,047.60	Per diem
HC MRI LOWER EXT ANY JOINT NON CONTRAST	73721		Both			$2,163.00	$1,323.60	AETNA			$309.49			999999999	$182.02	$1,323.60	Fee schedule
HC MRI LOWER EXT ANY JOINT NON CONTRAST	73721		Both			$2,163.00	$1,323.60	BCBS			$758.13			999999999	$182.02	$1,323.60	Fee schedule
HC MRI LOWER EXT ANY JOINT NON CONTRAST	73721		Both			$2,163.00	$1,323.60	HEALTHCHOICE			$317.13			999999999	$182.02	$1,323.60	Fee schedule
HC MRI LOWER EXT ANY JOINT NON CONTRAST	73721		Both			$2,163.00	$1,323.60	Medicaid			$182.02			999999999	$182.02	$1,323.60	Fee schedule
HC MRI LOWER EXT ANY JOINT NON CONTRAST	73721		Both			$2,163.00	$1,323.60	Medicare			$1,254.54			999999999	$182.02	$1,323.60	Per diem
HC XRAY ABDOMEN 2 VIEWS	74019		Both			$325.00	$195.00	AETNA			$26.16			999999999	$26.16	$246.04	Fee schedule
HC XRAY ABDOMEN 2 VIEWS	74019		Both			$325.00	$195.00	BCBS			$99.99			999999999	$26.16	$246.04	Fee schedule
HC XRAY ABDOMEN 2 VIEWS	74019		Both			$325.00	$195.00	HEALTHCHOICE			$49.84			999999999	$26.16	$246.04	Fee schedule
HC XRAY ABDOMEN 2 VIEWS	74019		Both			$325.00	$195.00	Medicaid			$31.98			999999999	$26.16	$246.04	Fee schedule
HC XRAY ABDOMEN 2 VIEWS	74019		Both			$325.00	$195.00	Medicare			$246.04			999999999	$26.16	$246.04	Per diem
HC CT ABDOMEN PELVIS WO CONTRAST	74176		Both			$1,943.00	$1,165.80	AETNA			$258.73			999999999	$165.63	$1,165.80	Fee schedule
HC CT ABDOMEN PELVIS WO CONTRAST	74176		Both			$1,943.00	$1,165.80	BCBS			$868.04			999999999	$165.63	$1,165.80	Fee schedule
HC CT ABDOMEN PELVIS WO CONTRAST	74176		Both			$1,943.00	$1,165.80	HEALTHCHOICE			$280.68			999999999	$165.63	$1,165.80	Fee schedule
HC CT ABDOMEN PELVIS WO CONTRAST	74176		Both			$1,943.00	$1,165.80	Medicaid			$165.63			999999999	$165.63	$1,165.80	Fee schedule
HC CT ABDOMEN PELVIS WO CONTRAST	74176		Both			$1,943.00	$1,165.80	Medicare			$1,104.73			999999999	$165.63	$1,165.80	Per diem
HC CT ABDOMEN PELVIS W CONTRAST	74177		Both			$3,063.00	$1,837.80	AETNA			$384.81			999999999	$273.87	$1,837.80	Fee schedule
HC CT ABDOMEN PELVIS W CONTRAST	74177		Both			$3,063.00	$1,837.80	BCBS			$868.04			999999999	$273.87	$1,837.80	Fee schedule
HC CT ABDOMEN PELVIS W CONTRAST	74177		Both			$3,063.00	$1,837.80	HEALTHCHOICE			$452.87			999999999	$273.87	$1,837.80	Fee schedule
HC CT ABDOMEN PELVIS W CONTRAST	74177		Both			$3,063.00	$1,837.80	Medicaid			$273.87			999999999	$273.87	$1,837.80	Fee schedule
HC CT ABDOMEN PELVIS W CONTRAST	74177		Both			$3,063.00	$1,837.80	Medicare			$1,741.74			999999999	$273.87	$1,837.80	Per diem
HC CT ABDOMEN PELVIS WWO CONTRAST	74178		Both			$3,898.00	$2,338.80	AETNA			$449.95			999999999	$306.61	$2,338.80	Fee schedule
HC CT ABDOMEN PELVIS WWO CONTRAST	74178		Both			$3,898.00	$2,338.80	BCBS			$868.04			999999999	$306.61	$2,338.80	Fee schedule
HC CT ABDOMEN PELVIS WWO CONTRAST	74178		Both			$3,898.00	$2,338.80	HEALTHCHOICE			$508.71			999999999	$306.61	$2,338.80	Fee schedule
HC CT ABDOMEN PELVIS WWO CONTRAST	74178		Both			$3,898.00	$2,338.80	Medicaid			$306.61			999999999	$306.61	$2,338.80	Fee schedule
HC CT ABDOMEN PELVIS WWO CONTRAST	74178		Both			$3,898.00	$2,338.80	Medicare			$2,216.76			999999999	$306.61	$2,338.80	Per diem
HC US HEAD NECK TISSUES B - SCAN REAL TIME	76536		Both			$773.00	$463.80	AETNA			$93.04			999999999	$93.04	$463.80	Fee schedule
HC US HEAD NECK TISSUES B - SCAN REAL TIME	76536		Both			$773.00	$463.80	BCBS			$270.41			999999999	$93.04	$463.80	Fee schedule
HC US HEAD NECK TISSUES B - SCAN REAL TIME	76536		Both			$773.00	$463.80	HEALTHCHOICE			$160.26			999999999	$93.04	$463.80	Fee schedule
HC US HEAD NECK TISSUES B - SCAN REAL TIME	76536		Both			$773.00	$463.80	Medicaid			$96.06			999999999	$93.04	$463.80	Fee schedule
HC US HEAD NECK TISSUES B - SCAN REAL TIME	76536		Both			$773.00	$463.80	Medicare			$439.70			999999999	$93.04	$463.80	Per diem
HC US ABDOMEN COMPLETE	76700		Both			$773.00	$463.80	AETNA			$103.95			999999999	$101.46	$463.80	Fee schedule
HC US ABDOMEN COMPLETE	76700		Both			$773.00	$463.80	BCBS			$317.11			999999999	$101.46	$463.80	Fee schedule
HC US ABDOMEN COMPLETE	76700		Both			$773.00	$463.80	HEALTHCHOICE			$171.38			999999999	$101.46	$463.80	Fee schedule
HC US ABDOMEN COMPLETE	76700		Both			$773.00	$463.80	Medicaid			$101.46			999999999	$101.46	$463.80	Fee schedule
HC US ABDOMEN COMPLETE	76700		Both			$773.00	$463.80	Medicare			$439.70			999999999	$101.46	$463.80	Per diem
HC US ABDOMEN LIMITED	76705		Both			$773.00	$463.80	AETNA			$82.52			999999999	$76.49	$463.80	Fee schedule
HC US ABDOMEN LIMITED	76705		Both			$773.00	$463.80	BCBS			$317.11			999999999	$76.49	$463.80	Fee schedule
HC US ABDOMEN LIMITED	76705		Both			$773.00	$463.80	HEALTHCHOICE			$126.87			999999999	$76.49	$463.80	Fee schedule
HC US ABDOMEN LIMITED	76705		Both			$773.00	$463.80	Medicaid			$76.49			999999999	$76.49	$463.80	Fee schedule
HC US ABDOMEN LIMITED	76705		Both			$773.00	$463.80	Medicare			$439.70			999999999	$76.49	$463.80	Per diem
HC US OB 14+ WKS SINGLE GEST	76805		Both			$773.00	$463.80	AETNA			$111.42			999999999	$111.42	$463.80	Fee schedule
HC US OB 14+ WKS SINGLE GEST	76805		Both			$773.00	$463.80	BCBS			$372.96			999999999	$111.42	$463.80	Fee schedule
HC US OB 14+ WKS SINGLE GEST	76805		Both			$773.00	$463.80	HEALTHCHOICE			$195.51			999999999	$111.42	$463.80	Fee schedule
HC US OB 14+ WKS SINGLE GEST	76805		Both			$773.00	$463.80	Medicaid			$118.11			999999999	$111.42	$463.80	Fee schedule
HC US OB 14+ WKS SINGLE GEST	76805		Both			$773.00	$463.80	Medicare			$439.70			999999999	$111.42	$463.80	Per diem
HC US TRANSVAGINAL NON OB	76830		Both			$773.00	$463.80	AETNA			$58.18			999999999	$58.18	$463.80	Fee schedule
HC US TRANSVAGINAL NON OB	76830		Both			$773.00	$463.80	BCBS			$371.11			999999999	$58.18	$463.80	Fee schedule
HC US TRANSVAGINAL NON OB	76830		Both			$773.00	$463.80	HEALTHCHOICE			$170.66			999999999	$58.18	$463.80	Fee schedule
HC US TRANSVAGINAL NON OB	76830		Both			$773.00	$463.80	Medicaid			$103.84			999999999	$58.18	$463.80	Fee schedule
HC US TRANSVAGINAL NON OB	76830		Both			$773.00	$463.80	Medicare			$439.70			999999999	$58.18	$463.80	Per diem
HC US PELVIS COMPLETE	76856		Both			$773.00	$463.80	AETNA			$95.07			999999999	$91.75	$463.80	Fee schedule
HC US PELVIS COMPLETE	76856		Both			$773.00	$463.80	BCBS			$270.41			999999999	$91.75	$463.80	Fee schedule
HC US PELVIS COMPLETE	76856		Both			$773.00	$463.80	HEALTHCHOICE			$152.43			999999999	$91.75	$463.80	Fee schedule
HC US PELVIS COMPLETE	76856		Both			$773.00	$463.80	Medicaid			$91.75			999999999	$91.75	$463.80	Fee schedule
HC US PELVIS COMPLETE	76856		Both			$773.00	$463.80	Medicare			$439.70			999999999	$91.75	$463.80	Per diem
MAMMOGRAM ONE BREAST	77065		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$108.49	Fee schedule
MAMMOGRAM ONE BREAST	77065		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$108.49	Fee schedule
MAMMOGRAM ONE BREAST	77065		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$108.49	Fee schedule
MAMMOGRAM ONE BREAST	77065		Both			$0.00	$0.00	Medicaid			$108.49			999999999	$0.00	$108.49	Fee schedule
MAMMOGRAM ONE BREAST	77065		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$108.49	Per diem
MAMMOGRAM BOTH BREAST	77066		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$136.73	Fee schedule
MAMMOGRAM BOTH BREAST	77066		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$136.73	Fee schedule
MAMMOGRAM BOTH BREAST	77066		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$136.73	Fee schedule
MAMMOGRAM BOTH BREAST	77066		Both			$0.00	$0.00	Medicaid			$136.73			999999999	$0.00	$136.73	Fee schedule
MAMMOGRAM BOTH BREAST	77066		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$136.73	Per diem
MAMMOGRAM, SCREENING BILATERAL	77067		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
MAMMOGRAM, SCREENING BILATERAL	77067		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
MAMMOGRAM, SCREENING BILATERAL	77067		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
MAMMOGRAM, SCREENING BILATERAL	77067		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
MAMMOGRAM, SCREENING BILATERAL	77067		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
HC DEXA BONE DENSITY AXIAL SKELETON	77080		Both			$302.00	$181.20	AETNA			$37.40			999999999	$32.71	$181.20	Fee schedule
HC DEXA BONE DENSITY AXIAL SKELETON	77080		Both			$302.00	$181.20	BCBS			$141.93			999999999	$32.71	$181.20	Fee schedule
HC DEXA BONE DENSITY AXIAL SKELETON	77080		Both			$302.00	$181.20	HEALTHCHOICE			$54.45			999999999	$32.71	$181.20	Fee schedule
HC DEXA BONE DENSITY AXIAL SKELETON	77080		Both			$302.00	$181.20	Medicaid			$32.71			999999999	$32.71	$181.20	Fee schedule
HC DEXA BONE DENSITY AXIAL SKELETON	77080		Both			$302.00	$181.20	Medicare			$171.61			999999999	$32.71	$181.20	Per diem
LCHG BASIC METABOLIC PANEL (CA IONIZED)	80047		Both			$65.00	$39.00	AETNA			$8.14			999999999	$8.14	$49.37	Fee schedule
LCHG BASIC METABOLIC PANEL (CA IONIZED)	80047		Both			$65.00	$39.00	BCBS			$49.37			999999999	$8.14	$49.37	Fee schedule
LCHG BASIC METABOLIC PANEL (CA IONIZED)	80047		Both			$65.00	$39.00	HEALTHCHOICE			$16.48			999999999	$8.14	$49.37	Fee schedule
LCHG BASIC METABOLIC PANEL (CA IONIZED)	80047		Both			$65.00	$39.00	Medicaid			$12.21			999999999	$8.14	$49.37	Fee schedule
LCHG BASIC METABOLIC PANEL (CA IONIZED)	80047		Both			$65.00	$39.00	Medicare			$37.15			999999999	$8.14	$49.37	Per diem
LCHG BASIC METABOLIC PANEL (CA TOTAL)	80048		Both			$91.00	$54.60	AETNA			$8.14			999999999	$7.53	$54.60	Fee schedule
LCHG BASIC METABOLIC PANEL (CA TOTAL)	80048		Both			$91.00	$54.60	BCBS			$49.37			999999999	$7.53	$54.60	Fee schedule
LCHG BASIC METABOLIC PANEL (CA TOTAL)	80048		Both			$91.00	$54.60	HEALTHCHOICE			$10.15			999999999	$7.53	$54.60	Fee schedule
LCHG BASIC METABOLIC PANEL (CA TOTAL)	80048		Both			$91.00	$54.60	Medicaid			$7.53			999999999	$7.53	$54.60	Fee schedule
LCHG BASIC METABOLIC PANEL (CA TOTAL)	80048		Both			$91.00	$54.60	Medicare			$51.78			999999999	$7.53	$54.60	Per diem
LCHG COMPREHENSIVE METABOLIC PANEL	80053		Both			$134.00	$80.40	AETNA			$10.17			999999999	$9.39	$80.40	Fee schedule
LCHG COMPREHENSIVE METABOLIC PANEL	80053		Both			$134.00	$80.40	BCBS			$49.37			999999999	$9.39	$80.40	Fee schedule
LCHG COMPREHENSIVE METABOLIC PANEL	80053		Both			$134.00	$80.40	HEALTHCHOICE			$12.67			999999999	$9.39	$80.40	Fee schedule
LCHG COMPREHENSIVE METABOLIC PANEL	80053		Both			$134.00	$80.40	Medicaid			$9.39			999999999	$9.39	$80.40	Fee schedule
LCHG COMPREHENSIVE METABOLIC PANEL	80053		Both			$134.00	$80.40	Medicare			$76.33			999999999	$9.39	$80.40	Per diem
OBSTETRIC BLOOD TEST PANEL	80055		Both			$0.00	$0.00	AETNA			$35.68			999999999	$0.00	$57.37	Fee schedule
OBSTETRIC BLOOD TEST PANEL	80055		Both			$0.00	$0.00	BCBS			$49.37			999999999	$0.00	$57.37	Fee schedule
OBSTETRIC BLOOD TEST PANEL	80055		Both			$0.00	$0.00	HEALTHCHOICE			$57.37			999999999	$0.00	$57.37	Fee schedule
OBSTETRIC BLOOD TEST PANEL	80055		Both			$0.00	$0.00	Medicaid			$42.53			999999999	$0.00	$57.37	Fee schedule
OBSTETRIC BLOOD TEST PANEL	80055		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$57.37	Per diem
LCHG LIPID PROFILE	80061		Both			$82.00	$49.20	AETNA			$12.89			999999999	$11.91	$49.37	Fee schedule
LCHG LIPID PROFILE	80061		Both			$82.00	$49.20	BCBS			$49.37			999999999	$11.91	$49.37	Fee schedule
LCHG LIPID PROFILE	80061		Both			$82.00	$49.20	HEALTHCHOICE			$16.07			999999999	$11.91	$49.37	Fee schedule
LCHG LIPID PROFILE	80061		Both			$82.00	$49.20	Medicaid			$11.91			999999999	$11.91	$49.37	Fee schedule
LCHG LIPID PROFILE	80061		Both			$82.00	$49.20	Medicare			$46.76			999999999	$11.91	$49.37	Per diem
KIDNEY FUNCTION PANEL	80069		Both			$0.00	$0.00	AETNA			$8.36			999999999	$0.00	$49.37	Fee schedule
KIDNEY FUNCTION PANEL	80069		Both			$0.00	$0.00	BCBS			$49.37			999999999	$0.00	$49.37	Fee schedule
KIDNEY FUNCTION PANEL	80069		Both			$0.00	$0.00	HEALTHCHOICE			$10.42			999999999	$0.00	$49.37	Fee schedule
KIDNEY FUNCTION PANEL	80069		Both			$0.00	$0.00	Medicaid			$7.72			999999999	$0.00	$49.37	Fee schedule
KIDNEY FUNCTION PANEL	80069		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$49.37	Per diem
LCHG HEPATITIS SCREEN ACUTE	80074		Both			$127.00	$76.20	AETNA			$45.83			999999999	$42.37	$76.20	Fee schedule
LCHG HEPATITIS SCREEN ACUTE	80074		Both			$127.00	$76.20	BCBS			$49.37			999999999	$42.37	$76.20	Fee schedule
LCHG HEPATITIS SCREEN ACUTE	80074		Both			$127.00	$76.20	HEALTHCHOICE			$57.16			999999999	$42.37	$76.20	Fee schedule
LCHG HEPATITIS SCREEN ACUTE	80074		Both			$127.00	$76.20	Medicaid			$42.37			999999999	$42.37	$76.20	Fee schedule
LCHG HEPATITIS SCREEN ACUTE	80074		Both			$127.00	$76.20	Medicare			$72.47			999999999	$42.37	$76.20	Per diem
LCHG HEPATIC FUNCTION PANEL	80076		Both			$106.00	$63.60	AETNA			$7.86			999999999	$7.27	$63.60	Fee schedule
LCHG HEPATIC FUNCTION PANEL	80076		Both			$106.00	$63.60	BCBS			$49.37			999999999	$7.27	$63.60	Fee schedule
LCHG HEPATIC FUNCTION PANEL	80076		Both			$106.00	$63.60	HEALTHCHOICE			$9.80			999999999	$7.27	$63.60	Fee schedule
LCHG HEPATIC FUNCTION PANEL	80076		Both			$106.00	$63.60	Medicaid			$7.27			999999999	$7.27	$63.60	Fee schedule
LCHG HEPATIC FUNCTION PANEL	80076		Both			$106.00	$63.60	Medicare			$60.53			999999999	$7.27	$63.60	Per diem
LCHG DIGOXIN LEVEL	80162		Both			$112.00	$67.20	AETNA			$12.78			999999999	$11.81	$67.20	Fee schedule
LCHG DIGOXIN LEVEL	80162		Both			$112.00	$67.20	BCBS			$59.46			999999999	$11.81	$67.20	Fee schedule
LCHG DIGOXIN LEVEL	80162		Both			$112.00	$67.20	HEALTHCHOICE			$15.94			999999999	$11.81	$67.20	Fee schedule
LCHG DIGOXIN LEVEL	80162		Both			$112.00	$67.20	Medicaid			$11.81			999999999	$11.81	$67.20	Fee schedule
LCHG DIGOXIN LEVEL	80162		Both			$112.00	$67.20	Medicare			$63.95			999999999	$11.81	$67.20	Per diem
LCHG VALPROIC ACID LEVEL	80164		Both			$93.00	$55.80	AETNA			$13.04			999999999	$12.04	$59.46	Fee schedule
LCHG VALPROIC ACID LEVEL	80164		Both			$93.00	$55.80	BCBS			$59.46			999999999	$12.04	$59.46	Fee schedule
LCHG VALPROIC ACID LEVEL	80164		Both			$93.00	$55.80	HEALTHCHOICE			$13.25			999999999	$12.04	$59.46	Fee schedule
LCHG VALPROIC ACID LEVEL	80164		Both			$93.00	$55.80	Medicaid			$12.04			999999999	$12.04	$59.46	Fee schedule
LCHG VALPROIC ACID LEVEL	80164		Both			$93.00	$55.80	Medicare			$52.86			999999999	$12.04	$59.46	Per diem
LCHG VANCOMYCIN LEVEL TROUGH	80202		Both			$103.00	$61.80	AETNA			$13.04			999999999	$12.04	$61.80	Fee schedule
LCHG VANCOMYCIN LEVEL TROUGH	80202		Both			$103.00	$61.80	BCBS			$59.46			999999999	$12.04	$61.80	Fee schedule
LCHG VANCOMYCIN LEVEL TROUGH	80202		Both			$103.00	$61.80	HEALTHCHOICE			$16.25			999999999	$12.04	$61.80	Fee schedule
LCHG VANCOMYCIN LEVEL TROUGH	80202		Both			$103.00	$61.80	Medicaid			$12.04			999999999	$12.04	$61.80	Fee schedule
LCHG VANCOMYCIN LEVEL TROUGH	80202		Both			$103.00	$61.80	Medicare			$58.83			999999999	$12.04	$61.80	Per diem
LCHG DRUG SCREEN SGLCLS A V	80307		Both			$82.00	$49.20	AETNA			$55.87			999999999	$46.89	$138.33	Fee schedule
LCHG DRUG SCREEN SGLCLS A V	80307		Both			$82.00	$49.20	BCBS			$138.33			999999999	$46.89	$138.33	Fee schedule
LCHG DRUG SCREEN SGLCLS A V	80307		Both			$82.00	$49.20	HEALTHCHOICE			$74.57			999999999	$46.89	$138.33	Fee schedule
LCHG DRUG SCREEN SGLCLS A V	80307		Both			$82.00	$49.20	Medicaid			$55.27			999999999	$46.89	$138.33	Fee schedule
LCHG DRUG SCREEN SGLCLS A V	80307		Both			$82.00	$49.20	Medicare			$46.89			999999999	$46.89	$138.33	Per diem
LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	81001		Both			$37.00	$22.20	AETNA			$3.05			999999999	$2.82	$22.20	Fee schedule
LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	81001		Both			$37.00	$22.20	BCBS			$14.43			999999999	$2.82	$22.20	Fee schedule
LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	81001		Both			$37.00	$22.20	HEALTHCHOICE			$3.80			999999999	$2.82	$22.20	Fee schedule
LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	81001		Both			$37.00	$22.20	Medicaid			$2.82			999999999	$2.82	$22.20	Fee schedule
LCHG URINALYSIS ROUTINE AUTO W MICROSCOPIC	81001		Both			$37.00	$22.20	Medicare			$21.32			999999999	$2.82	$22.20	Per diem
LCHG URINALYSIS DIPSTICK AUTO	81003		Both			$30.00	$18.00	AETNA			$2.16			999999999	$2.00	$18.00	Fee schedule
LCHG URINALYSIS DIPSTICK AUTO	81003		Both			$30.00	$18.00	BCBS			$10.17			999999999	$2.00	$18.00	Fee schedule
LCHG URINALYSIS DIPSTICK AUTO	81003		Both			$30.00	$18.00	HEALTHCHOICE			$2.70			999999999	$2.00	$18.00	Fee schedule
LCHG URINALYSIS DIPSTICK AUTO	81003		Both			$30.00	$18.00	Medicaid			$2.00			999999999	$2.00	$18.00	Fee schedule
LCHG URINALYSIS DIPSTICK AUTO	81003		Both			$30.00	$18.00	Medicare			$17.05			999999999	$2.00	$18.00	Per diem
LCHG HCG URINE QUALITATIVE	81025		Both			$42.00	$25.20	AETNA			$6.09			999999999	$6.09	$25.20	Fee schedule
LCHG HCG URINE QUALITATIVE	81025		Both			$42.00	$25.20	BCBS			$14.43			999999999	$6.09	$25.20	Fee schedule
LCHG HCG URINE QUALITATIVE	81025		Both			$42.00	$25.20	HEALTHCHOICE			$10.33			999999999	$6.09	$25.20	Fee schedule
LCHG HCG URINE QUALITATIVE	81025		Both			$42.00	$25.20	Medicaid			$7.66			999999999	$6.09	$25.20	Fee schedule
LCHG HCG URINE QUALITATIVE	81025		Both			$42.00	$25.20	Medicare			$23.87			999999999	$6.09	$25.20	Per diem
LCHG VOLUME MEASURE URINE	81050		Both			$37.00	$22.20	AETNA			$2.88			999999999	$2.88	$22.20	Fee schedule
LCHG VOLUME MEASURE URINE	81050		Both			$37.00	$22.20	BCBS			$14.43			999999999	$2.88	$22.20	Fee schedule
LCHG VOLUME MEASURE URINE	81050		Both			$37.00	$22.20	HEALTHCHOICE			$4.37			999999999	$2.88	$22.20	Fee schedule
LCHG VOLUME MEASURE URINE	81050		Both			$37.00	$22.20	Medicaid			$3.24			999999999	$2.88	$22.20	Fee schedule
LCHG VOLUME MEASURE URINE	81050		Both			$37.00	$22.20	Medicare			$21.32			999999999	$2.88	$22.20	Per diem
LCHG MICROALBUMIN URINE RANDOM QUANT	82043		Both			$37.00	$22.20	AETNA			$5.57			999999999	$5.14	$22.20	Fee schedule
LCHG MICROALBUMIN URINE RANDOM QUANT	82043		Both			$37.00	$22.20	BCBS			$14.43			999999999	$5.14	$22.20	Fee schedule
LCHG MICROALBUMIN URINE RANDOM QUANT	82043		Both			$37.00	$22.20	HEALTHCHOICE			$6.94			999999999	$5.14	$22.20	Fee schedule
LCHG MICROALBUMIN URINE RANDOM QUANT	82043		Both			$37.00	$22.20	Medicaid			$5.14			999999999	$5.14	$22.20	Fee schedule
LCHG MICROALBUMIN URINE RANDOM QUANT	82043		Both			$37.00	$22.20	Medicare			$21.32			999999999	$5.14	$22.20	Per diem
HC BAT NON DOT DOT	82075		Both			$27.00	$16.20	AETNA			$0.01			999999999	$0.00	$45.57	Fee schedule
LCHG ALCOHOL BREATH TEST	82075		Both			$75.00	$45.00	AETNA			$0.01			999999999	$0.00	$45.57	Fee schedule
HC BAT NON DOT DOT	82075		Both			$27.00	$16.20	BCBS			$45.57			999999999	$0.00	$45.57	Fee schedule
LCHG ALCOHOL BREATH TEST	82075		Both			$75.00	$45.00	BCBS			$45.57			999999999	$0.00	$45.57	Fee schedule
HC BAT NON DOT DOT	82075		Both			$27.00	$16.20	HEALTHCHOICE			$36.00			999999999	$0.00	$45.57	Fee schedule
LCHG ALCOHOL BREATH TEST	82075		Both			$75.00	$45.00	HEALTHCHOICE			$36.00			999999999	$0.00	$45.57	Fee schedule
HC BAT NON DOT DOT	82075		Both			$27.00	$16.20	Medicaid			$0.00			999999999	$0.00	$45.57	Fee schedule
LCHG ALCOHOL BREATH TEST	82075		Both			$75.00	$45.00	Medicaid			$0.00			999999999	$0.00	$45.57	Fee schedule
HC BAT NON DOT DOT	82075		Both			$27.00	$16.20	Medicare			$15.23			999999999	$0.00	$45.57	Per diem
LCHG ALCOHOL BREATH TEST	82075		Both			$75.00	$45.00	Medicare			$42.63			999999999	$0.00	$45.57	Per diem
LCHG AMYLASE BLOOD	82150		Both			$66.00	$39.60	AETNA			$6.24			999999999	$5.76	$45.57	Fee schedule
LCHG AMYLASE BLOOD	82150		Both			$66.00	$39.60	BCBS			$45.57			999999999	$5.76	$45.57	Fee schedule
LCHG AMYLASE BLOOD	82150		Both			$66.00	$39.60	HEALTHCHOICE			$7.78			999999999	$5.76	$45.57	Fee schedule
LCHG AMYLASE BLOOD	82150		Both			$66.00	$39.60	Medicaid			$5.76			999999999	$5.76	$45.57	Fee schedule
LCHG AMYLASE BLOOD	82150		Both			$66.00	$39.60	Medicare			$37.51			999999999	$5.76	$45.57	Per diem
LCHG OCCULT BLOOD FECES	82270		Both			$21.00	$12.60	AETNA			$3.14			999999999	$3.14	$23.81	Fee schedule
LCHG OCCULT BLOOD FECES	82270		Both			$21.00	$12.60	BCBS			$23.81			999999999	$3.14	$23.81	Fee schedule
LCHG OCCULT BLOOD FECES	82270		Both			$21.00	$12.60	HEALTHCHOICE			$5.26			999999999	$3.14	$23.81	Fee schedule
LCHG OCCULT BLOOD FECES	82270		Both			$21.00	$12.60	Medicaid			$3.90			999999999	$3.14	$23.81	Fee schedule
LCHG OCCULT BLOOD FECES	82270		Both			$21.00	$12.60	Medicare			$11.94			999999999	$3.14	$23.81	Per diem
LCHG VITAMIN D 25-HYDROXY	82306		Both			$189.00	$113.40	AETNA			$28.49			999999999	$26.33	$138.33	Fee schedule
LCHG VITAMIN D 25-HYDROXY	82306		Both			$189.00	$113.40	BCBS			$138.33			999999999	$26.33	$138.33	Fee schedule
LCHG VITAMIN D 25-HYDROXY	82306		Both			$189.00	$113.40	HEALTHCHOICE			$35.52			999999999	$26.33	$138.33	Fee schedule
LCHG VITAMIN D 25-HYDROXY	82306		Both			$189.00	$113.40	Medicaid			$26.33			999999999	$26.33	$138.33	Fee schedule
LCHG VITAMIN D 25-HYDROXY	82306		Both			$189.00	$113.40	Medicare			$107.43			999999999	$26.33	$138.33	Per diem
LCHG CK BLOOD	82550		Both			$54.00	$32.40	AETNA			$6.27			999999999	$5.79	$32.40	Fee schedule
LCHG CK BLOOD	82550		Both			$54.00	$32.40	BCBS			$23.81			999999999	$5.79	$32.40	Fee schedule
LCHG CK BLOOD	82550		Both			$54.00	$32.40	HEALTHCHOICE			$7.81			999999999	$5.79	$32.40	Fee schedule
LCHG CK BLOOD	82550		Both			$54.00	$32.40	Medicaid			$5.79			999999999	$5.79	$32.40	Fee schedule
LCHG CK BLOOD	82550		Both			$54.00	$32.40	Medicare			$30.69			999999999	$5.79	$32.40	Per diem
LCHG CREATININE BLOOD	82565		Both			$45.00	$27.00	AETNA			$4.93			999999999	$4.55	$27.00	Fee schedule
LCHG CREATININE BLOOD	82565		Both			$45.00	$27.00	BCBS			$23.81			999999999	$4.55	$27.00	Fee schedule
LCHG CREATININE BLOOD	82565		Both			$45.00	$27.00	HEALTHCHOICE			$6.14			999999999	$4.55	$27.00	Fee schedule
LCHG CREATININE BLOOD	82565		Both			$45.00	$27.00	Medicaid			$4.55			999999999	$4.55	$27.00	Fee schedule
LCHG CREATININE BLOOD	82565		Both			$45.00	$27.00	Medicare			$25.58			999999999	$4.55	$27.00	Per diem
LCHG CREATININE URINE RANDOM	82570		Both			$33.00	$19.80	AETNA			$4.98			999999999	$4.61	$23.81	Fee schedule
LCHG CREATININE URINE RANDOM	82570		Both			$33.00	$19.80	BCBS			$23.81			999999999	$4.61	$23.81	Fee schedule
LCHG CREATININE URINE RANDOM	82570		Both			$33.00	$19.80	HEALTHCHOICE			$6.22			999999999	$4.61	$23.81	Fee schedule
LCHG CREATININE URINE RANDOM	82570		Both			$33.00	$19.80	Medicaid			$4.61			999999999	$4.61	$23.81	Fee schedule
LCHG CREATININE URINE RANDOM	82570		Both			$33.00	$19.80	Medicare			$18.76			999999999	$4.61	$23.81	Per diem
LCHG VITAMIN B12	82607		Both			$94.00	$56.40	AETNA			$14.50			999999999	$13.41	$74.32	Fee schedule
LCHG VITAMIN B12	82607		Both			$94.00	$56.40	BCBS			$74.32			999999999	$13.41	$74.32	Fee schedule
LCHG VITAMIN B12	82607		Both			$94.00	$56.40	HEALTHCHOICE			$18.10			999999999	$13.41	$74.32	Fee schedule
LCHG VITAMIN B12	82607		Both			$94.00	$56.40	Medicaid			$13.41			999999999	$13.41	$74.32	Fee schedule
LCHG VITAMIN B12	82607		Both			$94.00	$56.40	Medicare			$53.46			999999999	$13.41	$74.32	Per diem
LCHG ESTRADIOL	82670		Both			$151.00	$90.60	AETNA			$26.89			999999999	$24.85	$98.66	Fee schedule
LCHG ESTRADIOL	82670		Both			$151.00	$90.60	BCBS			$98.66			999999999	$24.85	$98.66	Fee schedule
LCHG ESTRADIOL	82670		Both			$151.00	$90.60	HEALTHCHOICE			$33.53			999999999	$24.85	$98.66	Fee schedule
LCHG ESTRADIOL	82670		Both			$151.00	$90.60	Medicaid			$24.85			999999999	$24.85	$98.66	Fee schedule
LCHG ESTRADIOL	82670		Both			$151.00	$90.60	Medicare			$86.11			999999999	$24.85	$98.66	Per diem
LCHG FERRITIN	82728		Both			$93.00	$55.80	AETNA			$13.11			999999999	$12.12	$55.80	Fee schedule
LCHG FERRITIN	82728		Both			$93.00	$55.80	BCBS			$45.57			999999999	$12.12	$55.80	Fee schedule
LCHG FERRITIN	82728		Both			$93.00	$55.80	HEALTHCHOICE			$16.36			999999999	$12.12	$55.80	Fee schedule
LCHG FERRITIN	82728		Both			$93.00	$55.80	Medicaid			$12.12			999999999	$12.12	$55.80	Fee schedule
LCHG FERRITIN	82728		Both			$93.00	$55.80	Medicare			$52.86			999999999	$12.12	$55.80	Per diem
LCHG FOLATE	82746		Both			$98.00	$58.80	AETNA			$14.15			999999999	$13.08	$58.80	Fee schedule
LCHG FOLATE	82746		Both			$98.00	$58.80	BCBS			$45.57			999999999	$13.08	$58.80	Fee schedule
LCHG FOLATE	82746		Both			$98.00	$58.80	HEALTHCHOICE			$17.64			999999999	$13.08	$58.80	Fee schedule
LCHG FOLATE	82746		Both			$98.00	$58.80	Medicaid			$13.08			999999999	$13.08	$58.80	Fee schedule
LCHG FOLATE	82746		Both			$98.00	$58.80	Medicare			$55.77			999999999	$13.08	$58.80	Per diem
LCHG IMMUNOGLOBULIN	82784		Both			$45.00	$27.00	AETNA			$8.95			999999999	$8.27	$45.57	Fee schedule
LCHG IMMUNOGLOBULIN	82784		Both			$45.00	$27.00	BCBS			$45.57			999999999	$8.27	$45.57	Fee schedule
LCHG IMMUNOGLOBULIN	82784		Both			$45.00	$27.00	HEALTHCHOICE			$11.16			999999999	$8.27	$45.57	Fee schedule
LCHG IMMUNOGLOBULIN	82784		Both			$45.00	$27.00	Medicaid			$8.27			999999999	$8.27	$45.57	Fee schedule
LCHG IMMUNOGLOBULIN	82784		Both			$45.00	$27.00	Medicare			$25.58			999999999	$8.27	$45.57	Per diem
LCHG BLOOD GASES ARTERIAL I	82803		Both			$186.00	$111.60	AETNA			$18.62			999999999	$18.62	$111.60	Fee schedule
LCHG BLOOD GASES ARTERIAL I	82803		Both			$186.00	$111.60	BCBS			$45.57			999999999	$18.62	$111.60	Fee schedule
LCHG BLOOD GASES ARTERIAL I	82803		Both			$186.00	$111.60	HEALTHCHOICE			$31.28			999999999	$18.62	$111.60	Fee schedule
LCHG BLOOD GASES ARTERIAL I	82803		Both			$186.00	$111.60	Medicaid			$23.19			999999999	$18.62	$111.60	Fee schedule
LCHG BLOOD GASES ARTERIAL I	82803		Both			$186.00	$111.60	Medicare			$105.72			999999999	$18.62	$111.60	Per diem
HC LAB GLUCOSE BLD POCT (IP)	82962		Both			$19.00	$11.40	AETNA			$2.25			999999999	$2.25	$23.81	Fee schedule
HC LAB GLUCOSE BLD POCT (IP)	82962		Both			$19.00	$11.40	BCBS			$23.81			999999999	$2.25	$23.81	Fee schedule
HC LAB GLUCOSE BLD POCT (IP)	82962		Both			$19.00	$11.40	HEALTHCHOICE			$3.94			999999999	$2.25	$23.81	Fee schedule
HC LAB GLUCOSE BLD POCT (IP)	82962		Both			$19.00	$11.40	Medicaid			$2.92			999999999	$2.25	$23.81	Fee schedule
HC LAB GLUCOSE BLD POCT (IP)	82962		Both			$19.00	$11.40	Medicare			$10.55			999999999	$2.25	$23.81	Per diem
LCHG GGT	82977		Both			$63.00	$37.80	AETNA			$6.93			999999999	$6.40	$37.80	Fee schedule
LCHG GGT	82977		Both			$63.00	$37.80	BCBS			$23.81			999999999	$6.40	$37.80	Fee schedule
LCHG GGT	82977		Both			$63.00	$37.80	HEALTHCHOICE			$8.64			999999999	$6.40	$37.80	Fee schedule
LCHG GGT	82977		Both			$63.00	$37.80	Medicaid			$6.40			999999999	$6.40	$37.80	Fee schedule
LCHG GGT	82977		Both			$63.00	$37.80	Medicare			$35.81			999999999	$6.40	$37.80	Per diem
LCHG FSH	83001		Both			$127.00	$76.20	AETNA			$17.88			999999999	$16.53	$88.88	Fee schedule
LCHG FSH	83001		Both			$127.00	$76.20	BCBS			$88.88			999999999	$16.53	$88.88	Fee schedule
LCHG FSH	83001		Both			$127.00	$76.20	HEALTHCHOICE			$22.30			999999999	$16.53	$88.88	Fee schedule
LCHG FSH	83001		Both			$127.00	$76.20	Medicaid			$16.53			999999999	$16.53	$88.88	Fee schedule
LCHG FSH	83001		Both			$127.00	$76.20	Medicare			$72.47			999999999	$16.53	$88.88	Per diem
LCHG LH	83002		Both			$127.00	$76.20	AETNA			$17.82			999999999	$16.47	$98.66	Fee schedule
LCHG LH	83002		Both			$127.00	$76.20	BCBS			$98.66			999999999	$16.47	$98.66	Fee schedule
LCHG LH	83002		Both			$127.00	$76.20	HEALTHCHOICE			$22.22			999999999	$16.47	$98.66	Fee schedule
LCHG LH	83002		Both			$127.00	$76.20	Medicaid			$16.47			999999999	$16.47	$98.66	Fee schedule
LCHG LH	83002		Both			$127.00	$76.20	Medicare			$72.47			999999999	$16.47	$98.66	Per diem
LCHG HAPTOGLOBIN	83010		Both			$78.00	$46.80	AETNA			$12.10			999999999	$11.19	$46.80	Fee schedule
LCHG HAPTOGLOBIN	83010		Both			$78.00	$46.80	BCBS			$45.57			999999999	$11.19	$46.80	Fee schedule
LCHG HAPTOGLOBIN	83010		Both			$78.00	$46.80	HEALTHCHOICE			$15.10			999999999	$11.19	$46.80	Fee schedule
LCHG HAPTOGLOBIN	83010		Both			$78.00	$46.80	Medicaid			$11.19			999999999	$11.19	$46.80	Fee schedule
LCHG HAPTOGLOBIN	83010		Both			$78.00	$46.80	Medicare			$44.34			999999999	$11.19	$46.80	Per diem
LCHG HEMOGLOBIN A1C	83036		Both			$58.00	$34.80	AETNA			$8.32			999999999	$8.32	$45.57	Fee schedule
LCHG HEMOGLOBIN A1C	83036		Both			$58.00	$34.80	BCBS			$45.57			999999999	$8.32	$45.57	Fee schedule
LCHG HEMOGLOBIN A1C	83036		Both			$58.00	$34.80	HEALTHCHOICE			$11.65			999999999	$8.32	$45.57	Fee schedule
LCHG HEMOGLOBIN A1C	83036		Both			$58.00	$34.80	Medicaid			$8.64			999999999	$8.32	$45.57	Fee schedule
LCHG HEMOGLOBIN A1C	83036		Both			$58.00	$34.80	Medicare			$33.25			999999999	$8.32	$45.57	Per diem
LCHG IRON BLOOD	83540		Both			$37.00	$22.20	AETNA			$5.36			999999999	$5.36	$23.81	Fee schedule
LCHG IRON BLOOD	83540		Both			$37.00	$22.20	BCBS			$23.81			999999999	$5.36	$23.81	Fee schedule
LCHG IRON BLOOD	83540		Both			$37.00	$22.20	HEALTHCHOICE			$7.76			999999999	$5.36	$23.81	Fee schedule
LCHG IRON BLOOD	83540		Both			$37.00	$22.20	Medicaid			$5.75			999999999	$5.36	$23.81	Fee schedule
LCHG IRON BLOOD	83540		Both			$37.00	$22.20	Medicare			$21.05			999999999	$5.36	$23.81	Per diem
LCHG TIBC	83550		Both			$59.00	$35.40	AETNA			$8.41			999999999	$7.77	$45.57	Fee schedule
LCHG TIBC	83550		Both			$59.00	$35.40	BCBS			$45.57			999999999	$7.77	$45.57	Fee schedule
LCHG TIBC	83550		Both			$59.00	$35.40	HEALTHCHOICE			$10.49			999999999	$7.77	$45.57	Fee schedule
LCHG TIBC	83550		Both			$59.00	$35.40	Medicaid			$7.77			999999999	$7.77	$45.57	Fee schedule
LCHG TIBC	83550		Both			$59.00	$35.40	Medicare			$33.59			999999999	$7.77	$45.57	Per diem
LCHG ISTAT LACTIC ACID	83605		Both			$80.00	$48.00	AETNA			$10.28			999999999	$10.28	$48.00	Fee schedule
LCHG ISTAT LACTIC ACID	83605		Both			$80.00	$48.00	BCBS			$45.57			999999999	$10.28	$48.00	Fee schedule
LCHG ISTAT LACTIC ACID	83605		Both			$80.00	$48.00	HEALTHCHOICE			$13.88			999999999	$10.28	$48.00	Fee schedule
LCHG ISTAT LACTIC ACID	83605		Both			$80.00	$48.00	Medicaid			$10.29			999999999	$10.28	$48.00	Fee schedule
LCHG ISTAT LACTIC ACID	83605		Both			$80.00	$48.00	Medicare			$45.68			999999999	$10.28	$48.00	Per diem
LCHG LDH BLOOD	83615		Both			$45.00	$27.00	AETNA			$5.81			999999999	$5.37	$27.00	Fee schedule
LCHG LDH BLOOD	83615		Both			$45.00	$27.00	BCBS			$23.81			999999999	$5.37	$27.00	Fee schedule
LCHG LDH BLOOD	83615		Both			$45.00	$27.00	HEALTHCHOICE			$7.25			999999999	$5.37	$27.00	Fee schedule
LCHG LDH BLOOD	83615		Both			$45.00	$27.00	Medicaid			$5.37			999999999	$5.37	$27.00	Fee schedule
LCHG LDH BLOOD	83615		Both			$45.00	$27.00	Medicare			$25.58			999999999	$5.37	$27.00	Per diem
LCHG LIPASE BLOOD	83690		Both			$59.00	$35.40	AETNA			$6.63			999999999	$6.13	$35.40	Fee schedule
LCHG LIPASE BLOOD	83690		Both			$59.00	$35.40	BCBS			$23.81			999999999	$6.13	$35.40	Fee schedule
LCHG LIPASE BLOOD	83690		Both			$59.00	$35.40	HEALTHCHOICE			$8.27			999999999	$6.13	$35.40	Fee schedule
LCHG LIPASE BLOOD	83690		Both			$59.00	$35.40	Medicaid			$6.13			999999999	$6.13	$35.40	Fee schedule
LCHG LIPASE BLOOD	83690		Both			$59.00	$35.40	Medicare			$33.50			999999999	$6.13	$35.40	Per diem
LCHG LDL CHOLESTEROL	83721		Both			$60.00	$36.00	AETNA			$9.18			999999999	$9.18	$45.57	Fee schedule
LCHG LDL CHOLESTEROL	83721		Both			$60.00	$36.00	BCBS			$45.57			999999999	$9.18	$45.57	Fee schedule
LCHG LDL CHOLESTEROL	83721		Both			$60.00	$36.00	HEALTHCHOICE			$12.60			999999999	$9.18	$45.57	Fee schedule
LCHG LDL CHOLESTEROL	83721		Both			$60.00	$36.00	Medicaid			$9.34			999999999	$9.18	$45.57	Fee schedule
LCHG LDL CHOLESTEROL	83721		Both			$60.00	$36.00	Medicare			$34.10			999999999	$9.18	$45.57	Per diem
LCHG MAGNESIUM BLOOD	83735		Both			$45.00	$27.00	AETNA			$6.45			999999999	$5.96	$27.00	Fee schedule
LCHG MAGNESIUM BLOOD	83735		Both			$45.00	$27.00	BCBS			$23.81			999999999	$5.96	$27.00	Fee schedule
LCHG MAGNESIUM BLOOD	83735		Both			$45.00	$27.00	HEALTHCHOICE			$8.04			999999999	$5.96	$27.00	Fee schedule
LCHG MAGNESIUM BLOOD	83735		Both			$45.00	$27.00	Medicaid			$5.96			999999999	$5.96	$27.00	Fee schedule
LCHG MAGNESIUM BLOOD	83735		Both			$45.00	$27.00	Medicare			$25.58			999999999	$5.96	$27.00	Per diem
LCHG B-TYPE NATRIURETIC PEPTIDE	83880		Both			$402.00	$241.20	AETNA			$32.66			999999999	$32.66	$241.20	Fee schedule
LCHG B-TYPE NATRIURETIC PEPTIDE	83880		Both			$402.00	$241.20	BCBS			$138.33			999999999	$32.66	$241.20	Fee schedule
LCHG B-TYPE NATRIURETIC PEPTIDE	83880		Both			$402.00	$241.20	HEALTHCHOICE			$47.11			999999999	$32.66	$241.20	Fee schedule
LCHG B-TYPE NATRIURETIC PEPTIDE	83880		Both			$402.00	$241.20	Medicaid			$34.92			999999999	$32.66	$241.20	Fee schedule
LCHG B-TYPE NATRIURETIC PEPTIDE	83880		Both			$402.00	$241.20	Medicare			$228.50			999999999	$32.66	$241.20	Per diem
LCHG LIGHT CHAINS FREE EA	83883		Both			$387.00	$232.20	AETNA			$13.08			999999999	$12.10	$232.20	Fee schedule
LCHG LIGHT CHAINS FREE EA	83883		Both			$387.00	$232.20	BCBS			$66.02			999999999	$12.10	$232.20	Fee schedule
LCHG LIGHT CHAINS FREE EA	83883		Both			$387.00	$232.20	HEALTHCHOICE			$16.32			999999999	$12.10	$232.20	Fee schedule
LCHG LIGHT CHAINS FREE EA	83883		Both			$387.00	$232.20	Medicaid			$12.10			999999999	$12.10	$232.20	Fee schedule
LCHG LIGHT CHAINS FREE EA	83883		Both			$387.00	$232.20	Medicare			$219.85			999999999	$12.10	$232.20	Per diem
LCHG PSA TOTAL	84153		Both			$115.00	$69.00	AETNA			$17.70			999999999	$16.36	$69.00	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN DIAG	84153		Both			$114.00	$68.40	AETNA			$17.70			999999999	$16.36	$68.40	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN DIAG	84153		Both			$114.00	$68.40	BCBS			$45.57			999999999	$16.36	$68.40	Fee schedule
LCHG PSA TOTAL	84153		Both			$115.00	$69.00	BCBS			$45.57			999999999	$16.36	$69.00	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN DIAG	84153		Both			$114.00	$68.40	HEALTHCHOICE			$22.07			999999999	$16.36	$68.40	Fee schedule
LCHG PSA TOTAL	84153		Both			$115.00	$69.00	HEALTHCHOICE			$22.07			999999999	$16.36	$69.00	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN DIAG	84153		Both			$114.00	$68.40	Medicaid			$16.36			999999999	$16.36	$68.40	Fee schedule
LCHG PSA TOTAL	84153		Both			$115.00	$69.00	Medicaid			$16.36			999999999	$16.36	$69.00	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN DIAG	84153		Both			$114.00	$68.40	Medicare			$65.04			999999999	$16.36	$68.40	Per diem
LCHG PSA TOTAL	84153		Both			$115.00	$69.00	Medicare			$65.65			999999999	$16.36	$69.00	Per diem
LCHG PSA FREE	84154		Both			$223.00	$133.80	AETNA			$17.70			999999999	$16.36	$133.80	Fee schedule
LCHG PSA FREE	84154		Both			$223.00	$133.80	BCBS			$45.57			999999999	$16.36	$133.80	Fee schedule
LCHG PSA FREE	84154		Both			$223.00	$133.80	HEALTHCHOICE			$65.00			999999999	$16.36	$133.80	Fee schedule
LCHG PSA FREE	84154		Both			$223.00	$133.80	Medicaid			$16.36			999999999	$16.36	$133.80	Fee schedule
LCHG PSA FREE	84154		Both			$223.00	$133.80	Medicare			$127.04			999999999	$16.36	$133.80	Per diem
LCHG PROTEIN TOTAL BLOOD I	84155		Both			$45.00	$27.00	AETNA			$3.53			999999999	$3.26	$27.00	Fee schedule
LCHG PROTEIN TOTAL BLOOD I	84155		Both			$45.00	$27.00	BCBS			$23.81			999999999	$3.26	$27.00	Fee schedule
LCHG PROTEIN TOTAL BLOOD I	84155		Both			$45.00	$27.00	HEALTHCHOICE			$4.40			999999999	$3.26	$27.00	Fee schedule
LCHG PROTEIN TOTAL BLOOD I	84155		Both			$45.00	$27.00	Medicaid			$3.26			999999999	$3.26	$27.00	Fee schedule
LCHG PROTEIN TOTAL BLOOD I	84155		Both			$45.00	$27.00	Medicare			$25.58			999999999	$3.26	$27.00	Per diem
LCHG PROTEIN URINE RANDOM QUANTITATIVE	84156		Both			$30.00	$18.00	AETNA			$3.53			999999999	$3.26	$23.81	Fee schedule
LCHG PROTEIN URINE RANDOM QUANTITATIVE	84156		Both			$30.00	$18.00	BCBS			$23.81			999999999	$3.26	$23.81	Fee schedule
LCHG PROTEIN URINE RANDOM QUANTITATIVE	84156		Both			$30.00	$18.00	HEALTHCHOICE			$4.40			999999999	$3.26	$23.81	Fee schedule
LCHG PROTEIN URINE RANDOM QUANTITATIVE	84156		Both			$30.00	$18.00	Medicaid			$3.26			999999999	$3.26	$23.81	Fee schedule
LCHG PROTEIN URINE RANDOM QUANTITATIVE	84156		Both			$30.00	$18.00	Medicare			$17.05			999999999	$3.26	$23.81	Per diem
LCHG PROTEIN ELECTROPHORESIS BLOOD	84165		Both			$73.00	$43.80	AETNA			$10.33			999999999	$9.55	$45.57	Fee schedule
LCHG PROTEIN ELECTROPHORESIS BLOOD	84165		Both			$73.00	$43.80	BCBS			$45.57			999999999	$9.55	$45.57	Fee schedule
LCHG PROTEIN ELECTROPHORESIS BLOOD	84165		Both			$73.00	$43.80	HEALTHCHOICE			$12.89			999999999	$9.55	$45.57	Fee schedule
LCHG PROTEIN ELECTROPHORESIS BLOOD	84165		Both			$73.00	$43.80	Medicaid			$9.55			999999999	$9.55	$45.57	Fee schedule
LCHG PROTEIN ELECTROPHORESIS BLOOD	84165		Both			$73.00	$43.80	Medicare			$41.78			999999999	$9.55	$45.57	Per diem
LCHG TESTOSTERONE FREE	84402		Both			$159.00	$95.40	AETNA			$24.50			999999999	$22.66	$98.66	Fee schedule
LCHG TESTOSTERONE FREE	84402		Both			$159.00	$95.40	BCBS			$98.66			999999999	$22.66	$98.66	Fee schedule
LCHG TESTOSTERONE FREE	84402		Both			$159.00	$95.40	HEALTHCHOICE			$30.56			999999999	$22.66	$98.66	Fee schedule
LCHG TESTOSTERONE FREE	84402		Both			$159.00	$95.40	Medicaid			$22.66			999999999	$22.66	$98.66	Fee schedule
LCHG TESTOSTERONE FREE	84402		Both			$159.00	$95.40	Medicare			$90.38			999999999	$22.66	$98.66	Per diem
LCHG TESTOSTERONE TOTAL	84403		Both			$177.00	$106.20	AETNA			$24.84			999999999	$22.96	$106.20	Fee schedule
LCHG TESTOSTERONE TOTAL	84403		Both			$177.00	$106.20	BCBS			$98.66			999999999	$22.96	$106.20	Fee schedule
LCHG TESTOSTERONE TOTAL	84403		Both			$177.00	$106.20	HEALTHCHOICE			$30.97			999999999	$22.96	$106.20	Fee schedule
LCHG TESTOSTERONE TOTAL	84403		Both			$177.00	$106.20	Medicaid			$22.96			999999999	$22.96	$106.20	Fee schedule
LCHG TESTOSTERONE TOTAL	84403		Both			$177.00	$106.20	Medicare			$100.61			999999999	$22.96	$106.20	Per diem
LCHG T4 TOTAL	84436		Both			$58.00	$34.80	AETNA			$6.61			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL I	84436		Both			$58.00	$34.80	AETNA			$6.61			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL	84436		Both			$58.00	$34.80	BCBS			$74.32			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL I	84436		Both			$58.00	$34.80	BCBS			$74.32			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL	84436		Both			$58.00	$34.80	HEALTHCHOICE			$8.24			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL I	84436		Both			$58.00	$34.80	HEALTHCHOICE			$8.24			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL	84436		Both			$58.00	$34.80	Medicaid			$6.11			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL I	84436		Both			$58.00	$34.80	Medicaid			$6.11			999999999	$6.11	$74.32	Fee schedule
LCHG T4 TOTAL	84436		Both			$58.00	$34.80	Medicare			$33.25			999999999	$6.11	$74.32	Per diem
LCHG T4 TOTAL I	84436		Both			$58.00	$34.80	Medicare			$33.25			999999999	$6.11	$74.32	Per diem
LCHG T4 FREE	84439		Both			$70.00	$42.00	AETNA			$8.68			999999999	$8.02	$74.32	Fee schedule
LCHG T4 FREE	84439		Both			$70.00	$42.00	BCBS			$74.32			999999999	$8.02	$74.32	Fee schedule
LCHG T4 FREE	84439		Both			$70.00	$42.00	HEALTHCHOICE			$10.82			999999999	$8.02	$74.32	Fee schedule
LCHG T4 FREE	84439		Both			$70.00	$42.00	Medicaid			$8.02			999999999	$8.02	$74.32	Fee schedule
LCHG T4 FREE	84439		Both			$70.00	$42.00	Medicare			$40.07			999999999	$8.02	$74.32	Per diem
LCHG TSH	84443		Both			$114.00	$68.40	AETNA			$16.17			999999999	$14.94	$74.32	Fee schedule
LCHG TSH	84443		Both			$114.00	$68.40	BCBS			$74.32			999999999	$14.94	$74.32	Fee schedule
LCHG TSH	84443		Both			$114.00	$68.40	HEALTHCHOICE			$20.16			999999999	$14.94	$74.32	Fee schedule
LCHG TSH	84443		Both			$114.00	$68.40	Medicaid			$14.94			999999999	$14.94	$74.32	Fee schedule
LCHG TSH	84443		Both			$114.00	$68.40	Medicare			$64.80			999999999	$14.94	$74.32	Per diem
LCHG T3 UPTAKE	84479		Both			$40.00	$24.00	AETNA			$6.22			999999999	$5.75	$74.32	Fee schedule
LCHG T3 UPTAKE	84479		Both			$40.00	$24.00	BCBS			$74.32			999999999	$5.75	$74.32	Fee schedule
LCHG T3 UPTAKE	84479		Both			$40.00	$24.00	HEALTHCHOICE			$7.76			999999999	$5.75	$74.32	Fee schedule
LCHG T3 UPTAKE	84479		Both			$40.00	$24.00	Medicaid			$5.75			999999999	$5.75	$74.32	Fee schedule
LCHG T3 UPTAKE	84479		Both			$40.00	$24.00	Medicare			$23.02			999999999	$5.75	$74.32	Per diem
LCHG T3 TOTAL	84480		Both			$45.00	$27.00	AETNA			$13.64			999999999	$12.61	$74.32	Fee schedule
LCHG T3 TOTAL	84480		Both			$45.00	$27.00	BCBS			$74.32			999999999	$12.61	$74.32	Fee schedule
LCHG T3 TOTAL	84480		Both			$45.00	$27.00	HEALTHCHOICE			$17.02			999999999	$12.61	$74.32	Fee schedule
LCHG T3 TOTAL	84480		Both			$45.00	$27.00	Medicaid			$12.61			999999999	$12.61	$74.32	Fee schedule
LCHG T3 TOTAL	84480		Both			$45.00	$27.00	Medicare			$25.58			999999999	$12.61	$74.32	Per diem
LCHG T3 FREE	84481		Both			$117.00	$70.20	AETNA			$16.30			999999999	$15.07	$74.32	Fee schedule
LCHG T3 FREE	84481		Both			$117.00	$70.20	BCBS			$74.32			999999999	$15.07	$74.32	Fee schedule
LCHG T3 FREE	84481		Both			$117.00	$70.20	HEALTHCHOICE			$20.33			999999999	$15.07	$74.32	Fee schedule
LCHG T3 FREE	84481		Both			$117.00	$70.20	Medicaid			$15.07			999999999	$15.07	$74.32	Fee schedule
LCHG T3 FREE	84481		Both			$117.00	$70.20	Medicare			$66.50			999999999	$15.07	$74.32	Per diem
LCHG TROPONIN I	84484		Both			$66.00	$39.60	AETNA			$9.47			999999999	$9.47	$45.57	Fee schedule
LCHG TROPONIN I	84484		Both			$66.00	$39.60	BCBS			$45.57			999999999	$9.47	$45.57	Fee schedule
LCHG TROPONIN I	84484		Both			$66.00	$39.60	HEALTHCHOICE			$14.96			999999999	$9.47	$45.57	Fee schedule
LCHG TROPONIN I	84484		Both			$66.00	$39.60	Medicaid			$11.09			999999999	$9.47	$45.57	Fee schedule
LCHG TROPONIN I	84484		Both			$66.00	$39.60	Medicare			$37.51			999999999	$9.47	$45.57	Per diem
LCHG BUN	84520		Both			$45.00	$27.00	AETNA			$3.80			999999999	$3.51	$27.00	Fee schedule
LCHG BUN	84520		Both			$45.00	$27.00	BCBS			$23.81			999999999	$3.51	$27.00	Fee schedule
LCHG BUN	84520		Both			$45.00	$27.00	HEALTHCHOICE			$4.74			999999999	$3.51	$27.00	Fee schedule
LCHG BUN	84520		Both			$45.00	$27.00	Medicaid			$3.51			999999999	$3.51	$27.00	Fee schedule
LCHG BUN	84520		Both			$45.00	$27.00	Medicare			$25.58			999999999	$3.51	$27.00	Per diem
LCHG URIC ACID BLOOD	84550		Both			$45.00	$27.00	AETNA			$4.35			999999999	$4.02	$27.00	Fee schedule
LCHG URIC ACID BLOOD	84550		Both			$45.00	$27.00	BCBS			$23.81			999999999	$4.02	$27.00	Fee schedule
LCHG URIC ACID BLOOD	84550		Both			$45.00	$27.00	HEALTHCHOICE			$5.42			999999999	$4.02	$27.00	Fee schedule
LCHG URIC ACID BLOOD	84550		Both			$45.00	$27.00	Medicaid			$4.02			999999999	$4.02	$27.00	Fee schedule
LCHG URIC ACID BLOOD	84550		Both			$45.00	$27.00	Medicare			$25.58			999999999	$4.02	$27.00	Per diem
LCHG HCG BETA BLOOD QUANTITATIVE	84702		Both			$102.00	$61.20	AETNA			$14.49			999999999	$13.39	$74.32	Fee schedule
LCHG HCG BETA BLOOD QUANTITATIVE	84702		Both			$102.00	$61.20	BCBS			$74.32			999999999	$13.39	$74.32	Fee schedule
LCHG HCG BETA BLOOD QUANTITATIVE	84702		Both			$102.00	$61.20	HEALTHCHOICE			$18.06			999999999	$13.39	$74.32	Fee schedule
LCHG HCG BETA BLOOD QUANTITATIVE	84702		Both			$102.00	$61.20	Medicaid			$13.39			999999999	$13.39	$74.32	Fee schedule
LCHG HCG BETA BLOOD QUANTITATIVE	84702		Both			$102.00	$61.20	Medicare			$57.98			999999999	$13.39	$74.32	Per diem
LCHG DIFFERENTIAL MANUAL	85007		Both			$58.00	$34.80	AETNA			$3.31			999999999	$3.31	$34.80	Fee schedule
LCHG DIFFERENTIAL MANUAL	85007		Both			$58.00	$34.80	BCBS			$33.51			999999999	$3.31	$34.80	Fee schedule
LCHG DIFFERENTIAL MANUAL	85007		Both			$58.00	$34.80	HEALTHCHOICE			$4.56			999999999	$3.31	$34.80	Fee schedule
LCHG DIFFERENTIAL MANUAL	85007		Both			$58.00	$34.80	Medicaid			$3.38			999999999	$3.31	$34.80	Fee schedule
LCHG DIFFERENTIAL MANUAL	85007		Both			$58.00	$34.80	Medicare			$33.25			999999999	$3.31	$34.80	Per diem
LCHG HEMATOCRIT	85014		Both			$18.00	$10.80	AETNA			$2.28			999999999	$2.11	$33.51	Fee schedule
LCHG HEMATOCRIT	85014		Both			$18.00	$10.80	BCBS			$33.51			999999999	$2.11	$33.51	Fee schedule
LCHG HEMATOCRIT	85014		Both			$18.00	$10.80	HEALTHCHOICE			$2.84			999999999	$2.11	$33.51	Fee schedule
LCHG HEMATOCRIT	85014		Both			$18.00	$10.80	Medicaid			$2.11			999999999	$2.11	$33.51	Fee schedule
LCHG HEMATOCRIT	85014		Both			$18.00	$10.80	Medicare			$10.23			999999999	$2.11	$33.51	Per diem
LCHG HEMOGLOBIN	85018		Both			$18.00	$10.80	AETNA			$2.28			999999999	$2.11	$33.51	Fee schedule
LCHG HEMOGLOBIN	85018		Both			$18.00	$10.80	BCBS			$33.51			999999999	$2.11	$33.51	Fee schedule
LCHG HEMOGLOBIN	85018		Both			$18.00	$10.80	HEALTHCHOICE			$2.84			999999999	$2.11	$33.51	Fee schedule
LCHG HEMOGLOBIN	85018		Both			$18.00	$10.80	Medicaid			$2.11			999999999	$2.11	$33.51	Fee schedule
LCHG HEMOGLOBIN	85018		Both			$18.00	$10.80	Medicare			$10.23			999999999	$2.11	$33.51	Per diem
LCHG PT-INR	85610		Both			$37.00	$23.80	AETNA			$3.78			999999999	$3.78	$19.80	Fee schedule
LCHG PT-INR	85610		Both			$33.00	$19.80	BCBS			$17.83			999999999	$3.78	$19.80	Fee schedule
LCHG PT-INR	85610		Both			$34.00	$20.80	HEALTHCHOICE			$5.15			999999999	$3.78	$19.80	Fee schedule
LCHG PT-INR	85610		Both			$35.00	$21.80	Medicaid			$3.82			999999999	$3.78	$19.80	Fee schedule
LCHG PT-INR	85610		Both			$36.00	$22.80	Medicare			$18.76			999999999	$3.78	$19.80	Per diem
LCHG SED RATE WINTROBE	85651		Both			$33.00	$19.80	AETNA			$3.42			999999999	$3.42	$33.51	Fee schedule
LCHG SED RATE WINTROBE	85651		Both			$33.00	$19.80	BCBS			$33.51			999999999	$3.42	$33.51	Fee schedule
LCHG SED RATE WINTROBE	85651		Both			$33.00	$19.80	HEALTHCHOICE			$5.12			999999999	$3.42	$33.51	Fee schedule
LCHG SED RATE WINTROBE	85651		Both			$33.00	$19.80	Medicaid			$3.80			999999999	$3.42	$33.51	Fee schedule
LCHG SED RATE WINTROBE	85651		Both			$33.00	$19.80	Medicare			$18.76			999999999	$3.42	$33.51	Per diem
LCHG PTT	85730		Both			$45.00	$27.00	AETNA			$5.78			999999999	$5.35	$27.00	Fee schedule
LCHG PTT	85730		Both			$45.00	$27.00	BCBS			$17.83			999999999	$5.35	$27.00	Fee schedule
LCHG PTT	85730		Both			$45.00	$27.00	HEALTHCHOICE			$7.21			999999999	$5.35	$27.00	Fee schedule
LCHG PTT	85730		Both			$45.00	$27.00	Medicaid			$5.35			999999999	$5.35	$27.00	Fee schedule
LCHG PTT	85730		Both			$45.00	$27.00	Medicare			$25.58			999999999	$5.35	$27.00	Per diem
LCHG ANA BLOOD SCREEN	86038		Both			$30.00	$18.00	AETNA			$11.63			999999999	$10.75	$39.77	Fee schedule
LCHG ANA BLOOD SCREEN	86038		Both			$30.00	$18.00	BCBS			$39.77			999999999	$10.75	$39.77	Fee schedule
LCHG ANA BLOOD SCREEN	86038		Both			$30.00	$18.00	HEALTHCHOICE			$14.51			999999999	$10.75	$39.77	Fee schedule
LCHG ANA BLOOD SCREEN	86038		Both			$30.00	$18.00	Medicaid			$10.75			999999999	$10.75	$39.77	Fee schedule
LCHG ANA BLOOD SCREEN	86038		Both			$30.00	$18.00	Medicare			$17.05			999999999	$10.75	$39.77	Per diem
LCHG C-REACTIVE PROTEIN	86140		Both			$33.00	$19.80	AETNA			$4.98			999999999	$4.61	$39.77	Fee schedule
LCHG C-REACTIVE PROTEIN	86140		Both			$33.00	$19.80	BCBS			$39.77			999999999	$4.61	$39.77	Fee schedule
LCHG C-REACTIVE PROTEIN	86140		Both			$33.00	$19.80	HEALTHCHOICE			$6.22			999999999	$4.61	$39.77	Fee schedule
LCHG C-REACTIVE PROTEIN	86140		Both			$33.00	$19.80	Medicaid			$4.61			999999999	$4.61	$39.77	Fee schedule
LCHG C-REACTIVE PROTEIN	86140		Both			$33.00	$19.80	Medicare			$18.76			999999999	$4.61	$39.77	Per diem
LCHG DNA ANTIBODY DOUBLE STRANDED	86225		Both			$85.00	$51.00	AETNA			$13.22			999999999	$12.22	$51.00	Fee schedule
LCHG DNA ANTIBODY DOUBLE STRANDED	86225		Both			$85.00	$51.00	BCBS			$39.77			999999999	$12.22	$51.00	Fee schedule
LCHG DNA ANTIBODY DOUBLE STRANDED	86225		Both			$85.00	$51.00	HEALTHCHOICE			$16.49			999999999	$12.22	$51.00	Fee schedule
LCHG DNA ANTIBODY DOUBLE STRANDED	86225		Both			$85.00	$51.00	Medicaid			$12.22			999999999	$12.22	$51.00	Fee schedule
LCHG DNA ANTIBODY DOUBLE STRANDED	86225		Both			$85.00	$51.00	Medicare			$48.60			999999999	$12.22	$51.00	Per diem
LCHG SS-A ANTIBODY	86235		Both			$117.00	$70.20	AETNA			$17.26			999999999	$15.95	$70.20	Fee schedule
LCHG SS-B ANTIBODY	86235		Both			$112.00	$67.20	AETNA			$17.26			999999999	$15.95	$67.20	Fee schedule
LCHG RNP ANTIBODY	86235		Both			$135.00	$81.00	AETNA			$17.26			999999999	$15.95	$81.00	Fee schedule
LCHG SM ANTIBODY ENA	86235		Both			$112.00	$67.20	AETNA			$17.26			999999999	$15.95	$67.20	Fee schedule
LCHG SS-A ANTIBODY	86235		Both			$117.00	$70.20	BCBS			$66.02			999999999	$15.95	$70.20	Fee schedule
LCHG SS-B ANTIBODY	86235		Both			$112.00	$67.20	BCBS			$66.02			999999999	$15.95	$67.20	Fee schedule
LCHG RNP ANTIBODY	86235		Both			$135.00	$81.00	BCBS			$66.02			999999999	$15.95	$81.00	Fee schedule
LCHG SM ANTIBODY ENA	86235		Both			$112.00	$67.20	BCBS			$66.02			999999999	$15.95	$67.20	Fee schedule
LCHG SS-A ANTIBODY	86235		Both			$117.00	$70.20	HEALTHCHOICE			$21.52			999999999	$15.95	$70.20	Fee schedule
LCHG SS-B ANTIBODY	86235		Both			$112.00	$67.20	HEALTHCHOICE			$21.52			999999999	$15.95	$67.20	Fee schedule
LCHG RNP ANTIBODY	86235		Both			$135.00	$81.00	HEALTHCHOICE			$21.52			999999999	$15.95	$81.00	Fee schedule
LCHG SM ANTIBODY ENA	86235		Both			$112.00	$67.20	HEALTHCHOICE			$21.52			999999999	$15.95	$67.20	Fee schedule
LCHG SS-A ANTIBODY	86235		Both			$117.00	$70.20	Medicaid			$15.95			999999999	$15.95	$70.20	Fee schedule
LCHG SS-B ANTIBODY	86235		Both			$112.00	$67.20	Medicaid			$15.95			999999999	$15.95	$67.20	Fee schedule
LCHG RNP ANTIBODY	86235		Both			$135.00	$81.00	Medicaid			$15.95			999999999	$15.95	$81.00	Fee schedule
LCHG SM ANTIBODY ENA	86235		Both			$112.00	$67.20	Medicaid			$15.95			999999999	$15.95	$67.20	Fee schedule
LCHG SS-A ANTIBODY	86235		Both			$117.00	$70.20	Medicare			$66.50			999999999	$15.95	$70.20	Per diem
LCHG SS-B ANTIBODY	86235		Both			$112.00	$67.20	Medicare			$63.95			999999999	$15.95	$67.20	Per diem
LCHG RNP ANTIBODY	86235		Both			$135.00	$81.00	Medicare			$76.73			999999999	$15.95	$81.00	Per diem
LCHG SM ANTIBODY ENA	86235		Both			$112.00	$67.20	Medicare			$63.95			999999999	$15.95	$67.20	Per diem
LCHG MONONUCLEOSIS SCREEN	86308		Both			$81.00	$48.60	AETNA			$4.98			999999999	$4.61	$48.60	Fee schedule
LCHG MONONUCLEOSIS SCREEN	86308		Both			$81.00	$48.60	BCBS			$39.77			999999999	$4.61	$48.60	Fee schedule
LCHG MONONUCLEOSIS SCREEN	86308		Both			$81.00	$48.60	HEALTHCHOICE			$6.22			999999999	$4.61	$48.60	Fee schedule
LCHG MONONUCLEOSIS SCREEN	86308		Both			$81.00	$48.60	Medicaid			$4.61			999999999	$4.61	$48.60	Fee schedule
LCHG MONONUCLEOSIS SCREEN	86308		Both			$81.00	$48.60	Medicare			$46.04			999999999	$4.61	$48.60	Per diem
LCHG MICROSOMAL ANTIBODY	86376		Both			$48.00	$28.80	AETNA			$13.99			999999999	$12.94	$98.66	Fee schedule
LCHG MICROSOMAL ANTIBODY	86376		Both			$48.00	$28.80	BCBS			$98.66			999999999	$12.94	$98.66	Fee schedule
LCHG MICROSOMAL ANTIBODY	86376		Both			$48.00	$28.80	HEALTHCHOICE			$17.46			999999999	$12.94	$98.66	Fee schedule
LCHG MICROSOMAL ANTIBODY	86376		Both			$48.00	$28.80	Medicaid			$12.94			999999999	$12.94	$98.66	Fee schedule
LCHG MICROSOMAL ANTIBODY	86376		Both			$48.00	$28.80	Medicare			$27.28			999999999	$12.94	$98.66	Per diem
LCHG RHEUMATOID FACTOR BLOOD QUANT	86431		Both			$45.00	$27.00	AETNA			$5.46			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT I	86431		Both			$45.00	$27.00	AETNA			$5.46			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT	86431		Both			$45.00	$27.00	BCBS			$39.77			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT I	86431		Both			$45.00	$27.00	BCBS			$39.77			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT	86431		Both			$45.00	$27.00	HEALTHCHOICE			$6.80			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT I	86431		Both			$45.00	$27.00	HEALTHCHOICE			$6.80			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT	86431		Both			$45.00	$27.00	Medicaid			$5.04			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT I	86431		Both			$45.00	$27.00	Medicaid			$5.04			999999999	$5.04	$39.77	Fee schedule
LCHG RHEUMATOID FACTOR BLOOD QUANT	86431		Both			$45.00	$27.00	Medicare			$25.58			999999999	$5.04	$39.77	Per diem
LCHG RHEUMATOID FACTOR BLOOD QUANT I	86431		Both			$45.00	$27.00	Medicare			$25.58			999999999	$5.04	$39.77	Per diem
LCHG LYME DISEASE AB IGM	86618		Both			$117.00	$70.20	AETNA			$16.39			999999999	$15.15	$70.20	Fee schedule
LCHG LYME DISEASE AB IGM	86618		Both			$117.00	$70.20	BCBS			$66.02			999999999	$15.15	$70.20	Fee schedule
LCHG LYME DISEASE AB IGM	86618		Both			$117.00	$70.20	HEALTHCHOICE			$20.44			999999999	$15.15	$70.20	Fee schedule
LCHG LYME DISEASE AB IGM	86618		Both			$117.00	$70.20	Medicaid			$15.15			999999999	$15.15	$70.20	Fee schedule
LCHG LYME DISEASE AB IGM	86618		Both			$117.00	$70.20	Medicare			$66.50			999999999	$15.15	$70.20	Per diem
LCHG HELICOBACTER PYLORI IGM	86677		Both			$99.00	$59.40	AETNA			$13.97			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG	86677		Both			$99.00	$59.40	AETNA			$13.97			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG QUAL	86677		Both			$43.00	$25.80	AETNA			$13.97			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGA	86677		Both			$99.00	$59.40	AETNA			$13.97			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGM	86677		Both			$99.00	$59.40	BCBS			$66.02			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG	86677		Both			$99.00	$59.40	BCBS			$66.02			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG QUAL	86677		Both			$43.00	$25.80	BCBS			$66.02			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGA	86677		Both			$99.00	$59.40	BCBS			$66.02			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGM	86677		Both			$99.00	$59.40	HEALTHCHOICE			$20.22			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG	86677		Both			$99.00	$59.40	HEALTHCHOICE			$20.22			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG QUAL	86677		Both			$43.00	$25.80	HEALTHCHOICE			$20.22			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGA	86677		Both			$99.00	$59.40	HEALTHCHOICE			$20.22			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGM	86677		Both			$99.00	$59.40	Medicaid			$14.99			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG	86677		Both			$99.00	$59.40	Medicaid			$14.99			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI ANTIBODY IGG QUAL	86677		Both			$43.00	$25.80	Medicaid			$14.99			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGA	86677		Both			$99.00	$59.40	Medicaid			$14.99			999999999	$13.97	$66.02	Fee schedule
LCHG HELICOBACTER PYLORI IGM	86677		Both			$99.00	$59.40	Medicare			$56.27			999999999	$13.97	$66.02	Per diem
LCHG HELICOBACTER PYLORI ANTIBODY IGG	86677		Both			$99.00	$59.40	Medicare			$56.27			999999999	$13.97	$66.02	Per diem
LCHG HELICOBACTER PYLORI ANTIBODY IGG QUAL	86677		Both			$43.00	$25.80	Medicare			$24.36			999999999	$13.97	$66.02	Per diem
LCHG HELICOBACTER PYLORI IGA	86677		Both			$99.00	$59.40	Medicare			$56.27			999999999	$13.97	$66.02	Per diem
LCHG SARS-COV-2 (COVID-19) ANTIBODY IGG	86769		Both			$54.00	$32.40	AETNA			$42.13			999999999	$30.45	$42.13	Fee schedule
LCHG SARS-COV-2 (COVID-19) ANTIBODY IGG	86769		Both			$54.00	$32.40	BCBS			$39.77			999999999	$30.45	$42.13	Fee schedule
LCHG SARS-COV-2 (COVID-19) ANTIBODY IGG	86769		Both			$54.00	$32.40	HEALTHCHOICE			$30.95			999999999	$30.45	$42.13	Fee schedule
LCHG SARS-COV-2 (COVID-19) ANTIBODY IGG	86769		Both			$54.00	$32.40	Medicaid			$40.02			999999999	$30.45	$42.13	Fee schedule
LCHG SARS-COV-2 (COVID-19) ANTIBODY IGG	86769		Both			$54.00	$32.40	Medicare			$30.45			999999999	$30.45	$42.13	Per diem
LCHG THYROGLOBULIN ANTIBODY	86800		Both			$48.00	$28.80	AETNA			$15.30			999999999	$14.15	$28.80	Fee schedule
LCHG THYROGLOBULIN ANTIBODY	86800		Both			$48.00	$28.80	BCBS			$23.81			999999999	$14.15	$28.80	Fee schedule
LCHG THYROGLOBULIN ANTIBODY	86800		Both			$48.00	$28.80	HEALTHCHOICE			$19.09			999999999	$14.15	$28.80	Fee schedule
LCHG THYROGLOBULIN ANTIBODY	86800		Both			$48.00	$28.80	Medicaid			$14.15			999999999	$14.15	$28.80	Fee schedule
LCHG THYROGLOBULIN ANTIBODY	86800		Both			$48.00	$28.80	Medicare			$27.28			999999999	$14.15	$28.80	Per diem
LCHG HEPATITIS C ANTIBODY	86803		Both			$99.00	$59.40	AETNA			$13.73			999999999	$12.69	$66.02	Fee schedule
LCHG HEPATITIS C ANTIBODY	86803		Both			$99.00	$59.40	BCBS			$66.02			999999999	$12.69	$66.02	Fee schedule
LCHG HEPATITIS C ANTIBODY	86803		Both			$99.00	$59.40	HEALTHCHOICE			$17.12			999999999	$12.69	$66.02	Fee schedule
LCHG HEPATITIS C ANTIBODY	86803		Both			$99.00	$59.40	Medicaid			$12.69			999999999	$12.69	$66.02	Fee schedule
LCHG HEPATITIS C ANTIBODY	86803		Both			$99.00	$59.40	Medicare			$56.27			999999999	$12.69	$66.02	Per diem
LCHG ANTIBODY SCREEN	86850		Both			$55.00	$33.00	AETNA			$10.19			999999999	$8.69	$39.77	Fee schedule
LCHG ANTIBODY SCREEN	86850		Both			$55.00	$33.00	BCBS			$39.77			999999999	$8.69	$39.77	Fee schedule
LCHG ANTIBODY SCREEN	86850		Both			$55.00	$33.00	HEALTHCHOICE			$11.72			999999999	$8.69	$39.77	Fee schedule
LCHG ANTIBODY SCREEN	86850		Both			$55.00	$33.00	Medicaid			$8.69			999999999	$8.69	$39.77	Fee schedule
LCHG ANTIBODY SCREEN	86850		Both			$55.00	$33.00	Medicare			$31.55			999999999	$8.69	$39.77	Per diem
LCHG BLOOD TYPE ABO	86900		Both			$33.00	$19.80	AETNA			$2.87			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE ABO	86900		Both			$33.00	$19.80	BCBS			$13.53			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE ABO	86900		Both			$33.00	$19.80	HEALTHCHOICE			$3.59			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE ABO	86900		Both			$33.00	$19.80	Medicaid			$2.66			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE ABO	86900		Both			$33.00	$19.80	Medicare			$18.76			999999999	$2.66	$19.80	Per diem
LCHG BLOOD TYPE RH I	86901		Both			$33.00	$19.80	AETNA			$2.87			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE RH I	86901		Both			$33.00	$19.80	BCBS			$13.53			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE RH I	86901		Both			$33.00	$19.80	HEALTHCHOICE			$3.59			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE RH I	86901		Both			$33.00	$19.80	Medicaid			$2.66			999999999	$2.66	$19.80	Fee schedule
LCHG BLOOD TYPE RH I	86901		Both			$33.00	$19.80	Medicare			$18.76			999999999	$2.66	$19.80	Per diem
LCHG COMPATIBILITY TEST ANTIGLOBULIN	86922		Both			$225.00	$135.00	AETNA			$15.49			999999999	$0.00	$210.68	Fee schedule
LCHG COMPATIBILITY TEST ANTIGLOBULIN	86922		Both			$225.00	$135.00	BCBS			$210.68			999999999	$0.00	$210.68	Fee schedule
LCHG COMPATIBILITY TEST ANTIGLOBULIN	86922		Both			$225.00	$135.00	HEALTHCHOICE			$0.00			999999999	$0.00	$210.68	Fee schedule
LCHG COMPATIBILITY TEST ANTIGLOBULIN	86922		Both			$225.00	$135.00	Medicaid			$42.14			999999999	$0.00	$210.68	Fee schedule
LCHG COMPATIBILITY TEST ANTIGLOBULIN	86922		Both			$225.00	$135.00	Medicare			$127.89			999999999	$0.00	$210.68	Per diem
LCHG CULTURE BLOOD	87040		Both			$84.00	$50.40	AETNA			$9.93			999999999	$9.18	$129.09	Fee schedule
LCHG CULTURE BLOOD	87040		Both			$84.00	$50.40	BCBS			$129.09			999999999	$9.18	$129.09	Fee schedule
LCHG CULTURE BLOOD	87040		Both			$84.00	$50.40	HEALTHCHOICE			$12.38			999999999	$9.18	$129.09	Fee schedule
LCHG CULTURE BLOOD	87040		Both			$84.00	$50.40	Medicaid			$9.18			999999999	$9.18	$129.09	Fee schedule
LCHG CULTURE BLOOD	87040		Both			$84.00	$50.40	Medicare			$47.75			999999999	$9.18	$129.09	Per diem
LCHG CULTURE SALMONELLA+SHIGELLA	87045		Both			$66.00	$39.60	AETNA			$9.08			999999999	$8.40	$39.60	Fee schedule
LCHG CULTURE SALMONELLA+SHIGELLA	87045		Both			$66.00	$39.60	BCBS			$35.55			999999999	$8.40	$39.60	Fee schedule
LCHG CULTURE SALMONELLA+SHIGELLA	87045		Both			$66.00	$39.60	HEALTHCHOICE			$11.33			999999999	$8.40	$39.60	Fee schedule
LCHG CULTURE SALMONELLA+SHIGELLA	87045		Both			$66.00	$39.60	Medicaid			$8.40			999999999	$8.40	$39.60	Fee schedule
LCHG CULTURE SALMONELLA+SHIGELLA	87045		Both			$66.00	$39.60	Medicare			$37.51			999999999	$8.40	$39.60	Per diem
LCHG CULTURE STOOL EACH ORGANISM	87046		Both			$70.00	$42.00	AETNA			$9.08			999999999	$8.40	$42.00	Fee schedule
LCHG CULTURE STOOL EACH ORGANISM	87046		Both			$70.00	$42.00	BCBS			$35.55			999999999	$8.40	$42.00	Fee schedule
LCHG CULTURE STOOL EACH ORGANISM	87046		Both			$70.00	$42.00	HEALTHCHOICE			$11.33			999999999	$8.40	$42.00	Fee schedule
LCHG CULTURE STOOL EACH ORGANISM	87046		Both			$70.00	$42.00	Medicaid			$8.40			999999999	$8.40	$42.00	Fee schedule
LCHG CULTURE STOOL EACH ORGANISM	87046		Both			$70.00	$42.00	Medicare			$40.07			999999999	$8.40	$42.00	Per diem
LCHG CULTURE ROUTINE	87070		Both			$66.00	$39.60	AETNA			$8.29			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE RESPIRATORY	87070		Both			$66.00	$39.60	AETNA			$8.29			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE GENITAL	87070		Both			$66.00	$39.60	AETNA			$8.29			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE ROUTINE	87070		Both			$66.00	$39.60	BCBS			$35.55			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE RESPIRATORY	87070		Both			$66.00	$39.60	BCBS			$35.55			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE GENITAL	87070		Both			$66.00	$39.60	BCBS			$35.55			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE ROUTINE	87070		Both			$66.00	$39.60	HEALTHCHOICE			$10.34			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE RESPIRATORY	87070		Both			$66.00	$39.60	HEALTHCHOICE			$10.34			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE GENITAL	87070		Both			$66.00	$39.60	HEALTHCHOICE			$10.34			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE ROUTINE	87070		Both			$66.00	$39.60	Medicaid			$7.67			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE RESPIRATORY	87070		Both			$66.00	$39.60	Medicaid			$7.67			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE GENITAL	87070		Both			$66.00	$39.60	Medicaid			$7.67			999999999	$7.67	$39.60	Fee schedule
LCHG CULTURE ROUTINE	87070		Both			$66.00	$39.60	Medicare			$37.51			999999999	$7.67	$39.60	Per diem
LCHG CULTURE RESPIRATORY	87070		Both			$66.00	$39.60	Medicare			$37.51			999999999	$7.67	$39.60	Per diem
LCHG CULTURE GENITAL	87070		Both			$66.00	$39.60	Medicare			$37.51			999999999	$7.67	$39.60	Per diem
LCHG CULTURE ANAEROBE	87075		Both			$66.00	$39.60	AETNA			$9.11			999999999	$8.42	$39.60	Fee schedule
LCHG CULTURE ANAEROBE	87075		Both			$66.00	$39.60	BCBS			$35.55			999999999	$8.42	$39.60	Fee schedule
LCHG CULTURE ANAEROBE	87075		Both			$66.00	$39.60	HEALTHCHOICE			$11.36			999999999	$8.42	$39.60	Fee schedule
LCHG CULTURE ANAEROBE	87075		Both			$66.00	$39.60	Medicaid			$8.42			999999999	$8.42	$39.60	Fee schedule
LCHG CULTURE ANAEROBE	87075		Both			$66.00	$39.60	Medicare			$37.51			999999999	$8.42	$39.60	Per diem
LCHG ORGANISM ID AEROBE EACH REFER	87077		Both			$51.00	$30.60	AETNA			$7.78			999999999	$7.19	$35.55	Fee schedule
LCHG ORGANISM ID AEROBE EACH REFER	87077		Both			$51.00	$30.60	BCBS			$35.55			999999999	$7.19	$35.55	Fee schedule
LCHG ORGANISM ID AEROBE EACH REFER	87077		Both			$51.00	$30.60	HEALTHCHOICE			$9.70			999999999	$7.19	$35.55	Fee schedule
LCHG ORGANISM ID AEROBE EACH REFER	87077		Both			$51.00	$30.60	Medicaid			$7.19			999999999	$7.19	$35.55	Fee schedule
LCHG ORGANISM ID AEROBE EACH REFER	87077		Both			$51.00	$30.60	Medicare			$28.99			999999999	$7.19	$35.55	Per diem
LCHG CULTURE URINE	87086		Both			$66.00	$39.60	AETNA			$7.77			999999999	$7.18	$39.60	Fee schedule
LCHG CULTURE URINE	87086		Both			$66.00	$39.60	BCBS			$35.55			999999999	$7.18	$39.60	Fee schedule
LCHG CULTURE URINE	87086		Both			$66.00	$39.60	HEALTHCHOICE			$9.68			999999999	$7.18	$39.60	Fee schedule
LCHG CULTURE URINE	87086		Both			$66.00	$39.60	Medicaid			$7.18			999999999	$7.18	$39.60	Fee schedule
LCHG CULTURE URINE	87086		Both			$66.00	$39.60	Medicare			$37.51			999999999	$7.18	$39.60	Per diem
LCHG ORGANISM ID URINE	87088		Both			$51.00	$30.60	AETNA			$5.92			999999999	$5.92	$35.55	Fee schedule
LCHG ORGANISM ID URINE	87088		Both			$51.00	$30.60	BCBS			$35.55			999999999	$5.92	$35.55	Fee schedule
LCHG ORGANISM ID URINE	87088		Both			$51.00	$30.60	HEALTHCHOICE			$9.71			999999999	$5.92	$35.55	Fee schedule
LCHG ORGANISM ID URINE	87088		Both			$51.00	$30.60	Medicaid			$7.20			999999999	$5.92	$35.55	Fee schedule
LCHG ORGANISM ID URINE	87088		Both			$51.00	$30.60	Medicare			$28.99			999999999	$5.92	$35.55	Per diem
LCHG O+P	87177		Both			$45.00	$27.00	AETNA			$841.00			999999999	$7.92	$841.00	Fee schedule
LCHG O+P	87177		Both			$45.00	$27.00	BCBS			$35.55			999999999	$7.92	$841.00	Fee schedule
LCHG O+P	87177		Both			$45.00	$27.00	HEALTHCHOICE			$10.68			999999999	$7.92	$841.00	Fee schedule
LCHG O+P	87177		Both			$45.00	$27.00	Medicaid			$7.92			999999999	$7.92	$841.00	Fee schedule
LCHG O+P	87177		Both			$45.00	$27.00	Medicare			$25.58			999999999	$7.92	$841.00	Per diem
LCHG SUSCEPTIBILITY URINE	87186		Both			$57.00	$34.20	AETNA			$8.32			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY EACH REFER	87186		Both			$57.00	$34.20	AETNA			$8.32			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY URINE	87186		Both			$57.00	$34.20	BCBS			$35.55			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY EACH REFER	87186		Both			$57.00	$34.20	BCBS			$35.55			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY URINE	87186		Both			$57.00	$34.20	HEALTHCHOICE			$10.38			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY EACH REFER	87186		Both			$57.00	$34.20	HEALTHCHOICE			$10.38			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY URINE	87186		Both			$57.00	$34.20	Medicaid			$7.69			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY EACH REFER	87186		Both			$57.00	$34.20	Medicaid			$7.69			999999999	$7.69	$35.55	Fee schedule
LCHG SUSCEPTIBILITY URINE	87186		Both			$57.00	$34.20	Medicare			$32.40			999999999	$7.69	$35.55	Per diem
LCHG SUSCEPTIBILITY EACH REFER	87186		Both			$57.00	$34.20	Medicare			$32.40			999999999	$7.69	$35.55	Per diem
LCHG GRAM STAIN SMEAR	87205		Both			$33.00	$19.80	AETNA			$4.11			999999999	$3.80	$35.55	Fee schedule
LCHG GRAM STAIN SMEAR	87205		Both			$33.00	$19.80	BCBS			$35.55			999999999	$3.80	$35.55	Fee schedule
LCHG GRAM STAIN SMEAR	87205		Both			$33.00	$19.80	HEALTHCHOICE			$5.12			999999999	$3.80	$35.55	Fee schedule
LCHG GRAM STAIN SMEAR	87205		Both			$33.00	$19.80	Medicaid			$3.80			999999999	$3.80	$35.55	Fee schedule
LCHG GRAM STAIN SMEAR	87205		Both			$33.00	$19.80	Medicare			$18.76			999999999	$3.80	$35.55	Per diem
LCHG STAIN TRICHROME	87209		Both			$45.00	$27.00	AETNA			$17.30			999999999	$15.99	$129.09	Fee schedule
LCHG STAIN TRICHROME	87209		Both			$45.00	$27.00	BCBS			$129.09			999999999	$15.99	$129.09	Fee schedule
LCHG STAIN TRICHROME	87209		Both			$45.00	$27.00	HEALTHCHOICE			$21.58			999999999	$15.99	$129.09	Fee schedule
LCHG STAIN TRICHROME	87209		Both			$45.00	$27.00	Medicaid			$15.99			999999999	$15.99	$129.09	Fee schedule
LCHG STAIN TRICHROME	87209		Both			$45.00	$27.00	Medicare			$25.58			999999999	$15.99	$129.09	Per diem
LCHG WET PREP SMEAR	87210		Both			$45.00	$27.00	AETNA			$4.11			999999999	$4.11	$35.55	Fee schedule
LCHG WET PREP SMEAR	87210		Both			$45.00	$27.00	BCBS			$35.55			999999999	$4.11	$35.55	Fee schedule
LCHG WET PREP SMEAR	87210		Both			$45.00	$27.00	HEALTHCHOICE			$6.98			999999999	$4.11	$35.55	Fee schedule
LCHG WET PREP SMEAR	87210		Both			$45.00	$27.00	Medicaid			$5.18			999999999	$4.11	$35.55	Fee schedule
LCHG WET PREP SMEAR	87210		Both			$45.00	$27.00	Medicare			$25.58			999999999	$4.11	$35.55	Per diem
LCHG CLOSTRIDIUM DIFFICILE TOXIN BY EIA	87324		Both			$90.00	$54.00	AETNA			$11.54			999999999	$10.66	$54.00	Fee schedule
LCHG CLOSTRIDIUM DIFFICILE TOXIN BY EIA	87324		Both			$90.00	$54.00	BCBS			$39.77			999999999	$10.66	$54.00	Fee schedule
LCHG CLOSTRIDIUM DIFFICILE TOXIN BY EIA	87324		Both			$90.00	$54.00	HEALTHCHOICE			$14.38			999999999	$10.66	$54.00	Fee schedule
LCHG CLOSTRIDIUM DIFFICILE TOXIN BY EIA	87324		Both			$90.00	$54.00	Medicaid			$10.66			999999999	$10.66	$54.00	Fee schedule
LCHG CLOSTRIDIUM DIFFICILE TOXIN BY EIA	87324		Both			$90.00	$54.00	Medicare			$51.16			999999999	$10.66	$54.00	Per diem
LCHG SHIGA-LIKE TOXIN	87427		Both			$270.00	$162.00	AETNA			$11.54			999999999	$10.66	$162.00	Fee schedule
LCHG SHIGA-LIKE TOXIN	87427		Both			$270.00	$162.00	BCBS			$39.77			999999999	$10.66	$162.00	Fee schedule
LCHG SHIGA-LIKE TOXIN	87427		Both			$270.00	$162.00	HEALTHCHOICE			$14.38			999999999	$10.66	$162.00	Fee schedule
LCHG SHIGA-LIKE TOXIN	87427		Both			$270.00	$162.00	Medicaid			$10.66			999999999	$10.66	$162.00	Fee schedule
LCHG SHIGA-LIKE TOXIN	87427		Both			$270.00	$162.00	Medicare			$153.47			999999999	$10.66	$162.00	Per diem
LCHG CHLAMYDIA DNA PROBE	87491		Both			$126.00	$75.60	AETNA			$33.77			999999999	$31.21	$75.60	Fee schedule
LCHG CHLAMYDIA DNA PROBE	87491		Both			$126.00	$75.60	BCBS			$39.77			999999999	$31.21	$75.60	Fee schedule
LCHG CHLAMYDIA DNA PROBE	87491		Both			$126.00	$75.60	HEALTHCHOICE			$42.11			999999999	$31.21	$75.60	Fee schedule
LCHG CHLAMYDIA DNA PROBE	87491		Both			$126.00	$75.60	Medicaid			$31.21			999999999	$31.21	$75.60	Fee schedule
LCHG CHLAMYDIA DNA PROBE	87491		Both			$126.00	$75.60	Medicare			$71.62			999999999	$31.21	$75.60	Per diem
LCHG GC AMPLIFIED PROBE	87591		Both			$117.00	$70.20	AETNA			$33.77			999999999	$31.21	$129.09	Fee schedule
LCHG GC AMPLIFIED PROBE	87591		Both			$117.00	$70.20	BCBS			$129.09			999999999	$31.21	$129.09	Fee schedule
LCHG GC AMPLIFIED PROBE	87591		Both			$117.00	$70.20	HEALTHCHOICE			$42.11			999999999	$31.21	$129.09	Fee schedule
LCHG GC AMPLIFIED PROBE	87591		Both			$117.00	$70.20	Medicaid			$31.21			999999999	$31.21	$129.09	Fee schedule
LCHG GC AMPLIFIED PROBE	87591		Both			$117.00	$70.20	Medicare			$66.50			999999999	$31.21	$129.09	Per diem
LCHG SARS-COV-2 (COVID-19)	87635		Both			$111.00	$66.60	AETNA			$51.31			999999999	$0.00	$129.09	Fee schedule
LCHG SARS-COV-2 (COVID-19)	87635		Both			$111.00	$66.60	BCBS			$129.09			999999999	$0.00	$129.09	Fee schedule
LCHG SARS-COV-2 (COVID-19)	87635		Both			$111.00	$66.60	HEALTHCHOICE			$0.00			999999999	$0.00	$129.09	Fee schedule
LCHG SARS-COV-2 (COVID-19)	87635		Both			$111.00	$66.60	Medicaid			$48.74			999999999	$0.00	$129.09	Fee schedule
LCHG SARS-COV-2 (COVID-19)	87635		Both			$111.00	$66.60	Medicare			$63.27			999999999	$0.00	$129.09	Per diem
LCHG INFLUENZA A+B ANTIGEN RAPID	87804		Both			$76.00	$45.60	AETNA			$11.54			999999999	$11.54	$45.60	Fee schedule
LCHG INFLUENZA A+B ANTIGEN RAPID	87804		Both			$76.00	$45.60	BCBS			$35.55			999999999	$11.54	$45.60	Fee schedule
LCHG INFLUENZA A+B ANTIGEN RAPID	87804		Both			$76.00	$45.60	HEALTHCHOICE			$19.86			999999999	$11.54	$45.60	Fee schedule
LCHG INFLUENZA A+B ANTIGEN RAPID	87804		Both			$76.00	$45.60	Medicaid			$14.72			999999999	$11.54	$45.60	Fee schedule
LCHG INFLUENZA A+B ANTIGEN RAPID	87804		Both			$76.00	$45.60	Medicare			$43.48			999999999	$11.54	$45.60	Per diem
LCHG RSV RAPID AG BY IMMUNOASSAY	87807		Both			$94.00	$56.40	AETNA			$11.54			999999999	$11.54	$56.40	Fee schedule
LCHG RSV RAPID AG BY IMMUNOASSAY	87807		Both			$94.00	$56.40	BCBS			$35.55			999999999	$11.54	$56.40	Fee schedule
LCHG RSV RAPID AG BY IMMUNOASSAY	87807		Both			$94.00	$56.40	HEALTHCHOICE			$15.72			999999999	$11.54	$56.40	Fee schedule
LCHG RSV RAPID AG BY IMMUNOASSAY	87807		Both			$94.00	$56.40	Medicaid			$11.65			999999999	$11.54	$56.40	Fee schedule
LCHG RSV RAPID AG BY IMMUNOASSAY	87807		Both			$94.00	$56.40	Medicare			$53.71			999999999	$11.54	$56.40	Per diem
LCHG STREP A SCREEN DIRECT IMMUNO	87880		Both			$76.00	$45.60	AETNA			$11.54			999999999	$11.54	$45.60	Fee schedule
LCHG STREP A SCREEN DIRECT IMMUNO	87880		Both			$76.00	$45.60	BCBS			$35.55			999999999	$11.54	$45.60	Fee schedule
LCHG STREP A SCREEN DIRECT IMMUNO	87880		Both			$76.00	$45.60	HEALTHCHOICE			$19.84			999999999	$11.54	$45.60	Fee schedule
LCHG STREP A SCREEN DIRECT IMMUNO	87880		Both			$76.00	$45.60	Medicaid			$14.70			999999999	$11.54	$45.60	Fee schedule
LCHG STREP A SCREEN DIRECT IMMUNO	87880		Both			$76.00	$45.60	Medicare			$43.48			999999999	$11.54	$45.60	Per diem
LCHG SP G+M LEVEL IV TC NL	88305		Both			$111.00	$66.60	AETNA			$44.51			999999999	$44.51	$106.72	Fee schedule
LCHG SP G+M LEVEL IV TC NL	88305		Both			$111.00	$66.60	BCBS			$106.72			999999999	$44.51	$106.72	Fee schedule
LCHG SP G+M LEVEL IV TC NL	88305		Both			$111.00	$66.60	HEALTHCHOICE			$79.66			999999999	$44.51	$106.72	Fee schedule
LCHG SP G+M LEVEL IV TC NL	88305		Both			$111.00	$66.60	Medicaid			$62.25			999999999	$44.51	$106.72	Fee schedule
LCHG SP G+M LEVEL IV TC NL	88305		Both			$111.00	$66.60	Medicare			$63.09			999999999	$44.51	$106.72	Per diem
LCHG SP STAIN GROUP II TC NL	88313		Both			$211.00	$126.60	AETNA			$41.33			999999999	$41.33	$126.60	Fee schedule
LCHG SP STAIN GROUP II TC NL	88313		Both			$211.00	$126.60	BCBS			$106.72			999999999	$41.33	$126.60	Fee schedule
LCHG SP STAIN GROUP II TC NL	88313		Both			$211.00	$126.60	HEALTHCHOICE			$83.28			999999999	$41.33	$126.60	Fee schedule
LCHG SP STAIN GROUP II TC NL	88313		Both			$211.00	$126.60	Medicaid			$69.40			999999999	$41.33	$126.60	Fee schedule
LCHG SP STAIN GROUP II TC NL	88313		Both			$211.00	$126.60	Medicare			$120.22			999999999	$41.33	$126.60	Per diem
HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	90471		Both			$80.00	$48.00	AETNA			$10.00			999999999	$10.00	$48.00	Fee schedule
HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	90471		Both			$80.00	$48.00	BCBS			$30.62			999999999	$10.00	$48.00	Fee schedule
HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	90471		Both			$80.00	$48.00	HEALTHCHOICE			$17.52			999999999	$10.00	$48.00	Fee schedule
HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	90471		Both			$80.00	$48.00	Medicaid			$17.45			999999999	$10.00	$48.00	Fee schedule
HC IMMUNIZ ADMIN 1 SNGL/COMB VAC/TOXOID	90471		Both			$80.00	$48.00	Medicare			$45.68			999999999	$10.00	$48.00	Per diem
PR PSYTX PT AND OR FAMILY 30 MINUTES	90832		Both			$202.00	$121.20	AETNA			$45.00			999999999	$45.00	$121.20	Fee schedule
PR PSYTX PT AND OR FAMILY 30 MINUTES	90832		Both			$202.00	$121.20	BCBS			$63.65			999999999	$45.00	$121.20	Fee schedule
PR PSYTX PT AND OR FAMILY 30 MINUTES	90832		Both			$202.00	$121.20	HEALTHCHOICE			$67.12			999999999	$45.00	$121.20	Fee schedule
PR PSYTX PT AND OR FAMILY 30 MINUTES	90832		Both			$202.00	$121.20	Medicaid			$68.73			999999999	$45.00	$121.20	Fee schedule
PR PSYTX PT AND OR FAMILY 30 MINUTES	90832		Both			$202.00	$121.20	Medicare			$115.10			999999999	$45.00	$121.20	Per diem
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	AETNA			$80.00			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	AETNA			$80.00			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	BCBS			$84.38			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	BCBS			$84.38			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	HEALTHCHOICE			$89.49			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	HEALTHCHOICE			$89.49			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	Medicaid			$90.86			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	Medicaid			$90.86			999999999	$80.00	$155.40	Fee schedule
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	Medicare			$147.38			999999999	$80.00	$155.40	Per diem
PR PSYTX PT AND OR FAMILY 45 MINUTES	90834		Both			$259.00	$155.40	Medicare			$147.38			999999999	$80.00	$155.40	Per diem
PR PSYTX PT AND OR FAMILY 60 MINUTES	90837		Both			$270.00	$162.00	AETNA			$92.00			999999999	$92.00	$162.00	Fee schedule
PR PSYTX PT AND OR FAMILY 60 MINUTES	90837		Both			$270.00	$162.00	BCBS			$126.96			999999999	$92.00	$162.00	Fee schedule
PR PSYTX PT AND OR FAMILY 60 MINUTES	90837		Both			$270.00	$162.00	HEALTHCHOICE			$133.90			999999999	$92.00	$162.00	Fee schedule
PR PSYTX PT AND OR FAMILY 60 MINUTES	90837		Both			$270.00	$162.00	Medicaid			$133.75			999999999	$92.00	$162.00	Fee schedule
PR PSYTX PT AND OR FAMILY 60 MINUTES	90837		Both			$270.00	$162.00	Medicare			$153.47			999999999	$92.00	$162.00	Per diem
FAMILY PSYCHOTHERAPY 50 MINUTES	90846		Both			$0.00	$0.00	BCBS			$134.46			999999999	$0.00	$134.46	Fee schedule
FAMILY PSYCHOTHERAPY 50 MINUTES	90846		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$134.46	Fee schedule
FAMILY PSYCHOTHERAPY 50 MINUTES	90846		Both			$0.00	$0.00	Medicaid			$87.76			999999999	$0.00	$134.46	Fee schedule
FAMILY PSYCHOTHERAPY 50 MINUTES	90846		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$134.46	Per diem
FAMILY PSYCHOTHERAPY 50 MINUTES	90846		Both			$0.00	$0.00	AETNA			$82.00			999999999	$0.00	$134.46	Fee schedule
FAMILY PSYCHOTHERAPY W/PATIENT 50 MINUTES	90847		Both			$0.00	$0.00	AETNA			$82.00			999999999	$0.00	$139.72	Fee schedule
FAMILY PSYCHOTHERAPY W/PATIENT 50 MINUTES	90847		Both			$0.00	$0.00	BCBS			$139.72			999999999	$0.00	$139.72	Fee schedule
FAMILY PSYCHOTHERAPY W/PATIENT 50 MINUTES	90847		Both			$0.00	$0.00	HEALTHCHOICE			$112.21			999999999	$0.00	$139.72	Fee schedule
FAMILY PSYCHOTHERAPY W/PATIENT 50 MINUTES	90847		Both			$0.00	$0.00	Medicaid			$91.50			999999999	$0.00	$139.72	Fee schedule
FAMILY PSYCHOTHERAPY W/PATIENT 50 MINUTES	90847		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$139.72	Per diem
GROUP PSYCHOTHERAPY	90853		Both			$0.00	$0.00	AETNA			$40.00			999999999	$0.00	$40.00	Fee schedule
GROUP PSYCHOTHERAPY	90853		Both			$0.00	$0.00	BCBS			$33.50			999999999	$0.00	$40.00	Fee schedule
GROUP PSYCHOTHERAPY	90853		Both			$0.00	$0.00	HEALTHCHOICE			$26.54			999999999	$0.00	$40.00	Fee schedule
GROUP PSYCHOTHERAPY	90853		Both			$0.00	$0.00	Medicaid			$24.29			999999999	$0.00	$40.00	Fee schedule
GROUP PSYCHOTHERAPY	90853		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$40.00	Per diem
HC TX SPEECH DISORDER INDIVID 30 MIN ST	92507		Both			$317.00	$190.20	AETNA			$45.52			999999999	$45.52	$190.20	Fee schedule
HC TX SPEECH DISORDER INDIVID 30 MIN ST	92507		Both			$317.00	$190.20	BCBS			$161.93			999999999	$45.52	$190.20	Fee schedule
HC TX SPEECH DISORDER INDIVID 30 MIN ST	92507		Both			$317.00	$190.20	HEALTHCHOICE			$84.21			999999999	$45.52	$190.20	Fee schedule
HC TX SPEECH DISORDER INDIVID 30 MIN ST	92507		Both			$317.00	$190.20	Medicaid			$68.69			999999999	$45.52	$190.20	Fee schedule
HC TX SPEECH DISORDER INDIVID 30 MIN ST	92507		Both			$317.00	$190.20	Medicare			$180.26			999999999	$45.52	$190.20	Per diem
PR PURE TONE HEARING TEST, AIR	92551		Both			$13.00	$7.80	AETNA			$9.34			999999999	$7.31	$125.71	Fee schedule
PR PURE TONE HEARING TEST, AIR	92551		Both			$13.00	$7.80	BCBS			$125.71			999999999	$7.31	$125.71	Fee schedule
PR PURE TONE HEARING TEST, AIR	92551		Both			$13.00	$7.80	HEALTHCHOICE			$28.00			999999999	$7.31	$125.71	Fee schedule
PR PURE TONE HEARING TEST, AIR	92551		Both			$13.00	$7.80	Medicaid			$10.09			999999999	$7.31	$125.71	Fee schedule
PR PURE TONE HEARING TEST, AIR	92551		Both			$13.00	$7.80	Medicare			$7.31			999999999	$7.31	$125.71	Per diem
ELECTROCARDIOGRAM, ROUTINE, WITH REPORT AND INTERPRETATION	93000		Both			$0.00	$0.00	AETNA			$14.33			999999999	$0.00	$43.53	Fee schedule
ELECTROCARDIOGRAM, ROUTINE, WITH REPORT AND INTERPRETATION	93000		Both			$0.00	$0.00	BCBS			$43.53			999999999	$0.00	$43.53	Fee schedule
ELECTROCARDIOGRAM, ROUTINE, WITH REPORT AND INTERPRETATION	93000		Both			$0.00	$0.00	HEALTHCHOICE			$17.47			999999999	$0.00	$43.53	Fee schedule
ELECTROCARDIOGRAM, ROUTINE, WITH REPORT AND INTERPRETATION	93000		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$43.53	Fee schedule
ELECTROCARDIOGRAM, ROUTINE, WITH REPORT AND INTERPRETATION	93000		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$43.53	Per diem
HC EKG 12 LEAD	93005		Both			$211.00	$126.60	AETNA			$7.57			999999999	$5.31	$126.60	Fee schedule
HC EKG 12 LEAD	93005		Both			$211.00	$126.60	BCBS			$43.53			999999999	$5.31	$126.60	Fee schedule
HC EKG 12 LEAD	93005		Both			$211.00	$126.60	HEALTHCHOICE			$8.36			999999999	$5.31	$126.60	Fee schedule
HC EKG 12 LEAD	93005		Both			$211.00	$126.60	Medicaid			$5.31			999999999	$5.31	$126.60	Fee schedule
HC EKG 12 LEAD	93005		Both			$211.00	$126.60	Medicare			$118.78			999999999	$5.31	$126.60	Per diem
HC TTE 2D WO CON W DOPPLER AND COLOR CMPL	93306		Both			$2,710.00	$1,626.00	AETNA			$0.00			999999999	$0.00	$1,626.00	Fee schedule
HC TTE 2D WO CON W DOPPLER AND COLOR CMPL	93306		Both			$2,710.00	$1,626.00	BCBS			$0.00			999999999	$0.00	$1,626.00	Fee schedule
HC TTE 2D WO CON W DOPPLER AND COLOR CMPL	93306		Both			$2,710.00	$1,626.00	HEALTHCHOICE			$210.91			999999999	$0.00	$1,626.00	Fee schedule
HC TTE 2D WO CON W DOPPLER AND COLOR CMPL	93306		Both			$2,710.00	$1,626.00	Medicaid			$169.79			999999999	$0.00	$1,626.00	Fee schedule
HC TTE 2D WO CON W DOPPLER AND COLOR CMPL	93306		Both			$2,710.00	$1,626.00	Medicare			$1,540.77			999999999	$0.00	$1,626.00	Per diem
INSERTION OF CATH INTO LEFT HEART FOR DX	93452		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
INSERTION OF CATH INTO LEFT HEART FOR DX	93452		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
INSERTION OF CATH INTO LEFT HEART FOR DX	93452		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
INSERTION OF CATH INTO LEFT HEART FOR DX	93452		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
INSERTION OF CATH INTO LEFT HEART FOR DX	93452		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
HC CARD REHAB W/ EKG	93798		Both			$221.00	$132.60	AETNA			$19.65			999999999	$15.18	$152.35	Fee schedule
HC CARD REHAB W/ EKG	93798		Both			$221.00	$132.60	BCBS			$152.35			999999999	$15.18	$152.35	Fee schedule
HC CARD REHAB W/ EKG	93798		Both			$221.00	$132.60	HEALTHCHOICE			$15.18			999999999	$15.18	$152.35	Fee schedule
HC CARD REHAB W/ EKG	93798		Both			$221.00	$132.60	Medicaid			$22.32			999999999	$15.18	$152.35	Fee schedule
HC CARD REHAB W/ EKG	93798		Both			$221.00	$132.60	Medicare			$125.45			999999999	$15.18	$152.35	Per diem
HC SPIROMETRY	94010		Both			$17.00	$10.20	AETNA			$28.52			999999999	$10.20	$216.55	Fee schedule
HC SPIROMETRY	94010		Both			$17.00	$10.20	BCBS			$216.55			999999999	$10.20	$216.55	Fee schedule
HC SPIROMETRY	94010		Both			$17.00	$10.20	HEALTHCHOICE			$35.60			999999999	$10.20	$216.55	Fee schedule
HC SPIROMETRY	94010		Both			$17.00	$10.20	Medicaid			$23.05			999999999	$10.20	$216.55	Fee schedule
HC SPIROMETRY	94010		Both			$17.00	$10.20	Medicare			$100.49			999999999	$10.20	$216.55	Per diem
HC INHALATION TREATMENT W/MED SUBSEQUENT	94640		Both			$84.00	$50.40	AETNA			$14.41			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED	94640		Both			$92.00	$55.20	AETNA			$14.41			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED SUBSEQUENT	94640		Both			$84.00	$50.40	BCBS			$815.38			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED	94640		Both			$92.00	$55.20	BCBS			$815.38			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED SUBSEQUENT	94640		Both			$84.00	$50.40	HEALTHCHOICE			$17.42			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED	94640		Both			$92.00	$55.20	HEALTHCHOICE			$17.42			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED SUBSEQUENT	94640		Both			$84.00	$50.40	Medicaid			$7.56			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED	94640		Both			$92.00	$55.20	Medicaid			$7.56			999999999	$7.56	$815.38	Fee schedule
HC INHALATION TREATMENT W/MED SUBSEQUENT	94640		Both			$84.00	$50.40	Medicare			$47.63			999999999	$7.56	$815.38	Per diem
HC INHALATION TREATMENT W/MED	94640		Both			$92.00	$55.20	Medicare			$52.37			999999999	$7.56	$815.38	Per diem
HC SLEEP STUDY UNATTENDED	95806		Both			$388.00	$232.80	AETNA			$141.61			999999999	$0.00	$232.80	Fee schedule
HC SLEEP STUDY UNATTENDED	95806		Both			$388.00	$232.80	BCBS			$98.66			999999999	$0.00	$232.80	Fee schedule
HC SLEEP STUDY UNATTENDED	95806		Both			$388.00	$232.80	HEALTHCHOICE			$119.16			999999999	$0.00	$232.80	Fee schedule
HC SLEEP STUDY UNATTENDED	95806		Both			$388.00	$232.80	Medicaid			$0.00			999999999	$0.00	$232.80	Fee schedule
HC SLEEP STUDY UNATTENDED	95806		Both			$388.00	$232.80	Medicare			$220.46			999999999	$0.00	$232.80	Per diem
SLEEP STUDY	95810		Both			$0.00	$0.00	AETNA			$490.81			999999999	$0.00	$610.89	Fee schedule
SLEEP STUDY	95810		Both			$0.00	$0.00	BCBS			$55.35			999999999	$0.00	$610.89	Fee schedule
SLEEP STUDY	95810		Both			$0.00	$0.00	HEALTHCHOICE			$610.89			999999999	$0.00	$610.89	Fee schedule
SLEEP STUDY	95810		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$610.89	Fee schedule
SLEEP STUDY	95810		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$610.89	Per diem
HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	96360		Both			$206.00	$123.60	AETNA			$44.20			999999999	$27.86	$245.13	Fee schedule
HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	96360		Both			$206.00	$123.60	BCBS			$245.13			999999999	$27.86	$245.13	Fee schedule
HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	96360		Both			$206.00	$123.60	HEALTHCHOICE			$56.48			999999999	$27.86	$245.13	Fee schedule
HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	96360		Both			$206.00	$123.60	Medicaid			$27.86			999999999	$27.86	$245.13	Fee schedule
HC ED IV INF HYDRATION INIT 31 MIN TO 1HR	96360		Both			$206.00	$123.60	Medicare			$117.15			999999999	$27.86	$245.13	Per diem
HC IV INF HYDRATION EA ADDL HR	96361		Both			$73.00	$43.80	AETNA			$11.75			999999999	$10.98	$121.20	Fee schedule
HC IV INF HYDRATION EA ADDL HR	96361		Both			$73.00	$43.80	BCBS			$121.20			999999999	$10.98	$121.20	Fee schedule
HC IV INF HYDRATION EA ADDL HR	96361		Both			$73.00	$43.80	HEALTHCHOICE			$22.52			999999999	$10.98	$121.20	Fee schedule
HC IV INF HYDRATION EA ADDL HR	96361		Both			$73.00	$43.80	Medicaid			$10.98			999999999	$10.98	$121.20	Fee schedule
HC IV INF HYDRATION EA ADDL HR	96361		Both			$73.00	$43.80	Medicare			$41.36			999999999	$10.98	$121.20	Per diem
HC ED IV INF THER/PROPH/DIAG 1ST HR	96365		Both			$390.00	$234.00	AETNA			$57.04			999999999	$0.00	$234.00	Fee schedule
HC ED IV INF THER/PROPH/DIAG 1ST HR	96365		Both			$390.00	$234.00	BCBS			$0.00			999999999	$0.00	$234.00	Fee schedule
HC ED IV INF THER/PROPH/DIAG 1ST HR	96365		Both			$390.00	$234.00	HEALTHCHOICE			$116.60			999999999	$0.00	$234.00	Fee schedule
HC ED IV INF THER/PROPH/DIAG 1ST HR	96365		Both			$390.00	$234.00	Medicaid			$54.35			999999999	$0.00	$234.00	Fee schedule
HC ED IV INF THER/PROPH/DIAG 1ST HR	96365		Both			$390.00	$234.00	Medicare			$222.01			999999999	$0.00	$234.00	Per diem
HC IV INF THER/PROPH/DIAG EA ADDL HR	96366		Both			$60.00	$36.00	AETNA			$16.95			999999999	$16.95	$121.20	Fee schedule
HC IV INF THER/PROPH/DIAG EA ADDL HR	96366		Both			$60.00	$36.00	BCBS			$121.20			999999999	$16.95	$121.20	Fee schedule
HC IV INF THER/PROPH/DIAG EA ADDL HR	96366		Both			$60.00	$36.00	HEALTHCHOICE			$36.43			999999999	$16.95	$121.20	Fee schedule
HC IV INF THER/PROPH/DIAG EA ADDL HR	96366		Both			$60.00	$36.00	Medicaid			$17.77			999999999	$16.95	$121.20	Fee schedule
HC IV INF THER/PROPH/DIAG EA ADDL HR	96366		Both			$60.00	$36.00	Medicare			$34.18			999999999	$16.95	$121.20	Per diem
HC ED INJ THER/PROPH/DIAG SUBQ/IM	96372		Both			$114.00	$68.40	AETNA			$19.95			999999999	$12.39	$68.40	Fee schedule
HC ED INJ THER/PROPH/DIAG SUBQ/IM	96372		Both			$114.00	$68.40	BCBS			$30.62			999999999	$12.39	$68.40	Fee schedule
HC ED INJ THER/PROPH/DIAG SUBQ/IM	96372		Both			$114.00	$68.40	HEALTHCHOICE			$24.26			999999999	$12.39	$68.40	Fee schedule
HC ED INJ THER/PROPH/DIAG SUBQ/IM	96372		Both			$114.00	$68.40	Medicaid			$12.39			999999999	$12.39	$68.40	Fee schedule
HC ED INJ THER/PROPH/DIAG SUBQ/IM	96372		Both			$114.00	$68.40	Medicare			$64.78			999999999	$12.39	$68.40	Per diem
HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	96374		Both			$156.00	$93.60	AETNA			$43.48			999999999	$0.00	$93.60	Fee schedule
HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	96374		Both			$156.00	$93.60	BCBS			$0.00			999999999	$0.00	$93.60	Fee schedule
HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	96374		Both			$156.00	$93.60	HEALTHCHOICE			$65.20			999999999	$0.00	$93.60	Fee schedule
HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	96374		Both			$156.00	$93.60	Medicaid			$31.80			999999999	$0.00	$93.60	Fee schedule
HC ED INJ THER/PROPH/DIAG IVP SNGL OR INIT	96374		Both			$156.00	$93.60	Medicare			$88.49			999999999	$0.00	$93.60	Per diem
HC ED INJ THER/DIAG IVP EA ADDL NEW DRUG	96375		Both			$141.00	$84.60	AETNA			$17.11			999999999	$0.00	$84.60	Fee schedule
HC ED INJ THER/DIAG IVP EA ADDL NEW DRUG	96375		Both			$141.00	$84.60	BCBS			$0.00			999999999	$0.00	$84.60	Fee schedule
HC ED INJ THER/DIAG IVP EA ADDL NEW DRUG	96375		Both			$141.00	$84.60	HEALTHCHOICE			$27.20			999999999	$0.00	$84.60	Fee schedule
HC ED INJ THER/DIAG IVP EA ADDL NEW DRUG	96375		Both			$141.00	$84.60	Medicaid			$13.27			999999999	$0.00	$84.60	Fee schedule
HC ED INJ THER/DIAG IVP EA ADDL NEW DRUG	96375		Both			$141.00	$84.60	Medicare			$80.04			999999999	$0.00	$84.60	Per diem
HC ED IVP TPD EA ADD PUSH SAME DRUG	96376		Both			$71.00	$42.60	AETNA			$11.33			999999999	$0.00	$42.60	Fee schedule
HC ED IVP TPD EA ADD PUSH SAME DRUG	96376		Both			$71.00	$42.60	BCBS			$0.00			999999999	$0.00	$42.60	Fee schedule
HC ED IVP TPD EA ADD PUSH SAME DRUG	96376		Both			$71.00	$42.60	HEALTHCHOICE			$13.60			999999999	$0.00	$42.60	Fee schedule
HC ED IVP TPD EA ADD PUSH SAME DRUG	96376		Both			$71.00	$42.60	Medicaid			$0.00			999999999	$0.00	$42.60	Fee schedule
HC ED IVP TPD EA ADD PUSH SAME DRUG	96376		Both			$71.00	$42.60	Medicare			$40.12			999999999	$0.00	$42.60	Per diem
HC ULTRASOUND THERAPY EA 15 MIN PT	97035		Both			$54.00	$32.40	AETNA			$8.23			999999999	$0.00	$77.05	Fee schedule
HC ULTRASOUND THERAPY EA 15 MIN PT	97035		Both			$54.00	$32.40	BCBS			$77.05			999999999	$0.00	$77.05	Fee schedule
HC ULTRASOUND THERAPY EA 15 MIN PT	97035		Both			$54.00	$32.40	HEALTHCHOICE			$16.76			999999999	$0.00	$77.05	Fee schedule
HC ULTRASOUND THERAPY EA 15 MIN PT	97035		Both			$54.00	$32.40	Medicaid			$0.00			999999999	$0.00	$77.05	Fee schedule
HC ULTRASOUND THERAPY EA 15 MIN PT	97035		Both			$54.00	$32.40	Medicare			$30.45			999999999	$0.00	$77.05	Per diem
HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	97140		Both			$85.00	$51.00	AETNA			$19.39			999999999	$19.39	$77.05	Fee schedule
HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	97140		Both			$85.00	$51.00	BCBS			$77.05			999999999	$19.39	$77.05	Fee schedule
HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	97140		Both			$85.00	$51.00	HEALTHCHOICE			$32.81			999999999	$19.39	$77.05	Fee schedule
HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	97140		Both			$85.00	$51.00	Medicaid			$24.30			999999999	$19.39	$77.05	Fee schedule
HC MANUAL THER TECH 1+REGIONS EA 15 MIN PT	97140		Both			$85.00	$51.00	Medicare			$48.08			999999999	$19.39	$77.05	Per diem
HC PT EVAL LOW COMPLEXITY	97161		Both			$175.00	$105.00	AETNA			$54.12			999999999	$54.12	$105.00	Fee schedule
HC PT EVAL LOW COMPLEXITY	97161		Both			$175.00	$105.00	BCBS			$77.05			999999999	$54.12	$105.00	Fee schedule
HC PT EVAL LOW COMPLEXITY	97161		Both			$175.00	$105.00	HEALTHCHOICE			$99.12			999999999	$54.12	$105.00	Fee schedule
HC PT EVAL LOW COMPLEXITY	97161		Both			$175.00	$105.00	Medicaid			$89.79			999999999	$54.12	$105.00	Fee schedule
HC PT EVAL LOW COMPLEXITY	97161		Both			$175.00	$105.00	Medicare			$99.27			999999999	$54.12	$105.00	Per diem
HC PT EVAL MOD COMPLEXITY	97162		Both			$228.00	$136.80	AETNA			$54.12			999999999	$54.12	$136.80	Fee schedule
HC PT EVAL MOD COMPLEXITY	97162		Both			$228.00	$136.80	BCBS			$77.05			999999999	$54.12	$136.80	Fee schedule
HC PT EVAL MOD COMPLEXITY	97162		Both			$228.00	$136.80	HEALTHCHOICE			$99.12			999999999	$54.12	$136.80	Fee schedule
HC PT EVAL MOD COMPLEXITY	97162		Both			$228.00	$136.80	Medicaid			$89.79			999999999	$54.12	$136.80	Fee schedule
HC PT EVAL MOD COMPLEXITY	97162		Both			$228.00	$136.80	Medicare			$129.72			999999999	$54.12	$136.80	Per diem
HC THER ACTIVITIES EA 15 MIN PT	97530		Both			$82.00	$49.20	AETNA			$22.48			999999999	$22.48	$77.05	Fee schedule
HC THER ACTIVITIES EA 15 MIN OT	97530		Both			$82.00	$49.20	AETNA			$22.48			999999999	$22.48	$65.70	Fee schedule
HC THER ACTIVITIES EA 15 MIN PT	97530		Both			$82.00	$49.20	BCBS			$77.05			999999999	$22.48	$77.05	Fee schedule
HC THER ACTIVITIES EA 15 MIN OT	97530		Both			$82.00	$49.20	BCBS			$65.70			999999999	$22.48	$65.70	Fee schedule
HC THER ACTIVITIES EA 15 MIN PT	97530		Both			$82.00	$49.20	HEALTHCHOICE			$45.13			999999999	$22.48	$77.05	Fee schedule
HC THER ACTIVITIES EA 15 MIN OT	97530		Both			$82.00	$49.20	HEALTHCHOICE			$45.13			999999999	$22.48	$65.70	Fee schedule
HC THER ACTIVITIES EA 15 MIN PT	97530		Both			$82.00	$49.20	Medicaid			$32.77			999999999	$22.48	$77.05	Fee schedule
HC THER ACTIVITIES EA 15 MIN OT	97530		Both			$82.00	$49.20	Medicaid			$32.77			999999999	$22.48	$65.70	Fee schedule
HC THER ACTIVITIES EA 15 MIN PT	97530		Both			$82.00	$49.20	Medicare			$46.89			999999999	$22.48	$77.05	Per diem
HC THER ACTIVITIES EA 15 MIN OT	97530		Both			$82.00	$49.20	Medicare			$46.89			999999999	$22.48	$65.70	Per diem
HC DEBRID SELECTIVE 1ST 20SQ CM OR < PT	97597		Both			$214.00	$128.40	AETNA			$60.27			999999999	$44.04	$214.05	Fee schedule
HC DEBRID SELECTIVE 1ST 20SQ CM OR < PT	97597		Both			$214.00	$128.40	BCBS			$214.05			999999999	$44.04	$214.05	Fee schedule
HC DEBRID SELECTIVE 1ST 20SQ CM OR < PT	97597		Both			$214.00	$128.40	HEALTHCHOICE			$44.04			999999999	$44.04	$214.05	Fee schedule
HC DEBRID SELECTIVE 1ST 20SQ CM OR < PT	97597		Both			$214.00	$128.40	Medicaid			$87.23			999999999	$44.04	$214.05	Fee schedule
HC DEBRID SELECTIVE 1ST 20SQ CM OR < PT	97597		Both			$214.00	$128.40	Medicare			$121.80			999999999	$44.04	$214.05	Per diem
PR HC PRO PHONE CALL 21-30 MIN	98968		Both			$122.00	$73.20	AETNA			$32.15			999999999	$0.00	$98.66	Fee schedule
PR HC PRO PHONE CALL 21-30 MIN	98968		Both			$122.00	$73.20	BCBS			$98.66			999999999	$0.00	$98.66	Fee schedule
PR HC PRO PHONE CALL 21-30 MIN	98968		Both			$122.00	$73.20	HEALTHCHOICE			$0.00			999999999	$0.00	$98.66	Fee schedule
PR HC PRO PHONE CALL 21-30 MIN	98968		Both			$122.00	$73.20	Medicaid			$30.49			999999999	$0.00	$98.66	Fee schedule
PR HC PRO PHONE CALL 21-30 MIN	98968		Both			$122.00	$73.20	Medicare			$69.43			999999999	$0.00	$98.66	Per diem
HC DRUG COLLECTION NON DOT	99001		Both			$17.00	$10.20	AETNA			$13.00			999999999	$0.00	$13.00	Fee schedule
HC DRUG COLLECTION NON DOT	99001		Both			$17.00	$10.20	BCBS			$0.00			999999999	$0.00	$13.00	Fee schedule
HC DRUG COLLECTION NON DOT	99001		Both			$17.00	$10.20	HEALTHCHOICE			$8.00			999999999	$0.00	$13.00	Fee schedule
HC DRUG COLLECTION NON DOT	99001		Both			$17.00	$10.20	Medicaid			$0.00			999999999	$0.00	$13.00	Fee schedule
HC DRUG COLLECTION NON DOT	99001		Both			$17.00	$10.20	Medicare			$9.59			999999999	$0.00	$13.00	Per diem
HC MOD SED SAME PHYS 5>=YRS INIT 15 MIN	99152		Both			$59.00	$35.40	AETNA			$40.86			999999999	$0.00	$42.96	Fee schedule
HC MOD SED SAME PHYS 5>=YRS INIT 15 MIN	99152		Both			$59.00	$35.40	BCBS			$0.00			999999999	$0.00	$42.96	Fee schedule
HC MOD SED SAME PHYS 5>=YRS INIT 15 MIN	99152		Both			$59.00	$35.40	HEALTHCHOICE			$14.65			999999999	$0.00	$42.96	Fee schedule
HC MOD SED SAME PHYS 5>=YRS INIT 15 MIN	99152		Both			$59.00	$35.40	Medicaid			$42.96			999999999	$0.00	$42.96	Fee schedule
HC MOD SED SAME PHYS 5>=YRS INIT 15 MIN	99152		Both			$59.00	$35.40	Medicare			$33.50			999999999	$0.00	$42.96	Per diem
HC MOD SED SAME PHYS EA ADDL 15 MIN	99153		Both			$59.00	$35.40	AETNA			$8.54			999999999	$0.00	$35.40	Fee schedule
HC MOD SED SAME PHYS EA ADDL 15 MIN	99153		Both			$59.00	$35.40	BCBS			$0.00			999999999	$0.00	$35.40	Fee schedule
HC MOD SED SAME PHYS EA ADDL 15 MIN	99153		Both			$59.00	$35.40	HEALTHCHOICE			$11.51			999999999	$0.00	$35.40	Fee schedule
HC MOD SED SAME PHYS EA ADDL 15 MIN	99153		Both			$59.00	$35.40	Medicaid			$9.22			999999999	$0.00	$35.40	Fee schedule
HC MOD SED SAME PHYS EA ADDL 15 MIN	99153		Both			$59.00	$35.40	Medicare			$33.50			999999999	$0.00	$35.40	Per diem
PR OFFICE/OUTPT VISIT,NEW,LEVL II	99202		Both			$126.00	$75.60	AETNA			$68.05			999999999	$61.86	$93.31	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL II	99202		Both			$126.00	$75.60	BCBS			$93.31			999999999	$61.86	$93.31	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL II	99202		Both			$126.00	$75.60	HEALTHCHOICE			$61.86			999999999	$61.86	$93.31	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL II	99202		Both			$126.00	$75.60	Medicaid			$63.58			999999999	$61.86	$93.31	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL II	99202		Both			$126.00	$75.60	Medicare			$71.86			999999999	$61.86	$93.31	Per diem
PR OFFICE/OUTPT VISIT,NEW,LEVL III	99203		Both			$178.00	$106.80	AETNA			$98.99			999999999	$92.74	$135.89	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL III	99203		Both			$178.00	$106.80	BCBS			$135.89			999999999	$92.74	$135.89	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL III	99203		Both			$178.00	$106.80	HEALTHCHOICE			$92.74			999999999	$92.74	$135.89	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL III	99203		Both			$178.00	$106.80	Medicaid			$98.92			999999999	$92.74	$135.89	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL III	99203		Both			$178.00	$106.80	Medicare			$101.09			999999999	$92.74	$135.89	Per diem
PR OFFICE/OUTPT VISIT,NEW,LEVL IV	99204		Both			$251.00	$150.60	AETNA			$151.91			999999999	$142.51	$208.15	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL IV	99204		Both			$251.00	$150.60	BCBS			$208.15			999999999	$142.51	$208.15	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL IV	99204		Both			$251.00	$150.60	HEALTHCHOICE			$158.60			999999999	$142.51	$208.15	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL IV	99204		Both			$251.00	$150.60	Medicaid			$147.63			999999999	$142.51	$208.15	Fee schedule
PR OFFICE/OUTPT VISIT,NEW,LEVL IV	99204		Both			$251.00	$150.60	Medicare			$142.51			999999999	$142.51	$208.15	Per diem
PR OFFICE/OUTPT VISIT, NEW LEVL V	99205		Both			$0.00	$0.00	AETNA			$188.86			999999999	$0.00	$262.22	Fee schedule
PR OFFICE/OUTPT VISIT, NEW LEVL V	99205		Both			$0.00	$0.00	BCBS			$262.22			999999999	$0.00	$262.22	Fee schedule
PR OFFICE/OUTPT VISIT, NEW LEVL V	99205		Both			$0.00	$0.00	HEALTHCHOICE			$207.13			999999999	$0.00	$262.22	Fee schedule
PR OFFICE/OUTPT VISIT, NEW LEVL V	99205		Both			$0.00	$0.00	Medicaid			$195.08			999999999	$0.00	$262.22	Fee schedule
PR OFFICE/OUTPT VISIT, NEW LEVL V	99205		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$262.22	Per diem
PR OFFICE/OUTPT VISIT,EST,LEVL I	99211		Both			$43.00	$25.80	AETNA			$93.70			999999999	$11.31	$93.70	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL I	99211		Both			$43.00	$25.80	BCBS			$24.40			999999999	$11.31	$93.70	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL I	99211		Both			$43.00	$25.80	HEALTHCHOICE			$11.31			999999999	$11.31	$93.70	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL I	99211		Both			$43.00	$25.80	Medicaid			$20.02			999999999	$11.31	$93.70	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL I	99211		Both			$43.00	$25.80	Medicare			$24.38			999999999	$11.31	$93.70	Per diem
PR OFFICE/OUTPT VISIT,EST,LEVL II	99212		Both			$78.00	$46.80	AETNA			$39.76			999999999	$31.60	$54.07	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL II	99212		Both			$78.00	$46.80	BCBS			$54.07			999999999	$31.60	$54.07	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL II	99212		Both			$78.00	$46.80	HEALTHCHOICE			$31.60			999999999	$31.60	$54.07	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL II	99212		Both			$78.00	$46.80	Medicaid			$49.59			999999999	$31.60	$54.07	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL II	99212		Both			$78.00	$46.80	Medicare			$44.35			999999999	$31.60	$54.07	Per diem
PR OFFICE/OUTPT VISIT,EST,LEVL III	99213		Both			$100.00	$60.00	AETNA			$66.79			999999999	$56.63	$90.92	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL III	99213		Both			$100.00	$60.00	BCBS			$90.92			999999999	$56.63	$90.92	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL III	99213		Both			$100.00	$60.00	HEALTHCHOICE			$62.88			999999999	$56.63	$90.92	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL III	99213		Both			$100.00	$60.00	Medicaid			$79.76			999999999	$56.63	$90.92	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL III	99213		Both			$100.00	$60.00	Medicare			$56.63			999999999	$56.63	$90.92	Per diem
PR OFFICE/OUTPT VISIT,EST,LEVL IV	99214		Both			$156.00	$93.60	AETNA			$98.38			999999999	$88.91	$135.42	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL IV	99214		Both			$156.00	$93.60	BCBS			$135.42			999999999	$88.91	$135.42	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL IV	99214		Both			$156.00	$93.60	HEALTHCHOICE			$96.75			999999999	$88.91	$135.42	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL IV	99214		Both			$156.00	$93.60	Medicaid			$113.10			999999999	$88.91	$135.42	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL IV	99214		Both			$156.00	$93.60	Medicare			$88.91			999999999	$88.91	$135.42	Per diem
PR OFFICE/OUTPT VISIT,EST,LEVL V	99215		Both			$212.00	$127.20	AETNA			$132.08			999999999	$120.58	$183.27	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL V	99215		Both			$212.00	$127.20	BCBS			$183.27			999999999	$120.58	$183.27	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL V	99215		Both			$212.00	$127.20	HEALTHCHOICE			$136.64			999999999	$120.58	$183.27	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL V	99215		Both			$212.00	$127.20	Medicaid			$158.84			999999999	$120.58	$183.27	Fee schedule
PR OFFICE/OUTPT VISIT,EST,LEVL V	99215		Both			$212.00	$127.20	Medicare			$120.58			999999999	$120.58	$183.27	Per diem
PR INITIAL HOSPITAL CARE,LEVL I	99221		Both			$248.00	$148.80	AETNA			$93.70			999999999	$74.55	$148.80	Fee schedule
PR INITIAL HOSPITAL CARE,LEVL I	99221		Both			$248.00	$148.80	BCBS			$131.11			999999999	$74.55	$148.80	Fee schedule
PR INITIAL HOSPITAL CARE,LEVL I	99221		Both			$248.00	$148.80	HEALTHCHOICE			$124.83			999999999	$74.55	$148.80	Fee schedule
PR INITIAL HOSPITAL CARE,LEVL I	99221		Both			$248.00	$148.80	Medicaid			$74.55			999999999	$74.55	$148.80	Fee schedule
PR INITIAL HOSPITAL CARE,LEVL I	99221		Both			$248.00	$148.80	Medicare			$141.29			999999999	$74.55	$148.80	Per diem
PR SUBSEQUENT HOSPITAL CARE,LEVL I	99231		Both			$103.00	$61.80	AETNA			$36.13			999999999	$36.13	$61.80	Fee schedule
PR SUBSEQUENT HOSPITAL CARE,LEVL I	99231		Both			$103.00	$61.80	BCBS			$50.72			999999999	$36.13	$61.80	Fee schedule
PR SUBSEQUENT HOSPITAL CARE,LEVL I	99231		Both			$103.00	$61.80	HEALTHCHOICE			$48.23			999999999	$36.13	$61.80	Fee schedule
PR SUBSEQUENT HOSPITAL CARE,LEVL I	99231		Both			$103.00	$61.80	Medicaid			$44.66			999999999	$36.13	$61.80	Fee schedule
PR SUBSEQUENT HOSPITAL CARE,LEVL I	99231		Both			$103.00	$61.80	Medicare			$58.46			999999999	$36.13	$61.80	Per diem
PR HOSPITAL DISCHARGE DAY,<30 MIN	99238		Both			$192.00	$115.20	AETNA			$66.56			999999999	$66.56	$115.20	Fee schedule
PR HOSPITAL DISCHARGE DAY,<30 MIN	99238		Both			$192.00	$115.20	BCBS			$93.79			999999999	$66.56	$115.20	Fee schedule
PR HOSPITAL DISCHARGE DAY,<30 MIN	99238		Both			$192.00	$115.20	HEALTHCHOICE			$88.85			999999999	$66.56	$115.20	Fee schedule
PR HOSPITAL DISCHARGE DAY,<30 MIN	99238		Both			$192.00	$115.20	Medicaid			$77.22			999999999	$66.56	$115.20	Fee schedule
PR HOSPITAL DISCHARGE DAY,<30 MIN	99238		Both			$192.00	$115.20	Medicare			$109.01			999999999	$66.56	$115.20	Per diem
OFFICE CONSULTATION 40 MINUTES	99243		Both			$0.00	$0.00	AETNA			$108.76			999999999	$0.00	$114.88	Fee schedule
OFFICE CONSULTATION 40 MINUTES	99243		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$114.88	Fee schedule
OFFICE CONSULTATION 40 MINUTES	99243		Both			$0.00	$0.00	HEALTHCHOICE			$114.88			999999999	$0.00	$114.88	Fee schedule
OFFICE CONSULTATION 40 MINUTES	99243		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$114.88	Fee schedule
OFFICE CONSULTATION 40 MINUTES	99243		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$114.88	Per diem
OFFICE CONSULTATION 60 MINUTES	99244		Both			$0.00	$0.00	AETNA			$162.02			999999999	$0.00	$182.45	Fee schedule
OFFICE CONSULTATION 60 MINUTES	99244		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$182.45	Fee schedule
OFFICE CONSULTATION 60 MINUTES	99244		Both			$0.00	$0.00	HEALTHCHOICE			$182.45			999999999	$0.00	$182.45	Fee schedule
OFFICE CONSULTATION 60 MINUTES	99244		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$182.45	Fee schedule
OFFICE CONSULTATION 60 MINUTES	99244		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$182.45	Per diem
HC ED EMERGENT LEVEL II	99282		Both			$357.00	$214.20	AETNA			$38.39			999999999	$37.94	$214.20	Fee schedule
HC ED EMERGENT LEVEL II	99282		Both			$357.00	$214.20	BCBS			$53.59			999999999	$37.94	$214.20	Fee schedule
HC ED EMERGENT LEVEL II	99282		Both			$357.00	$214.20	HEALTHCHOICE			$86.20			999999999	$37.94	$214.20	Fee schedule
HC ED EMERGENT LEVEL II	99282		Both			$357.00	$214.20	Medicaid			$37.94			999999999	$37.94	$214.20	Fee schedule
HC ED EMERGENT LEVEL II	99282		Both			$357.00	$214.20	Medicare			$203.00			999999999	$37.94	$214.20	Per diem
HP EMERGENCY DEPT VISIT LEVEL 3 PROFESSIONAL FEE	99283		Both			$328.00	$196.80	AETNA			$57.41			999999999	$57.41	$196.80	Fee schedule
HC ED EMERGENT LEVEL III FACILITY	99283		Both			$536.00	$321.60	AETNA			$57.41			999999999	$57.41	$321.60	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 3 PROFESSIONAL FEE	99283		Both			$328.00	$196.80	BCBS			$80.87			999999999	$57.41	$196.80	Fee schedule
HC ED EMERGENT LEVEL III FACILITY	99283		Both			$536.00	$321.60	BCBS			$80.87			999999999	$57.41	$321.60	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 3 PROFESSIONAL FEE	99283		Both			$328.00	$196.80	HEALTHCHOICE			$119.49			999999999	$57.41	$196.80	Fee schedule
HC ED EMERGENT LEVEL III FACILITY	99283		Both			$536.00	$321.60	HEALTHCHOICE			$119.49			999999999	$57.41	$321.60	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 3 PROFESSIONAL FEE	99283		Both			$328.00	$196.80	Medicaid			$65.16			999999999	$57.41	$196.80	Fee schedule
HC ED EMERGENT LEVEL III FACILITY	99283		Both			$536.00	$321.60	Medicaid			$65.16			999999999	$57.41	$321.60	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 3 PROFESSIONAL FEE	99283		Both			$328.00	$196.80	Medicare			$186.35			999999999	$57.41	$196.80	Per diem
HC ED EMERGENT LEVEL III FACILITY	99283		Both			$536.00	$321.60	Medicare			$304.50			999999999	$57.41	$321.60	Per diem
HC ED EMERGENT LEVEL IV FACILITY	99284		Both			$867.00	$520.20	AETNA			$109.78			999999999	$109.78	$520.20	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 4 PROFESSIONAL FEE	99284		Both			$699.00	$419.40	AETNA			$109.78			999999999	$109.78	$419.40	Fee schedule
HC ED EMERGENT LEVEL IV FACILITY	99284		Both			$867.00	$520.20	BCBS			$154.08			999999999	$109.78	$520.20	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 4 PROFESSIONAL FEE	99284		Both			$699.00	$419.40	BCBS			$154.08			999999999	$109.78	$419.40	Fee schedule
HC ED EMERGENT LEVEL IV FACILITY	99284		Both			$867.00	$520.20	HEALTHCHOICE			$207.55			999999999	$109.78	$520.20	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 4 PROFESSIONAL FEE	99284		Both			$699.00	$419.40	HEALTHCHOICE			$207.55			999999999	$109.78	$419.40	Fee schedule
HC ED EMERGENT LEVEL IV FACILITY	99284		Both			$867.00	$520.20	Medicaid			$109.80			999999999	$109.78	$520.20	Fee schedule
HP EMERGENCY DEPT VISIT LEVEL 4 PROFESSIONAL FEE	99284		Both			$699.00	$419.40	Medicaid			$109.80			999999999	$109.78	$419.40	Fee schedule
HC ED EMERGENT LEVEL IV FACILITY	99284		Both			$867.00	$520.20	Medicare			$493.00			999999999	$109.78	$520.20	Per diem
HP EMERGENCY DEPT VISIT LEVEL 4 PROFESSIONAL FEE	99284		Both			$699.00	$419.40	Medicare			$397.68			999999999	$109.78	$419.40	Per diem
HC ED EMERGENT LEVEL V	99285		Both			$1,224.00	$734.40	AETNA			$160.95			999999999	$159.76	$734.40	Fee schedule
HC ED EMERGENT LEVEL V	99285		Both			$1,224.00	$734.40	BCBS			$228.72			999999999	$159.76	$734.40	Fee schedule
HC ED EMERGENT LEVEL V	99285		Both			$1,224.00	$734.40	HEALTHCHOICE			$284.41			999999999	$159.76	$734.40	Fee schedule
HC ED EMERGENT LEVEL V	99285		Both			$1,224.00	$734.40	Medicaid			$159.76			999999999	$159.76	$734.40	Fee schedule
HC ED EMERGENT LEVEL V	99285		Both			$1,224.00	$734.40	Medicare			$696.00			999999999	$159.76	$734.40	Per diem
PR NURSING FACILITY CARE INIT, STGHTFWD COMPLEXITY	99304		Both			$200.00	$120.00	AETNA			$85.80			999999999	$72.02	$120.00	Fee schedule
PR NURSING FACILITY CARE INIT, STGHTFWD COMPLEXITY	99304		Both			$200.00	$120.00	BCBS			$117.71			999999999	$72.02	$120.00	Fee schedule
PR NURSING FACILITY CARE INIT, STGHTFWD COMPLEXITY	99304		Both			$200.00	$120.00	HEALTHCHOICE			$105.85			999999999	$72.02	$120.00	Fee schedule
PR NURSING FACILITY CARE INIT, STGHTFWD COMPLEXITY	99304		Both			$200.00	$120.00	Medicaid			$72.02			999999999	$72.02	$120.00	Fee schedule
PR NURSING FACILITY CARE INIT, STGHTFWD COMPLEXITY	99304		Both			$200.00	$120.00	Medicare			$113.68			999999999	$72.02	$120.00	Per diem
PR NURSING FAC CARE SUBSEQ, LVL I	99307		Both			$90.00	$54.00	AETNA			$40.84			999999999	$35.31	$56.94	Fee schedule
PR NURSING FAC CARE SUBSEQ, LVL I	99307		Both			$90.00	$54.00	BCBS			$56.94			999999999	$35.31	$56.94	Fee schedule
PR NURSING FAC CARE SUBSEQ, LVL I	99307		Both			$90.00	$54.00	HEALTHCHOICE			$51.29			999999999	$35.31	$56.94	Fee schedule
PR NURSING FAC CARE SUBSEQ, LVL I	99307		Both			$90.00	$54.00	Medicaid			$35.31			999999999	$35.31	$56.94	Fee schedule
PR NURSING FAC CARE SUBSEQ, LVL I	99307		Both			$90.00	$54.00	Medicare			$51.41			999999999	$35.31	$56.94	Per diem
PR NURSING FAC DISCHRGE DAY,1-30 MIN	99315		Both			$149.00	$89.40	AETNA			$67.10			999999999	$67.10	$93.31	Fee schedule
PR NURSING FAC DISCHRGE DAY,1-30 MIN	99315		Both			$149.00	$89.40	BCBS			$93.31			999999999	$67.10	$93.31	Fee schedule
PR NURSING FAC DISCHRGE DAY,1-30 MIN	99315		Both			$149.00	$89.40	HEALTHCHOICE			$85.68			999999999	$67.10	$93.31	Fee schedule
PR NURSING FAC DISCHRGE DAY,1-30 MIN	99315		Both			$149.00	$89.40	Medicaid			$72.90			999999999	$67.10	$93.31	Fee schedule
PR NURSING FAC DISCHRGE DAY,1-30 MIN	99315		Both			$149.00	$89.40	Medicare			$84.46			999999999	$67.10	$93.31	Per diem
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY	99347		Both			$116.00	$69.60	AETNA			$87.23			999999999	$0.00	$122.02	Fee schedule
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY	99347		Both			$116.00	$69.60	BCBS			$122.02			999999999	$0.00	$122.02	Fee schedule
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY	99347		Both			$116.00	$69.60	HEALTHCHOICE			$111.64			999999999	$0.00	$122.02	Fee schedule
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY	99347		Both			$116.00	$69.60	Medicaid			$0.00			999999999	$0.00	$122.02	Fee schedule
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY	99347		Both			$116.00	$69.60	Medicare			$65.77			999999999	$0.00	$122.02	Per diem
PR PREVENTIVE VISIT,NEW,INFANT	99381		Both			$207.00	$124.20	AETNA			$88.88			999999999	$88.88	$139.24	Fee schedule
PR PREVENTIVE VISIT,NEW,INFANT	99381		Both			$207.00	$124.20	BCBS			$139.24			999999999	$88.88	$139.24	Fee schedule
PR PREVENTIVE VISIT,NEW,INFANT	99381		Both			$207.00	$124.20	HEALTHCHOICE			$136.39			999999999	$88.88	$139.24	Fee schedule
PR PREVENTIVE VISIT,NEW,INFANT	99381		Both			$207.00	$124.20	Medicaid			$95.95			999999999	$88.88	$139.24	Fee schedule
PR PREVENTIVE VISIT,NEW,INFANT	99381		Both			$207.00	$124.20	Medicare			$117.54			999999999	$88.88	$139.24	Per diem
PR PREVENTIVE VISIT, NEW, AGE 5-11	99383		Both			$222.00	$133.20	AETNA			$96.67			999999999	$96.67	$151.68	Fee schedule
PR PREVENTIVE VISIT, NEW, AGE 5-11	99383		Both			$222.00	$133.20	BCBS			$151.68			999999999	$96.67	$151.68	Fee schedule
PR PREVENTIVE VISIT, NEW, AGE 5-11	99383		Both			$222.00	$133.20	HEALTHCHOICE			$115.20			999999999	$96.67	$151.68	Fee schedule
PR PREVENTIVE VISIT, NEW, AGE 5-11	99383		Both			$222.00	$133.20	Medicaid			$104.26			999999999	$96.67	$151.68	Fee schedule
PR PREVENTIVE VISIT, NEW, AGE 5-11	99383		Both			$222.00	$133.20	Medicare			$126.10			999999999	$96.67	$151.68	Per diem
INITIAL PREVENTIVE MED EVAL 18-39 AGE	99385		Both			$0.00	$0.00	AETNA			$106.22			999999999	$0.00	$167.00	Fee schedule
INITIAL PREVENTIVE MED EVAL 18-39 AGE	99385		Both			$0.00	$0.00	BCBS			$167.00			999999999	$0.00	$167.00	Fee schedule
INITIAL PREVENTIVE MED EVAL 18-39 AGE	99385		Both			$0.00	$0.00	HEALTHCHOICE			$124.93			999999999	$0.00	$167.00	Fee schedule
INITIAL PREVENTIVE MED EVAL 18-39 AGE	99385		Both			$0.00	$0.00	Medicaid			$114.28			999999999	$0.00	$167.00	Fee schedule
INITIAL PREVENTIVE MED EVAL 18-39 AGE	99385		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$167.00	Per diem
INITIAL PREVENTIVE MED EVAL 40-64 AGE	99386		Both			$0.00	$0.00	AETNA			$123.29			999999999	$0.00	$193.79	Fee schedule
INITIAL PREVENTIVE MED EVAL 40-64 AGE	99386		Both			$0.00	$0.00	BCBS			$193.79			999999999	$0.00	$193.79	Fee schedule
INITIAL PREVENTIVE MED EVAL 40-64 AGE	99386		Both			$0.00	$0.00	HEALTHCHOICE			$147.24			999999999	$0.00	$193.79	Fee schedule
INITIAL PREVENTIVE MED EVAL 40-64 AGE	99386		Both			$0.00	$0.00	Medicaid			$132.01			999999999	$0.00	$193.79	Fee schedule
INITIAL PREVENTIVE MED EVAL 40-64 AGE	99386		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$193.79	Per diem
PR PREVENTIVE VISIT,EST,INFANT	99391		Both			$171.00	$102.60	AETNA			$79.90			999999999	$79.90	$103.43	Fee schedule
PR PREVENTIVE VISIT,EST,INFANT	99391		Both			$171.00	$102.60	BCBS			$94.93			999999999	$79.90	$103.43	Fee schedule
PR PREVENTIVE VISIT,EST,INFANT	99391		Both			$171.00	$102.60	HEALTHCHOICE			$103.43			999999999	$79.90	$103.43	Fee schedule
PR PREVENTIVE VISIT,EST,INFANT	99391		Both			$171.00	$102.60	Medicaid			$86.26			999999999	$79.90	$103.43	Fee schedule
PR PREVENTIVE VISIT,EST,INFANT	99391		Both			$171.00	$102.60	Medicare			$97.44			999999999	$79.90	$103.43	Per diem
PR PREVENTIVE VISIT,EST,AGE 1-4	99392		Both			$196.00	$117.60	AETNA			$85.55			999999999	$85.55	$133.98	Fee schedule
PR PREVENTIVE VISIT,EST,AGE 1-4	99392		Both			$196.00	$117.60	BCBS			$133.98			999999999	$85.55	$133.98	Fee schedule
PR PREVENTIVE VISIT,EST,AGE 1-4	99392		Both			$196.00	$117.60	HEALTHCHOICE			$92.48			999999999	$85.55	$133.98	Fee schedule
PR PREVENTIVE VISIT,EST,AGE 1-4	99392		Both			$196.00	$117.60	Medicaid			$92.29			999999999	$85.55	$133.98	Fee schedule
PR PREVENTIVE VISIT,EST,AGE 1-4	99392		Both			$196.00	$117.60	Medicare			$111.45			999999999	$85.55	$133.98	Per diem
PR PREVENTIVE VISIT,EST,AGE5-11	99393		Both			$194.00	$116.40	AETNA			$85.29			999999999	$85.29	$133.50	Fee schedule
PR PREVENTIVE VISIT,EST,AGE5-11	99393		Both			$194.00	$116.40	BCBS			$133.50			999999999	$85.29	$133.50	Fee schedule
PR PREVENTIVE VISIT,EST,AGE5-11	99393		Both			$194.00	$116.40	HEALTHCHOICE			$91.26			999999999	$85.29	$133.50	Fee schedule
PR PREVENTIVE VISIT,EST,AGE5-11	99393		Both			$194.00	$116.40	Medicaid			$92.01			999999999	$85.29	$133.50	Fee schedule
PR PREVENTIVE VISIT,EST,AGE5-11	99393		Both			$194.00	$116.40	Medicare			$110.23			999999999	$85.29	$133.50	Per diem
PR PREVENTIVE VISIT,EST,12-17	99394		Both			$217.00	$130.20	AETNA			$93.33			999999999	$93.33	$146.90	Fee schedule
PR PREVENTIVE VISIT,EST,12-17	99394		Both			$217.00	$130.20	BCBS			$146.90			999999999	$93.33	$146.90	Fee schedule
PR PREVENTIVE VISIT,EST,12-17	99394		Both			$217.00	$130.20	HEALTHCHOICE			$101.00			999999999	$93.33	$146.90	Fee schedule
PR PREVENTIVE VISIT,EST,12-17	99394		Both			$217.00	$130.20	Medicaid			$100.61			999999999	$93.33	$146.90	Fee schedule
PR PREVENTIVE VISIT,EST,12-17	99394		Both			$217.00	$130.20	Medicare			$123.63			999999999	$93.33	$146.90	Per diem
PR PREVENTIVE VISIT,EST,18-39	99395		Both			$217.00	$130.20	AETNA			$95.34			999999999	$95.34	$150.25	Fee schedule
PR PREVENTIVE VISIT,EST,18-39	99395		Both			$217.00	$130.20	BCBS			$150.25			999999999	$95.34	$150.25	Fee schedule
PR PREVENTIVE VISIT,EST,18-39	99395		Both			$217.00	$130.20	HEALTHCHOICE			$102.22			999999999	$95.34	$150.25	Fee schedule
PR PREVENTIVE VISIT,EST,18-39	99395		Both			$217.00	$130.20	Medicaid			$103.61			999999999	$95.34	$150.25	Fee schedule
PR PREVENTIVE VISIT,EST,18-39	99395		Both			$217.00	$130.20	Medicare			$123.63			999999999	$95.34	$150.25	Per diem
PR PREVENTIVE VISIT,EST,40-64	99396		Both			$238.00	$142.80	AETNA			$101.81			999999999	$101.81	$160.78	Fee schedule
PR PREVENTIVE VISIT,EST,40-64	99396		Both			$238.00	$142.80	BCBS			$160.78			999999999	$101.81	$160.78	Fee schedule
PR PREVENTIVE VISIT,EST,40-64	99396		Both			$238.00	$142.80	HEALTHCHOICE			$112.76			999999999	$101.81	$160.78	Fee schedule
PR PREVENTIVE VISIT,EST,40-64	99396		Both			$238.00	$142.80	Medicaid			$109.45			999999999	$101.81	$160.78	Fee schedule
PR PREVENTIVE VISIT,EST,40-64	99396		Both			$238.00	$142.80	Medicare			$135.20			999999999	$101.81	$160.78	Per diem
LCHG PROSTATE SPECIFIC ANTIGEN SCREEN	G0103		Both			$102.00	$61.20	AETNA			$17.70			999999999	$0.00	$61.20	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN SCREEN	G0103		Both			$102.00	$61.20	BCBS			$45.57			999999999	$0.00	$61.20	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN SCREEN	G0103		Both			$102.00	$61.20	HEALTHCHOICE			$0.00			999999999	$0.00	$61.20	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN SCREEN	G0103		Both			$102.00	$61.20	Medicaid			$17.18			999999999	$0.00	$61.20	Fee schedule
LCHG PROSTATE SPECIFIC ANTIGEN SCREEN	G0103		Both			$102.00	$61.20	Medicare			$58.17			999999999	$0.00	$61.20	Per diem
PR DIAB MANAGE TRN PER INDIV	G0108		Both			$81.00	$48.60	AETNA			$58.51			999999999	$0.00	$67.47	Fee schedule
PR DIAB MANAGE TRN PER INDIV	G0108		Both			$81.00	$48.60	BCBS			$67.47			999999999	$0.00	$67.47	Fee schedule
PR DIAB MANAGE TRN PER INDIV	G0108		Both			$81.00	$48.60	HEALTHCHOICE			$0.00			999999999	$0.00	$67.47	Fee schedule
PR DIAB MANAGE TRN PER INDIV	G0108		Both			$81.00	$48.60	Medicaid			$48.68			999999999	$0.00	$67.47	Fee schedule
PR DIAB MANAGE TRN PER INDIV	G0108		Both			$81.00	$48.60	Medicare			$45.82			999999999	$0.00	$67.47	Per diem
HC ELEC STIM UNATTENDED NON WOUND PT	G0283		Both			$64.00	$38.40	AETNA			$8.74			999999999	$0.00	$77.05	Fee schedule
HC ELEC STIM UNATTENDED NON WOUND PT	G0283		Both			$64.00	$38.40	BCBS			$77.05			999999999	$0.00	$77.05	Fee schedule
HC ELEC STIM UNATTENDED NON WOUND PT	G0283		Both			$64.00	$38.40	HEALTHCHOICE			$0.00			999999999	$0.00	$77.05	Fee schedule
HC ELEC STIM UNATTENDED NON WOUND PT	G0283		Both			$64.00	$38.40	Medicaid			$0.00			999999999	$0.00	$77.05	Fee schedule
HC ELEC STIM UNATTENDED NON WOUND PT	G0283		Both			$64.00	$38.40	Medicare			$36.54			999999999	$0.00	$77.05	Per diem
HC RB OBSERVATION PER HR	G0378		Both			$36.00	$21.60	AETNA			$45.30			999999999	$0.00	$73.57	Fee schedule
HC RB OBSERVATION PER HR	G0378		Both			$36.00	$21.60	BCBS			$73.57			999999999	$0.00	$73.57	Fee schedule
HC RB OBSERVATION PER HR	G0378		Both			$36.00	$21.60	HEALTHCHOICE			$0.00			999999999	$0.00	$73.57	Fee schedule
HC RB OBSERVATION PER HR	G0378		Both			$36.00	$21.60	Medicaid			$0.00			999999999	$0.00	$73.57	Fee schedule
HC RB OBSERVATION PER HR	G0378		Both			$36.00	$21.60	Medicare			$20.30			999999999	$0.00	$73.57	Per diem
HC PULM REHAB W/ EXER ONE HR FOR COPD	G0424		Both			$283.00	$169.80	AETNA			$33.30			999999999	$0.00	$409.54	Fee schedule
HC PULM REHAB W/ EXER ONE HR FOR COPD	G0424		Both			$283.00	$169.80	BCBS			$409.54			999999999	$0.00	$409.54	Fee schedule
HC PULM REHAB W/ EXER ONE HR FOR COPD	G0424		Both			$283.00	$169.80	HEALTHCHOICE			$0.00			999999999	$0.00	$409.54	Fee schedule
HC PULM REHAB W/ EXER ONE HR FOR COPD	G0424		Both			$283.00	$169.80	Medicaid			$0.00			999999999	$0.00	$409.54	Fee schedule
HC PULM REHAB W/ EXER ONE HR FOR COPD	G0424		Both			$283.00	$169.80	Medicare			$161.14			999999999	$0.00	$409.54	Per diem
PR ANNUAL WELLNESS VST; PPS SUBSQT VST	G0439		Both			$257.00	$154.20	AETNA			$123.65			999999999	$0.00	$154.20	Fee schedule
PR ANNUAL WELLNESS VST; PPS SUBSQT VST	G0439		Both			$257.00	$154.20	BCBS			$0.00			999999999	$0.00	$154.20	Fee schedule
PR ANNUAL WELLNESS VST; PPS SUBSQT VST	G0439		Both			$257.00	$154.20	HEALTHCHOICE			$0.00			999999999	$0.00	$154.20	Fee schedule
PR ANNUAL WELLNESS VST; PPS SUBSQT VST	G0439		Both			$257.00	$154.20	Medicaid			$0.00			999999999	$0.00	$154.20	Fee schedule
PR ANNUAL WELLNESS VST; PPS SUBSQT VST	G0439		Both			$257.00	$154.20	Medicare			$146.16			999999999	$0.00	$154.20	Per diem
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
HC CLIN DECISION SUPPORT NDSC AUC2	G1004		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
LCHG RBC LR	P9016		Both			$585.00	$351.00	AETNA			$197.09			999999999	$0.00	$2,683.30	Fee schedule
LCHG RBC LR	P9016		Both			$585.00	$351.00	BCBS			$2,683.30			999999999	$0.00	$2,683.30	Fee schedule
LCHG RBC LR	P9016		Both			$585.00	$351.00	HEALTHCHOICE			$0.00			999999999	$0.00	$2,683.30	Fee schedule
LCHG RBC LR	P9016		Both			$585.00	$351.00	Medicaid			$136.54			999999999	$0.00	$2,683.30	Fee schedule
LCHG RBC LR	P9016		Both			$585.00	$351.00	Medicare			$332.51			999999999	$0.00	$2,683.30	Per diem
LCHG PLATELET PHERESIS LR	P9035		Both			$2,303.00	$1,381.80	AETNA			$424.17			999999999	$0.00	$2,683.30	Fee schedule
LCHG PLATELET PHERESIS LR	P9035		Both			$2,303.00	$1,381.80	BCBS			$2,683.30			999999999	$0.00	$2,683.30	Fee schedule
LCHG PLATELET PHERESIS LR	P9035		Both			$2,303.00	$1,381.80	HEALTHCHOICE			$0.00			999999999	$0.00	$2,683.30	Fee schedule
LCHG PLATELET PHERESIS LR	P9035		Both			$2,303.00	$1,381.80	Medicaid			$389.81			999999999	$0.00	$2,683.30	Fee schedule
LCHG PLATELET PHERESIS LR	P9035		Both			$2,303.00	$1,381.80	Medicare			$1,309.59			999999999	$0.00	$2,683.30	Per diem
HC INSERT BLADDER CATH FOR SPECIMEN	P9612		Both			$64.00	$38.40	AETNA			$2.10			999999999	$0.00	$38.40	Fee schedule
HC INSERT BLADDER CATH FOR SPECIMEN	P9612		Both			$64.00	$38.40	BCBS			$0.00			999999999	$0.00	$38.40	Fee schedule
HC INSERT BLADDER CATH FOR SPECIMEN	P9612		Both			$64.00	$38.40	HEALTHCHOICE			$0.00			999999999	$0.00	$38.40	Fee schedule
HC INSERT BLADDER CATH FOR SPECIMEN	P9612		Both			$64.00	$38.40	Medicaid			$7.85			999999999	$0.00	$38.40	Fee schedule
HC INSERT BLADDER CATH FOR SPECIMEN	P9612		Both			$64.00	$38.40	Medicare			$36.54			999999999	$0.00	$38.40	Per diem
PR TELEHEALTH FACILITY FEE	Q3014		Both			$27.00	$16.20	AETNA			$26.65			999999999	$0.00	$26.65	Fee schedule
PR TELEHEALTH FACILITY FEE	Q3014		Both			$27.00	$16.20	BCBS			$20.00			999999999	$0.00	$26.65	Fee schedule
PR TELEHEALTH FACILITY FEE	Q3014		Both			$27.00	$16.20	HEALTHCHOICE			$0.00			999999999	$0.00	$26.65	Fee schedule
PR TELEHEALTH FACILITY FEE	Q3014		Both			$27.00	$16.20	Medicaid			$0.00			999999999	$0.00	$26.65	Fee schedule
PR TELEHEALTH FACILITY FEE	Q3014		Both			$27.00	$16.20	Medicare			$15.23			999999999	$0.00	$26.65	Per diem
HC EPIFIX PER SQ CM	Q4186		Both			$594.00	$356.40	AETNA			$93.67			999999999	$0.00	$356.40	Fee schedule
HC EPIFIX PER SQ CM	Q4186		Both			$594.00	$356.40	BCBS			$0.00			999999999	$0.00	$356.40	Fee schedule
HC EPIFIX PER SQ CM	Q4186		Both			$594.00	$356.40	HEALTHCHOICE			$0.00			999999999	$0.00	$356.40	Fee schedule
HC EPIFIX PER SQ CM	Q4186		Both			$594.00	$356.40	Medicaid			$143.68			999999999	$0.00	$356.40	Fee schedule
HC EPIFIX PER SQ CM	Q4186		Both			$594.00	$356.40	Medicare			$337.54			999999999	$0.00	$356.40	Per diem
IMPLT LENS TECNIS SILICON	V2632		Both			$434.00	$260.40	AETNA			$106.85			999999999	$0.00	$260.40	Fee schedule
IMPLT LENS TECNIS SILICON	V2632		Both			$434.00	$260.40	BCBS			$0.00			999999999	$0.00	$260.40	Fee schedule
IMPLT LENS TECNIS SILICON	V2632		Both			$434.00	$260.40	HEALTHCHOICE			$0.00			999999999	$0.00	$260.40	Fee schedule
IMPLT LENS TECNIS SILICON	V2632		Both			$434.00	$260.40	Medicaid			$0.00			999999999	$0.00	$260.40	Fee schedule
IMPLT LENS TECNIS SILICON	V2632		Both			$434.00	$260.40	Medicare			$246.65			999999999	$0.00	$260.40	Per diem
DRG 216	0		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 460	0		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 470	0		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 473	0		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 743	0		Both			$0.00	$0.00	AETNA			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 216	0		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 460	0		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 470	0		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 473	0		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 743	0		Both			$0.00	$0.00	BCBS			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 216	0		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 460	0		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 470	0		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 473	0		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 743	0		Both			$0.00	$0.00	HEALTHCHOICE			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 216	0		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 460	0		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 470	0		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 473	0		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 743	0		Both			$0.00	$0.00	Medicaid			$0.00			999999999	$0.00	$0.00	Fee schedule
DRG 216	0		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
DRG 460	0		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
DRG 470	0		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
DRG 473	0		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem
DRG 743	0		Both			$0.00	$0.00	Medicare			$0.00			999999999	$0.00	$0.00	Per diem