SHOPPABLE SERVICES
	Updated as of 01/01/2026
	Keokuk County Hospital & Clinics
	Service Department	Item Description		Standard Charge		Wellmark HMO Reimbursement	Wellmark PPO Reimbursement	Aetna (Commercial)	Aetna Medicare Adv	UHC (Commercial)	UHC Medicare Adv	Midlands Choice	Private Pay	Max	Min		Item Number	CPT	Dept
THERAPY SERVICES
	PT	NEEDLE INSERTION W/OUT INJECTIONS 1-2 MU		26.00		87.40	96.06	22.10	20.02	18.20	16.38	24.96	18.20	96.06	16.38		5620560	20560	56
	PT	NEEDLE INSERTION W/OUT INJECTION 3+ MUSC		36.00		87.40	96.06	30.60	27.72	25.20	22.68	34.56	25.20	96.06	22.68		5620561	20561	56
	PT	CANALITH REPOSITIONING PROCEDURE		97.00		178.53	196.22	82.45	74.69	67.90	61.11	93.12	67.90	196.22	61.11		5600005	95992	56
	PT	APPLICATION MODALITY 1/> AREAS		10.00		87.40	96.06	8.50	7.70	7.00	6.30	9.60	7.00	96.06	6.30		5600006	97010	56
	PT	ELECTRICAL STIMULATION (UNATTENDED)		139.00		87.40	96.06	118.15	107.03	97.30	87.57	133.44	97.30	118.15	87.40		5600008	97014	56
	PT	APP OF MODALITY VASOPNEUMATIC DEVICES		26.00		87.40	96.06	22.10	20.02	18.20	16.38	24.96	18.20	96.06	16.38		5600009	97016	56
	PT	ELECTRICAL STIMULATION (MANUAL)		170.00		87.40	96.06	144.50	130.90	119.00	107.10	163.20	119.00	144.50	87.40		5600010	97032	56
	PT	IONTOPHORESIS EACH 15 MIN		83.00		87.40	96.06	70.55	63.91	58.10	52.29	79.68	58.10	96.06	52.29		5600011	97033	56
	PT	ULTRASOUND EACH 15 MIN		64.00		87.40	96.06	54.40	49.28	44.80	40.32	61.44	44.80	96.06	40.32		5600012	97035	56
	PT	ROM/STRENGTH EXERCISE EACH 15 MIN		102.00		178.53	196.22	86.70	78.54	71.40	64.26	97.92	71.40	196.22	64.26		5600013	97110	56
	PT	NEUROMUSCULAR RE-ED		93.00		178.53	196.22	79.05	71.61	65.10	58.59	89.28	65.10	196.22	58.59		5600014	97112	56
	PT	GAIT TRAINING (15 MIN)		93.00		87.40	96.06	79.05	71.61	65.10	58.59	89.28	65.10	96.06	58.59		5600015	97116	56
	PT	MANUAL THERAPY TECHNIQUES EA15 MIN		126.00		178.53	196.22	107.10	97.02	88.20	79.38	120.96	88.20	196.22	79.38		5600017	97140	56
	PT	PT EVAL LOW COMP 20 MIN		142.00		226.34	248.76	120.70	109.34	99.40	89.46	136.32	99.40	248.76	89.46		5600018	97161	56
	PT	PT EVAL MOD COMP 30 MIN		203.00		226.34	248.76	172.55	156.31	142.10	127.89	194.88	142.10	248.76	127.89		5600019	97162	56
	PT	PT EVAL HIGH COMP 45 MIN		264.00		226.34	248.76	224.40	203.28	184.80	166.32	253.44	184.80	248.76	166.32		5600020	97163	56
	PT	PT RE-EVAL EST PLAN CARE		102.00		226.34	248.76	86.70	78.54	71.40	64.26	97.92	71.40	248.76	64.26		5600021	97164	56
	PT	PT THER/ACT/TRANSFER (FUNCTIONAL)15 MN		93.00		178.53	196.22	79.05	71.61	65.10	58.59	89.28	65.10	196.22	58.59		5600023	97530	56
	PT	SELF-CARE/HOME MGT TRAINING		71.00		87.40	96.06	60.35	54.67	49.70	44.73	68.16	49.70	96.06	44.73		5600024	97535	56
	OCCUPATIONAL THERAPY	ELECTRICAL STIM (MANUAL)		85.00		87.40	96.06	72.25	65.45	59.50	53.55	81.60	59.50	96.06	53.55		5500021	97032	55
	OCCUPATIONAL THERAPY	IONTOPHORESIS EACH 15 MIN		83.00		87.40	96.06	70.55	63.91	58.10	52.29	79.68	58.10	96.06	52.29		5500022	97033	55
	OCCUPATIONAL THERAPY	CONTRAST BATH		39.00		87.40	96.06	33.15	30.03	27.30	24.57	37.44	27.30	96.06	24.57		5500023	97034	55
	OCCUPATIONAL THERAPY	ULTRA SOUND EACH 15 MIN		64.00		87.40	96.06	54.40	49.28	44.80	40.32	61.44	44.80	96.06	40.32		5500024	97035	55
	OCCUPATIONAL THERAPY	THERAPEUTIC EXERCISE 0-15 MIN		78.00		178.53	196.22	66.30	60.06	54.60	49.14	74.88	54.60	196.22	49.14		5500025	97110	55
	OCCUPATIONAL THERAPY	NEUROMUSCULAR RE-ED		71.00		178.53	196.22	60.35	54.67	49.70	44.73	68.16	49.70	196.22	44.73		5500026	97112	55
	OCCUPATIONAL THERAPY	THER INTVN COGNITIVE FUNC INIT 15 MIN		124.00		178.53	196.22	105.40	95.48	86.80	78.12	119.04	86.80	196.22	78.12		5500027	97129	55
	OCCUPATIONAL THERAPY	THER INTERV COGNITIVE FUNCTION 15 MIN		124.00		178.53	196.22	105.40	95.48	86.80	78.12	119.04	86.80	196.22	78.12		5500028	97130	55
	OCCUPATIONAL THERAPY	MANUAL THERAPY TECHNIQUES EA 15 MIN		126.00		178.53	196.22	107.10	97.02	88.20	79.38	120.96	88.20	196.22	79.38		5500029	97140	55
	OCCUPATIONAL THERAPY	OT EVAL LOW COMP 30 MIN		147.00		203.93	224.13	124.95	113.19	102.90	92.61	141.12	102.90	224.13	92.61		5500003	97165	55
	OCCUPATIONAL THERAPY	OT EVAL MOD COMP 45 MIN		210.00		203.93	224.13	178.50	161.70	147.00	132.30	201.60	147.00	224.13	132.30		5500004	97166	55
	OCCUPATIONAL THERAPY	OT EVAL HIGH COMP 60 MIN		273.00		203.93	224.13	232.05	210.21	191.10	171.99	262.08	191.10	232.05	171.99		5500005	97167	55
	OCCUPATIONAL THERAPY	RE-EVALUATION OT   30 MINUTES		191.00		203.93	224.13	162.35	147.07	133.70	120.33	183.36	133.70	224.13	120.33		5500006	97168	55
	OCCUPATIONAL THERAPY	THERAPEUTIC ACTIVITIES		71.00		178.53	196.22	60.35	54.67	49.70	44.73	68.16	49.70	196.22	44.73		5500031	97530	55
	OCCUPATIONAL THERAPY	SENSORY INTEGRATION		65.00		178.53	196.22	55.25	50.05	45.50	40.95	62.40	45.50	196.22	40.95		5500033	97533	55
	OCCUPATIONAL THERAPY	ADL FUNC MOBILITY/SAFETY 0-15 MIN		71.00		87.40	96.06	60.35	54.67	49.70	44.73	68.16	49.70	96.06	44.73		5500034	97535	55
	OCCUPATIONAL THERAPY	ORTHO/PROSTH MGT TRAINING U/L/ AND TRUNK		108.00		178.53	196.22	91.80	83.16	75.60	68.04	103.68	75.60	196.22	68.04		5500007	97763	55
	SPEECH THERAPY	TX SPEECH LANG COMM		274.00		211.40	232.34	232.90	210.98	191.80	172.62	263.04	191.80	232.90	172.62		5400001	92507	54
	SPEECH THERAPY	TX SP LANG VOICE COMMINICAJ 2/>		50.00		178.53	196.22	42.50	38.50	35.00	31.50	48.00	35.00	196.22	31.50		5400002	92508	54
	SPEECH THERAPY	EVAL SPEECH FLUENCY		291.00		211.40	232.34	247.35	224.07	203.70	183.33	279.36	203.70	247.35	183.33		5400003	92521	54
	SPEECH THERAPY	EVAL SPEECH SOUND PROD		291.00		211.40	232.34	247.35	224.07	203.70	183.33	279.36	203.70	247.35	183.33		5400004	92522	54
	SPEECH THERAPY	EVAL LANGUAGE COMP		291.00		211.40	232.34	247.35	224.07	203.70	183.33	279.36	203.70	247.35	183.33		5400005	92523	54
	SPEECH THERAPY	BEHAVIORAL & QUALITATIVE ANALYSIS		96.00		211.40	232.34	81.60	73.92	67.20	60.48	92.16	67.20	232.34	60.48		5400006	92524	54
	SPEECH THERAPY	SWALLOWING RX		226.00		178.53	196.22	192.10	174.02	158.20	142.38	216.96	158.20	196.22	142.38		5400007	92526	54
	SPEECH THERAPY	EVAL NON SPEECH DEVICE RX		453.00		211.40	232.34	385.05	348.81	317.10	285.39	434.88	317.10	385.05	211.40		5400009	92605	54
	SPEECH THERAPY	SWALLOWING EVALUATION		254.00		211.40	232.34	215.90	195.58	177.80	160.02	243.84	177.80	232.34	160.02		5400010	92610	54
	SPEECH THERAPY	SWALLOWING EVALUATION (VIDEO)		270.00		315.23	346.46	229.50	207.90	189.00	170.10	259.20	189.00	346.46	170.10		5400011	92611	54
	SPEECH THERAPY	APHASIA EVALUATION		246.00		353.33	388.33	209.10	189.42	172.20	154.98	236.16	172.20	388.33	154.98		5400012	96105	54
	SPEECH THERAPY	COGNITIVE EVAL		251.00		353.33	388.33	213.35	193.27	175.70	158.13	240.96	175.70	388.33	158.13		5400013	96125	54
	SPEECH THERAPY	ROM/STRENGTH EXERCISE		65.00		178.53	196.22	55.25	50.05	45.50	40.95	62.40	45.50	196.22	40.95		5400014	97110	54
	SPEECH THERAPY	NEUROMUSCULAR RE-ED		65.00		178.53	196.22	55.25	50.05	45.50	40.95	62.40	45.50	196.22	40.95		5400015	97112	54
	SPEECH THERAPY	COGNITIVE FUNCTION INITIAL 15 MINS		124.00		178.53	196.22	105.40	95.48	86.80	78.12	119.04	86.80	196.22	78.12		5400016	97129	54
	SPEECH THERAPY	THER INTERV COGNITIVE--15 MINS (SPEECH)		124.00		178.53	196.22	105.40	95.48	86.80	78.12	119.04	86.80	196.22	78.12		5400017	97130	54
	SPEECH THERAPY	SPEECH THERAPY ACTIVITIES (FUNCTIONAL)		65.00		178.53	196.22	55.25	50.05	45.50	40.95	62.40	45.50	196.22	40.95		5400018	97530	54
	CARDIAC REHAB	HOLTER MONITOR EXTRNL ECG 48 HR		567.00		174.80	192.11	481.95	436.59	396.90	357.21	544.32	396.90	481.95	174.80		5300001	93225	53
	CARDIAC REHAB	HOLTER MONITOR EXTRNL ECG SCANNING		623.00		174.80	192.11	529.55	479.71	436.10	392.49	598.08	436.10	529.55	174.80		5300002	93226	53
	CARDIAC REHAB	REHAB W/CONTINUOUS ECG PER SESSION		109.00		363.04	399.01	92.65	83.93	76.30	68.67	104.64	76.30	399.01	68.67		5300003	93798	53
	CARDIAC REHAB	CARDIAC REHAB PER SESSION		109.00		363.04	399.01	92.65	83.93	76.30	68.67	104.64	76.30	399.01	68.67		5300003	93798	53
CARDIAC SERVICES
	PULMONARY FUNCTION	SPIROMETRY INC GRAPHIC REC TOTAL & TIMED		305.00		210.65	231.52	259.25	234.85	213.50	192.15	292.80	213.50	259.25	192.15		5100002	94010	51
	PULMONARY FUNCTION	BRONCHODILATION RESPONSIVENESS PRE/POST		565.00		444.47	488.50	480.25	435.05	395.50	355.95	542.40	395.50	488.50	355.95		5100003	94060	51
	PULMONARY FUNCTION	VITAL CAPACITY, TOTAL SEPARATE PROCEDURE		200.00		210.65	231.52	170.00	154.00	140.00	126.00	192.00	140.00	231.52	126.00		5100004	94150	51
	PULMONARY FUNCTION	MAXIMUM BREATHING CAPACITY, MAXIMAL VOL		200.00		210.65	231.52	170.00	154.00	140.00	126.00	192.00	140.00	231.52	126.00		5100005	94200	51
	PULMONARY FUNCTION	RESPIRATORY FLOW VOLUME LOOP		485.00		444.47	488.50	412.25	373.45	339.50	305.55	465.60	339.50	488.50	305.55		5100006	94375	51
	PULMONARY FUNCTION	PULMONARY REHAB (PER SESSION)W/OUT OXIME		265.00		178.53	196.22	225.25	204.05	185.50	166.95	254.40	185.50	225.25	166.95		5100007	94625	51
	PULMONARY FUNCTION	PULMONARY REHAB (PER SESSION)WITH OXIMET		295.00		178.53	196.22	250.75	227.15	206.50	185.85	283.20	206.50	250.75	178.53		5100008	94626	51
	PULMONARY FUNCTION	NEBULIZER TREATMENT		200.00		210.65	231.52	170.00	154.00	140.00	126.00	192.00	140.00	231.52	126.00		5100010	94640	51
	PULMONARY FUNCTION	PULMONARY SERVICE		1,293.00		210.65	231.52	1,099.05	995.61	905.10	814.59	1,241.28	905.10	1,099.05	210.65		5100001	94799	51
	EKG	EKG/ECG 12 LEADS OR > TRACING ONLY		145.00		73.95	81.28	123.25	111.65	101.50	91.35	139.20	101.50	123.25	73.95		5000001	93005	50
	EKG	RHYTHM ECG 1-3 LEADS TRACING ONLY		73.00		73.95	81.28	62.05	56.21	51.10	45.99	70.08	51.10	81.28	45.99		5000002	93041	50
RADIOLOGY SERVICES
	ULTRASOUND	US EXAM OF URINARY BLADDER		345.00		268.92	295.56	293.25	265.65	241.50	217.35	331.20	241.50	295.56	217.35		4400001	51798	44
	ULTRASOUND	US THYROID/ST NECK		446.00		257.72	283.25	379.10	343.42	312.20	280.98	428.16	312.20	379.10	257.72		4400003	76536	44
	ULTRASOUND	US ABDOMEN COMPLETE		674.00		393.67	432.67	572.90	518.98	471.80	424.62	647.04	471.80	572.90	393.67		4400004	76700	44
	ULTRASOUND	US ABDOMEN SINGLE ORGAN/QUADRANT		490.00		257.72	283.25	416.50	377.30	343.00	308.70	470.40	343.00	416.50	257.72		4400005	76705	44
	ULTRASOUND	US ABDOMINAL AORTA (AAA)		490.00		257.72	283.25	416.50	377.30	343.00	308.70	470.40	343.00	416.50	257.72		4400006	76706	44
	ULTRASOUND	US RENAL		455.00		257.72	283.25	386.75	350.35	318.50	286.65	436.80	318.50	386.75	257.72		4400007	76775	44
	ULTRASOUND	US TRANSVAGINAL		524.00		257.72	283.25	445.40	403.48	366.80	330.12	503.04	366.80	445.40	257.72		4400008	76830	44
	ULTRASOUND	US PELVIS		506.00		393.67	432.67	430.10	389.62	354.20	318.78	485.76	354.20	432.67	318.78		4400009	76856	44
	ULTRASOUND	US TESTICULAR		523.00		257.72	283.25	444.55	402.71	366.10	329.49	502.08	366.10	444.55	257.72		4400010	76870	44
	ULTRASOUND	US EXTREMITY LOWER LT		294.00		257.72	283.25	249.90	226.38	205.80	185.22	282.24	205.80	283.25	185.22		4400011	76881	44
	ULTRASOUND	US EXTREMITY UPPER LT		294.00		257.72	283.25	249.90	226.38	205.80	185.22	282.24	205.80	283.25	185.22		4400011	76881	44
	ULTRASOUND	US EXTREMITY LOWER RT		294.00		257.72	283.25	249.90	226.38	205.80	185.22	282.24	205.80	283.25	185.22		4400011	76881	44
	ULTRASOUND	US EXTREMITY UPPER RT		294.00		257.72	283.25	249.90	226.38	205.80	185.22	282.24	205.80	283.25	185.22		4400011	76881	44
	ULTRASOUND	US ECHO COMPLETE		1,564.00		1,266.91	1,392.42	1,329.40	1,204.28	1,094.80	985.32	1,501.44	1,094.80	1,392.42	985.32		4400012	93306	44
	ULTRASOUND	US ECHO 2D W/WO M-MODE COMPLETE		735.00		1,266.91	1,392.42	624.75	565.95	514.50	463.05	705.60	514.50	1,392.42	463.05		4400002	93307	44
	ULTRASOUND	US ECHO LIMITED		1,564.00		1,266.91	1,392.42	1,329.40	1,204.28	1,094.80	985.32	1,501.44	1,094.80	1,392.42	985.32		4400013	93308	44
	ULTRASOUND	US CAROTID DUPLEX BILAT		915.00		393.67	432.67	777.75	704.55	640.50	576.45	878.40	640.50	777.75	393.67		4400014	93880	44
	ULTRASOUND	US PERIPH DOPPLER BILAT LOWER EXT		1,638.00		393.67	432.67	1,392.30	1,261.26	1,146.60	1,031.94	1,572.48	1,146.60	1,392.30	393.67		4400015	93925	44
	ULTRASOUND	US PERIPH DOPPLER UNILAT UPPER EXT LT		578.00		257.72	283.25	491.30	445.06	404.60	364.14	554.88	404.60	491.30	257.72		4400016	93931	44
	ULTRASOUND	US PERIPH DOPPLER UNILAT LOWER EXT RT		614.00		257.72	283.25	521.90	472.78	429.80	386.82	589.44	429.80	521.90	257.72		4400017	93971	44
	CATSCAN	CT HEAD W/O		1,507.00		833.65	916.24	1,280.95	1,160.39	1,054.90	949.41	1,446.72	1,054.90	1,280.95	833.65		4300001	70450	43
	CATSCAN	CT HEAD W/WO		1,507.00		833.65	916.24	1,280.95	1,160.39	1,054.90	949.41	1,446.72	1,054.90	1,280.95	833.65		4300001	70450	43
	CATSCAN	CT HEAD WITH		1,748.00		833.65	916.24	1,485.80	1,345.96	1,223.60	1,101.24	1,678.08	1,223.60	1,485.80	833.65		4300002	70460	43
	CATSCAN	CT ORBIT WITHOUT CONTRAST		1,766.00		312.99	344.00	1,501.10	1,359.82	1,236.20	1,112.58	1,695.36	1,236.20	1,501.10	312.99		4300003	70480	43
	CATSCAN	CT ORBIT SELLA/POST FOSSA WITH CONTRAST		1,958.00		833.65	916.24	1,664.30	1,507.66	1,370.60	1,233.54	1,879.68	1,370.60	1,664.30	833.65		4300004	70481	43
	CATSCAN	CT ORBIT SELLA/POST FOSSA W & W/O CONTR		2,978.00		833.65	916.24	2,531.30	2,293.06	2,084.60	1,876.14	2,858.88	2,084.60	2,531.30	833.65		4300005	70482	43
	CATSCAN	CT MAXILLOFACIAL(SINUS) W/O		1,635.00		312.99	344.00	1,389.75	1,258.95	1,144.50	1,030.05	1,569.60	1,144.50	1,389.75	312.99		4300006	70486	43
	CATSCAN	CT MAXILLOFACIAL (SINUS) WITH CONTRAST		1,853.00		833.65	916.24	1,575.05	1,426.81	1,297.10	1,167.39	1,778.88	1,297.10	1,575.05	833.65		4300007	70487	43
	CATSCAN	CT MAXILLOFACIAL (SINUS) WITH & W/O CONT		2,194.00		833.65	916.24	1,864.90	1,689.38	1,535.80	1,382.22	2,106.24	1,535.80	1,864.90	833.65		4300008	70488	43
	CATSCAN	CT SOFT TISSUE NECK W/O		1,616.00		312.99	344.00	1,373.60	1,244.32	1,131.20	1,018.08	1,551.36	1,131.20	1,373.60	312.99		4300009	70490	43
	CATSCAN	CT SOFT TISUE NECK WITH		1,919.00		833.65	916.24	1,631.15	1,477.63	1,343.30	1,208.97	1,842.24	1,343.30	1,631.15	833.65		4300010	70491	43
	CATSCAN	CT SOFT TISSUE NECK W W/O		2,544.00		833.65	916.24	2,162.40	1,958.88	1,780.80	1,602.72	2,442.24	1,780.80	2,162.40	833.65		4300011	70492	43
	CATSCAN	CT CHEST W/O		1,718.00		312.99	344.00	1,460.30	1,322.86	1,202.60	1,082.34	1,649.28	1,202.60	1,460.30	312.99		4300012	71250	43
	CATSCAN	CT CHEST WITH		1,931.00		833.65	916.24	1,641.35	1,486.87	1,351.70	1,216.53	1,853.76	1,351.70	1,641.35	833.65		4300013	71260	43
	CATSCAN	CT CHEST WITH AND W/O		2,529.00		833.65	916.24	2,149.65	1,947.33	1,770.30	1,593.27	2,427.84	1,770.30	2,149.65	833.65		4300014	71270	43
	CATSCAN	CT LOW DOSE LUNG CA SCR W/O CONTRAST		860.00		312.99	344.00	731.00	662.20	602.00	541.80	825.60	602.00	731.00	312.99		4300034	71271	43
	CATSCAN	CT CERVICAL SPINE		1,762.00		312.99	344.00	1,497.70	1,356.74	1,233.40	1,110.06	1,691.52	1,233.40	1,497.70	312.99		4300015	72125	43
	CATSCAN	CT CERVICAL SPINE W		2,056.00		833.65	916.24	1,747.60	1,583.12	1,439.20	1,295.28	1,973.76	1,439.20	1,747.60	833.65		4300016	72126	43
	CATSCAN	CT CERVICAL SPINE W W/O		2,520.00		833.65	916.24	2,142.00	1,940.40	1,764.00	1,587.60	2,419.20	1,764.00	2,142.00	833.65		4300017	72127	43
	CATSCAN	CT THORACIC SPINE		1,725.00		312.99	344.00	1,466.25	1,328.25	1,207.50	1,086.75	1,656.00	1,207.50	1,466.25	312.99		4300018	72128	43
	CATSCAN	CT LUMBAR SPINE		1,868.00		312.99	344.00	1,587.80	1,438.36	1,307.60	1,176.84	1,793.28	1,307.60	1,587.80	312.99		4300019	72131	43
	CATSCAN	CT PELVIS (R/O FRACTURE)		1,577.00		312.99	344.00	1,340.45	1,214.29	1,103.90	993.51	1,513.92	1,103.90	1,340.45	312.99		4300020	72192	43
	CATSCAN	CT UPPER EXT W/O LT		1,710.00		312.99	344.00	1,453.50	1,316.70	1,197.00	1,077.30	1,641.60	1,197.00	1,453.50	312.99		4300021	73200	43
	CATSCAN	CT UPPER EXT W/O RT		1,710.00		312.99	344.00	1,453.50	1,316.70	1,197.00	1,077.30	1,641.60	1,197.00	1,453.50	312.99		4300021	73200	43
	CATSCAN	CT LOWER EXT W/O LT		1,710.00		312.99	344.00	1,453.50	1,316.70	1,197.00	1,077.30	1,641.60	1,197.00	1,453.50	312.99		4300022	73700	43
	CATSCAN	CT LOWER EXT W/O RT		1,710.00		312.99	344.00	1,453.50	1,316.70	1,197.00	1,077.30	1,641.60	1,197.00	1,453.50	312.99		4300022	73700	43
	CATSCAN	CT LOWER EXT WITH LT		1,916.00		833.65	916.24	1,628.60	1,475.32	1,341.20	1,207.08	1,839.36	1,341.20	1,628.60	833.65		4300023	73701	43
	CATSCAN	CT LOWER EXT WITH RT		1,916.00		833.65	916.24	1,628.60	1,475.32	1,341.20	1,207.08	1,839.36	1,341.20	1,628.60	833.65		4300023	73701	43
	CATSCAN	CT ABD PELVIS W/O		1,615.00		833.65	916.24	1,372.75	1,243.55	1,130.50	1,017.45	1,550.40	1,130.50	1,372.75	833.65		4300024	74176	43
	CATSCAN	CT ABD PELVIS WITH		1,811.00		833.65	916.24	1,539.35	1,394.47	1,267.70	1,140.93	1,738.56	1,267.70	1,539.35	833.65		4300025	74177	43
	CATSCAN	CT ABD/PEL W W/O		2,593.00		833.65	916.24	2,204.05	1,996.61	1,815.10	1,633.59	2,489.28	1,815.10	2,204.05	833.65		4300026	74178	43
	MRI	MR TMJ W/O		1,188.00		720.11	791.44	1,009.80	914.76	831.60	748.44	1,140.48	831.60	1,009.80	720.11		4200001	70336	42
	MRI	MR ORBIT/FACE/NECK W/O		1,700.00		720.11	791.44	1,445.00	1,309.00	1,190.00	1,071.00	1,632.00	1,190.00	1,445.00	720.11		4200002	70540	42
	MRI	MR ORBIT/FACE/NECK WITH		1,751.00		992.02	1,090.29	1,488.35	1,348.27	1,225.70	1,103.13	1,680.96	1,225.70	1,488.35	992.02		4200003	70542	42
	MRI	MR ORBIT/FACE/HEAD WITH AND W/O		1,803.00		602.83	662.55	1,532.55	1,388.31	1,262.10	1,135.89	1,730.88	1,262.10	1,532.55	602.83		4200004	70543	42
	MRI	MRA HEAD W/O		983.00		602.83	662.55	835.55	756.91	688.10	619.29	943.68	688.10	835.55	602.83		4200005	70544	42
	MRI	MRA HEAD WITH		1,034.00		602.83	662.55	878.90	796.18	723.80	651.42	992.64	723.80	878.90	602.83		4200006	70545	42
	MRI	MRA HEAD WITH AND W/O		1,293.00		602.83	662.55	1,099.05	995.61	905.10	814.59	1,241.28	905.10	1,099.05	602.83		4200007	70546	42
	MRI	MRA NECK W/O		983.00		602.83	662.55	835.55	756.91	688.10	619.29	943.68	688.10	835.55	602.83		4200008	70547	42
	MRI	MRA NECK WITH		1,034.00		602.83	662.55	878.90	796.18	723.80	651.42	992.64	723.80	878.90	602.83		4200009	70548	42
	MRI	MRA NECK WITH AND W/O		1,293.00		602.83	662.55	1,099.05	995.61	905.10	814.59	1,241.28	905.10	1,099.05	602.83		4200010	70549	42
	MRI	MR BRAIN W/O		1,197.00		720.11	791.44	1,017.45	921.69	837.90	754.11	1,149.12	837.90	1,017.45	720.11		4200011	70551	42
	MRI	MR BRAIN WITH		1,630.00		992.02	1,090.29	1,385.50	1,255.10	1,141.00	1,026.90	1,564.80	1,141.00	1,385.50	992.02		4200012	70552	42
	MRI	MR BRAIN WITH AND W/O		1,921.00		992.02	1,090.29	1,632.85	1,479.17	1,344.70	1,210.23	1,844.16	1,344.70	1,632.85	992.02		4200013	70553	42
	MRI	MR CHEST W/O		886.00		720.11	791.44	753.10	682.22	620.20	558.18	850.56	620.20	791.44	558.18		4200014	71550	42
	MRI	MR CHEST WITH		938.00		992.02	1,090.29	797.30	722.26	656.60	590.94	900.48	656.60	1,090.29	590.94		4200015	71551	42
	MRI	MRI CHEST W CONTRAST		938.00		992.02	1,090.29	797.30	722.26	656.60	590.94	900.48	656.60	1,090.29	590.94		4200015	71551	42
	MRI	MR CHEST WITH AND W/O		1,172.00		992.02	1,090.29	996.20	902.44	820.40	738.36	1,125.12	820.40	1,090.29	738.36		4200016	71552	42
	MRI	MRA CHEST W/WO CONTRAST		1,133.00		602.83	662.55	963.05	872.41	793.10	713.79	1,087.68	793.10	963.05	602.83		4200017	71555	42
	MRI	MR CERVICAL W/O		1,190.00		720.11	791.44	1,011.50	916.30	833.00	749.70	1,142.40	833.00	1,011.50	720.11		4200018	72141	42
	MRI	MR CERVICAL WITH		1,241.00		992.02	1,090.29	1,054.85	955.57	868.70	781.83	1,191.36	868.70	1,090.29	781.83		4200019	72142	42
	MRI	MR THORACIC W/O		1,190.00		720.11	791.44	1,011.50	916.30	833.00	749.70	1,142.40	833.00	1,011.50	720.11		4200020	72146	42
	MRI	MR THORACIC WITH		1,241.00		992.02	1,090.29	1,054.85	955.57	868.70	781.83	1,191.36	868.70	1,090.29	781.83		4200021	72147	42
	MRI	MR LUMBAR W/O		1,190.00		720.11	791.44	1,011.50	916.30	833.00	749.70	1,142.40	833.00	1,011.50	720.11		4200022	72148	42
	MRI	MR LUMBAR WITH		1,241.00		992.02	1,090.29	1,054.85	955.57	868.70	781.83	1,191.36	868.70	1,090.29	781.83		4200023	72149	42
	MRI	MR CERVICAL WITH AND W/O		1,253.00		992.02	1,090.29	1,065.05	964.81	877.10	789.39	1,202.88	877.10	1,090.29	789.39		4200024	72156	42
	MRI	MR THORACIC W W/O		1,253.00		992.02	1,090.29	1,065.05	964.81	877.10	789.39	1,202.88	877.10	1,090.29	789.39		4200025	72157	42
	MRI	MR LUMBAR W W/O		1,253.00		992.02	1,090.29	1,065.05	964.81	877.10	789.39	1,202.88	877.10	1,090.29	789.39		4200026	72158	42
	MRI	MR PELVIS W/O		1,246.00		720.11	791.44	1,059.10	959.42	872.20	784.98	1,196.16	872.20	1,059.10	720.11		4200027	72195	42
	MRI	MR PELVIS WITH		1,298.00		992.02	1,090.29	1,103.30	999.46	908.60	817.74	1,246.08	908.60	1,103.30	817.74		4200028	72196	42
	MRI	MR PELVIS WITH AND W/O		1,622.00		992.02	1,090.29	1,378.70	1,248.94	1,135.40	1,021.86	1,557.12	1,135.40	1,378.70	992.02		4200029	72197	42
	MRI	MRA PELVIS W/WO CONTRAST		1,494.00		602.83	662.55	1,269.90	1,150.38	1,045.80	941.22	1,434.24	1,045.80	1,269.90	602.83		4200030	72198	42
	MRI	MR UPPER EXT OTHER THAN JOINT W/O RT		1,700.00		720.11	791.44	1,445.00	1,309.00	1,190.00	1,071.00	1,632.00	1,190.00	1,445.00	720.11		4200031	73218	42
	MRI	MR UPPER EXT OTHER THAN JOINT W/O LT		1,700.00		720.11	791.44	1,445.00	1,309.00	1,190.00	1,071.00	1,632.00	1,190.00	1,445.00	720.11		4200031	73218	42
	MRI	MR UPPER EXT OTHER THAN JOINT WITH RT		1,751.00		992.02	1,090.29	1,488.35	1,348.27	1,225.70	1,103.13	1,680.96	1,225.70	1,488.35	992.02		4200032	73219	42
	MRI	MR UPPER EXT OTHER THAN JOINT WITH LT		1,751.00		992.02	1,090.29	1,488.35	1,348.27	1,225.70	1,103.13	1,680.96	1,225.70	1,488.35	992.02		4200032	73219	42
	MRI	MR UPPER EXT OTHER THAN JOINT W W/O LT		2,500.00		992.02	1,090.29	2,125.00	1,925.00	1,750.00	1,575.00	2,400.00	1,750.00	2,125.00	992.02		4200033	73220	42
	MRI	MR UPPER EXT OTHER THAN JOINT W W/O RT		2,500.00		992.02	1,090.29	2,125.00	1,925.00	1,750.00	1,575.00	2,400.00	1,750.00	2,125.00	992.02		4200033	73220	42
	MRI	MR ANY JOINT UPPER EXT W/O LT		1,244.00		720.11	791.44	1,057.40	957.88	870.80	783.72	1,194.24	870.80	1,057.40	720.11		4200034	73221	42
	MRI	MR ANY JOINT UPPER EXT W/O RT		1,244.00		720.11	791.44	1,057.40	957.88	870.80	783.72	1,194.24	870.80	1,057.40	720.11		4200034	73221	42
	MRI	MR ANY JOINT UPPER EXT WITH LT		1,295.00		992.02	1,090.29	1,100.75	997.15	906.50	815.85	1,243.20	906.50	1,100.75	815.85		4200035	73222	42
	MRI	MR ANY JOINT UPPER EXT WITH RT		1,295.00		992.02	1,090.29	1,100.75	997.15	906.50	815.85	1,243.20	906.50	1,100.75	815.85		4200035	73222	42
	MRI	MR ANY JOINT UPPER EXT W W/O LT		1,618.00		992.02	1,090.29	1,375.30	1,245.86	1,132.60	1,019.34	1,553.28	1,132.60	1,375.30	992.02		4200036	73223	42
	MRI	MR ANY JOINT UPPER EXT W W/O RT		1,618.00		992.02	1,090.29	1,375.30	1,245.86	1,132.60	1,019.34	1,553.28	1,132.60	1,375.30	992.02		4200036	73223	42
	MRI	MRA UPPER EXT W/WO CONTRAST LT		1,494.00		602.83	662.55	1,269.90	1,150.38	1,045.80	941.22	1,434.24	1,045.80	1,269.90	602.83		4200037	73225	42
	MRI	MRA UPPER EXT W/WO CONTRAST RT		1,494.00		602.83	662.55	1,269.90	1,150.38	1,045.80	941.22	1,434.24	1,045.80	1,269.90	602.83		4200037	73225	42
	MRI	MR LOWER EXT OTHER THAN JOINT W/O LT		1,700.00		720.11	791.44	1,445.00	1,309.00	1,190.00	1,071.00	1,632.00	1,190.00	1,445.00	720.11		4200038	73718	42
	MRI	MR LOWER EXT OTHER THAN JOINT W/O RT		1,700.00		720.11	791.44	1,445.00	1,309.00	1,190.00	1,071.00	1,632.00	1,190.00	1,445.00	720.11		4200038	73718	42
	MRI	MR LOWER EXT OTHER THAN JOINT WITH LT		1,751.00		992.02	1,090.29	1,488.35	1,348.27	1,225.70	1,103.13	1,680.96	1,225.70	1,488.35	992.02		4200039	73719	42
	MRI	MR LOWER EXT OTHER THAN JOINT WITH RT		1,751.00		992.02	1,090.29	1,488.35	1,348.27	1,225.70	1,103.13	1,680.96	1,225.70	1,488.35	992.02		4200039	73719	42
	MRI	MR LOWER EXT OTHER THAN JOINT W W/O RT		2,500.00		992.02	1,090.29	2,125.00	1,925.00	1,750.00	1,575.00	2,400.00	1,750.00	2,125.00	992.02		4200040	73720	42
	MRI	MR LOWER EXT OTHER THAN JOINT W W/O LT		2,500.00		992.02	1,090.29	2,125.00	1,925.00	1,750.00	1,575.00	2,400.00	1,750.00	2,125.00	992.02		4200040	73720	42
	MRI	MR ANY JOINT LOWER EXT W/O RT		1,246.00		720.11	791.44	1,059.10	959.42	872.20	784.98	1,196.16	872.20	1,059.10	720.11		4200041	73721	42
	MRI	MR ANY JOINT LOWER EXT W/O LT		1,246.00		720.11	791.44	1,059.10	959.42	872.20	784.98	1,196.16	872.20	1,059.10	720.11		4200041	73721	42
	MRI	MR ANY JOINT LOWER EXT WITH LT		1,298.00		992.02	1,090.29	1,103.30	999.46	908.60	817.74	1,246.08	908.60	1,103.30	817.74		4200042	73722	42
	MRI	MR ANY JOINT LOWER EXT WITH RT		1,298.00		992.02	1,090.29	1,103.30	999.46	908.60	817.74	1,246.08	908.60	1,103.30	817.74		4200042	73722	42
	MRI	MR ANY JOINT LOWER EXT W W/O LT		1,622.00		992.02	1,090.29	1,378.70	1,248.94	1,135.40	1,021.86	1,557.12	1,135.40	1,378.70	992.02		4200043	73723	42
	MRI	MR ANY JOINT LOWER EXT W W/O RT		1,622.00		992.02	1,090.29	1,378.70	1,248.94	1,135.40	1,021.86	1,557.12	1,135.40	1,378.70	992.02		4200043	73723	42
	MRI	MRA LOWER EXT W/WO CONTRAST LT		1,494.00		602.83	662.55	1,269.90	1,150.38	1,045.80	941.22	1,434.24	1,045.80	1,269.90	602.83		4200044	73725	42
	MRI	MRA LOWER EXT W/WO CONTRAST RT		1,494.00		602.83	662.55	1,269.90	1,150.38	1,045.80	941.22	1,434.24	1,045.80	1,269.90	602.83		4200044	73725	42
	MRI	MR ABDOMEN W/O		1,271.00		720.11	791.44	1,080.35	978.67	889.70	800.73	1,220.16	889.70	1,080.35	720.11		4200045	74181	42
	MRI	MR ABDOMEN WITH		1,322.00		992.02	1,090.29	1,123.70	1,017.94	925.40	832.86	1,269.12	925.40	1,123.70	832.86		4200046	74182	42
	MRI	MR ABDOMEN W W/O		1,653.00		992.02	1,090.29	1,405.05	1,272.81	1,157.10	1,041.39	1,586.88	1,157.10	1,405.05	992.02		4200047	74183	42
	MRI	MRA ABD W/WO CONTRAST		1,860.00		602.83	662.55	1,581.00	1,432.20	1,302.00	1,171.80	1,785.60	1,302.00	1,581.00	602.83		4200048	74185	42
	MAMMOGRAPHY	MAMMOGRAPHY UNILATERAL		242.00		205.43	225.78	205.70	186.34	169.40	152.46	232.32	169.40	225.78	152.46		4100001	77065	41
	MAMMOGRAPHY	MAMMOGRAPHY BILATERAL		263.00		205.43	225.78	223.55	202.51	184.10	165.69	252.48	184.10	225.78	165.69		4100002	77067	41
	RADIOLOGY	XR ORBITS		141.00		127.74	140.39	119.85	108.57	98.70	88.83	135.36	98.70	140.39	88.83		4000001	70030	40
	RADIOLOGY	XR MANDIBLE LT		299.00		127.74	140.39	254.15	230.23	209.30	188.37	287.04	209.30	254.15	127.74		4000002	70100	40
	RADIOLOGY	XR MANDIBLE RT		299.00		127.74	140.39	254.15	230.23	209.30	188.37	287.04	209.30	254.15	127.74		4000002	70100	40
	RADIOLOGY	XR FACIAL BONES		325.00		127.74	140.39	276.25	250.25	227.50	204.75	312.00	227.50	276.25	127.74		4000003	70150	40
	RADIOLOGY	XR NASAL BONES		253.00		127.74	140.39	215.05	194.81	177.10	159.39	242.88	177.10	215.05	127.74		4000004	70160	40
	RADIOLOGY	XR SINUS		285.00		127.74	140.39	242.25	219.45	199.50	179.55	273.60	199.50	242.25	127.74		4000005	70220	40
	RADIOLOGY	XR SKULL (PRE-MRI)		141.00		127.74	140.39	119.85	108.57	98.70	88.83	135.36	98.70	140.39	88.83		4000006	70250	40
	RADIOLOGY	XR SKULL		440.00		127.74	140.39	374.00	338.80	308.00	277.20	422.40	308.00	374.00	127.74		4000007	70260	40
	RADIOLOGY	XR TMJ		83.00		127.74	140.39	70.55	63.91	58.10	52.29	79.68	58.10	140.39	52.29		4000008	70330	40
	RADIOLOGY	XR NECK-SOFT TISSUE		229.00		127.74	140.39	194.65	176.33	160.30	144.27	219.84	160.30	194.65	127.74		4000009	70360	40
	RADIOLOGY	XR CHEST PORTABLE		137.00		127.74	140.39	116.45	105.49	95.90	86.31	131.52	95.90	140.39	86.31		4000010	71045	40
	RADIOLOGY	XR CHEST PA/LAT		201.00		127.74	140.39	170.85	154.77	140.70	126.63	192.96	140.70	170.85	126.63		4000011	71046	40
	RADIOLOGY	XR CHEST APICAL LORDOTIC		356.00		127.74	140.39	302.60	274.12	249.20	224.28	341.76	249.20	302.60	127.74		4000012	71047	40
	RADIOLOGY	XR RIBS UNILAT RT		225.00		127.74	140.39	191.25	173.25	157.50	141.75	216.00	157.50	191.25	127.74		4000013	71100	40
	RADIOLOGY	XR RIBS UNILAT LT		225.00		127.74	140.39	191.25	173.25	157.50	141.75	216.00	157.50	191.25	127.74		4000013	71100	40
	RADIOLOGY	XR CHEST PA W/RIBS LT		232.00		127.74	140.39	197.20	178.64	162.40	146.16	222.72	162.40	197.20	127.74		4000014	71101	40
	RADIOLOGY	XR CHEST PA W/RIBS RT		232.00		127.74	140.39	197.20	178.64	162.40	146.16	222.72	162.40	197.20	127.74		4000014	71101	40
	RADIOLOGY	XR RIBS, BILATERA; 3 VIEW POSTEROANTERI		232.00		127.74	140.39	197.20	178.64	162.40	146.16	222.72	162.40	197.20	127.74		4000093	71111	40
	RADIOLOGY	XR STERNUM		300.00		127.74	140.39	255.00	231.00	210.00	189.00	288.00	210.00	255.00	127.74		4000015	71120	40
	RADIOLOGY	XR C-SPINE		297.00		127.74	140.39	252.45	228.69	207.90	187.11	285.12	207.90	252.45	127.74		4000016	72040	40
	RADIOLOGY	XR C-SPINE W/OBL (ORTHO)		366.00		127.74	140.39	311.10	281.82	256.20	230.58	351.36	256.20	311.10	127.74		4000017	72050	40
	RADIOLOGY	XR C-SPINE INCUDE FLEX/EXT (ORTHO)		455.00		127.74	140.39	386.75	350.35	318.50	286.65	436.80	318.50	386.75	127.74		4000018	72052	40
	RADIOLOGY	XR T-SPINE		206.00		127.74	140.39	175.10	158.62	144.20	129.78	197.76	144.20	175.10	127.74		4000019	72070	40
	RADIOLOGY	XR THORACOLUMBAR		172.00		127.74	140.39	146.20	132.44	120.40	108.36	165.12	120.40	146.20	108.36		4000020	72080	40
	RADIOLOGY	XR SCOLIOSIS SERIES		211.00		127.74	140.39	179.35	162.47	147.70	132.93	202.56	147.70	179.35	127.74		4000021	72081	40
	RADIOLOGY	XR L-SPINE		274.00		127.74	140.39	232.90	210.98	191.80	172.62	263.04	191.80	232.90	127.74		4000022	72100	40
	RADIOLOGY	XR L-SPINE W/OBL (ORTHO)		242.00		127.74	140.39	205.70	186.34	169.40	152.46	232.32	169.40	205.70	127.74		4000023	72110	40
	RADIOLOGY	XR L-SPINE FLEX/EXT (ORTHO)		312.00		127.74	140.39	265.20	240.24	218.40	196.56	299.52	218.40	265.20	127.74		4000024	72114	40
	RADIOLOGY	XR PELVIS		202.00		127.74	140.39	171.70	155.54	141.40	127.26	193.92	141.40	171.70	127.26		4000025	72170	40
	RADIOLOGY	XR SI JOINTS 3 OR MORE VIEWS		168.00		127.74	140.39	142.80	129.36	117.60	105.84	161.28	117.60	142.80	105.84		4000026	72202	40
	RADIOLOGY	XR SACRUM/COCCYX		212.00		127.74	140.39	180.20	163.24	148.40	133.56	203.52	148.40	180.20	127.74		4000027	72220	40
	RADIOLOGY	XR CLAVICLE LT		238.00		127.74	140.39	202.30	183.26	166.60	149.94	228.48	166.60	202.30	127.74		4000028	73000	40
	RADIOLOGY	XR CLAVICLE RT		238.00		127.74	140.39	202.30	183.26	166.60	149.94	228.48	166.60	202.30	127.74		4000028	73000	40
	RADIOLOGY	XR SCAPULA LT		309.00		127.74	140.39	262.65	237.93	216.30	194.67	296.64	216.30	262.65	127.74		4000029	73010	40
	RADIOLOGY	XR SCAPULA RT		309.00		127.74	140.39	262.65	237.93	216.30	194.67	296.64	216.30	262.65	127.74		4000029	73010	40
	RADIOLOGY	XR SHOULDER 2 OR MORE VIEWS RT		247.00		127.74	140.39	209.95	190.19	172.90	155.61	237.12	172.90	209.95	127.74		4000030	73020	40
	RADIOLOGY	XR SHOULDER 2 OR MORE VIEWS LT		247.00		127.74	140.39	209.95	190.19	172.90	155.61	237.12	172.90	209.95	127.74		4000030	73020	40
	RADIOLOGY	XR SHOULDER RT		115.00		127.74	140.39	97.75	88.55	80.50	72.45	110.40	80.50	140.39	72.45		4000031	73030	40
	RADIOLOGY	XR SHOULDER LT		115.00		127.74	140.39	97.75	88.55	80.50	72.45	110.40	80.50	140.39	72.45		4000031	73030	40
	RADIOLOGY	XR AC JOINTS		267.00		127.74	140.39	226.95	205.59	186.90	168.21	256.32	186.90	226.95	127.74		4000032	73050	40
	RADIOLOGY	XR HUMERUS LT		229.00		127.74	140.39	194.65	176.33	160.30	144.27	219.84	160.30	194.65	127.74		4000033	73060	40
	RADIOLOGY	XR HUMERUS RT		229.00		127.74	140.39	194.65	176.33	160.30	144.27	219.84	160.30	194.65	127.74		4000033	73060	40
	RADIOLOGY	XR ELBOW RT		157.00		127.74	140.39	133.45	120.89	109.90	98.91	150.72	109.90	140.39	98.91		4000034	73070	40
	RADIOLOGY	XR ELBOW LT		157.00		127.74	140.39	133.45	120.89	109.90	98.91	150.72	109.90	140.39	98.91		4000034	73070	40
	RADIOLOGY	XR ELBOW W/RADIAL HEAD RT		175.00		127.74	140.39	148.75	134.75	122.50	110.25	168.00	122.50	148.75	110.25		4000035	73080	40
	RADIOLOGY	XR ELBOW W/RADIAL HEAD LT		175.00		127.74	140.39	148.75	134.75	122.50	110.25	168.00	122.50	148.75	110.25		4000035	73080	40
	RADIOLOGY	XR FOREARM LT		212.00		127.74	140.39	180.20	163.24	148.40	133.56	203.52	148.40	180.20	127.74		4000036	73090	40
	RADIOLOGY	XR FOREARM RT		212.00		127.74	140.39	180.20	163.24	148.40	133.56	203.52	148.40	180.20	127.74		4000036	73090	40
	RADIOLOGY	XR WRIST 3 VIEW LT		185.00		127.74	140.39	157.25	142.45	129.50	116.55	177.60	129.50	157.25	116.55		4000037	73100	40
	RADIOLOGY	XR WRIST 3 VIEW RT		185.00		127.74	140.39	157.25	142.45	129.50	116.55	177.60	129.50	157.25	116.55		4000037	73100	40
	RADIOLOGY	XR WRIST RT INC SCAPHOID VIEW		185.00		127.74	140.39	157.25	142.45	129.50	116.55	177.60	129.50	157.25	116.55		4000038	73110	40
	RADIOLOGY	XR WRIST LT INC SCAPHOID VIEW		185.00		127.74	140.39	157.25	142.45	129.50	116.55	177.60	129.50	157.25	116.55		4000038	73110	40
	RADIOLOGY	XR WRIST RT		114.00		127.74	140.39	96.90	87.78	79.80	71.82	109.44	79.80	140.39	71.82		4000038	73110	40
	RADIOLOGY	XR WRIST LT		114.00		127.74	140.39	96.90	87.78	79.80	71.82	109.44	79.80	140.39	71.82		4000038	73110	40
	RADIOLOGY	XR HAND 3 VIEW RT		107.00		127.74	140.39	90.95	82.39	74.90	67.41	102.72	74.90	140.39	67.41		4000040	73120	40
	RADIOLOGY	XR HAND 3 VIEW LT		107.00		127.74	140.39	90.95	82.39	74.90	67.41	102.72	74.90	140.39	67.41		4000040	73120	40
	RADIOLOGY	XR HAND RT		218.00		127.74	140.39	185.30	167.86	152.60	137.34	209.28	152.60	185.30	127.74		4000041	73130	40
	RADIOLOGY	XR HAND LT		218.00		127.74	140.39	185.30	167.86	152.60	137.34	209.28	152.60	185.30	127.74		4000041	73130	40
	RADIOLOGY	XR FINGERS RT		169.00		127.74	140.39	143.65	130.13	118.30	106.47	162.24	118.30	143.65	106.47		4000042	73140	40
	RADIOLOGY	XR FINGERS LT		169.00		127.74	140.39	143.65	130.13	118.30	106.47	162.24	118.30	143.65	106.47		4000042	73140	40
	RADIOLOGY	XR HIP LT		221.00		127.74	140.39	187.85	170.17	154.70	139.23	212.16	154.70	187.85	127.74		4000043	73502	40
	RADIOLOGY	XR HIP RT		221.00		127.74	140.39	187.85	170.17	154.70	139.23	212.16	154.70	187.85	127.74		4000043	73502	40
	RADIOLOGY	XR HIP LT UNI W/PELVIS MIN 4 VIEW		386.00		127.74	140.39	328.10	297.22	270.20	243.18	370.56	270.20	328.10	127.74		4000088	73503	40
	RADIOLOGY	XR HIP RT UNI W/PELVIS MIN 4 VIEW		386.00		127.74	140.39	328.10	297.22	270.20	243.18	370.56	270.20	328.10	127.74		4000088	73503	40
	RADIOLOGY	XR HIPS BILAT W/PELVIS 2 VIEWS		361.00		127.74	140.39	306.85	277.97	252.70	227.43	346.56	252.70	306.85	127.74		4000089	73521	40
	RADIOLOGY	XR HIPS BILATERAL  3-4 VIEWS		391.00		127.74	140.39	332.35	301.07	273.70	246.33	375.36	273.70	332.35	127.74		4000090	73522	40
	RADIOLOGY	XR HIPS BILAT W/PELVIS 5 VIEWS		361.00		127.74	140.39	306.85	277.97	252.70	227.43	346.56	252.70	306.85	127.74		4073523	73523	40
	RADIOLOGY	XR FEMUR LT		236.00		127.74	140.39	200.60	181.72	165.20	148.68	226.56	165.20	200.60	127.74		4000044	73552	40
	RADIOLOGY	XR FEMUR RT		236.00		127.74	140.39	200.60	181.72	165.20	148.68	226.56	165.20	200.60	127.74		4000044	73552	40
	RADIOLOGY	XR KNEE RT		164.00		127.74	140.39	139.40	126.28	114.80	103.32	157.44	114.80	140.39	103.32		4000045	73560	40
	RADIOLOGY	XR KNEE LT		164.00		127.74	140.39	139.40	126.28	114.80	103.32	157.44	114.80	140.39	103.32		4000045	73560	40
	RADIOLOGY	XR KNEE 3 VIEW LT		265.00		127.74	140.39	225.25	204.05	185.50	166.95	254.40	185.50	225.25	127.74		4000046	73562	40
	RADIOLOGY	XR KNEE 3 VIEW RT		265.00		127.74	140.39	225.25	204.05	185.50	166.95	254.40	185.50	225.25	127.74		4000046	73562	40
	RADIOLOGY	XR TIB-FIB LT		221.00		127.74	140.39	187.85	170.17	154.70	139.23	212.16	154.70	187.85	127.74		4000047	73590	40
	RADIOLOGY	XR TIB-FIB RT		221.00		127.74	140.39	187.85	170.17	154.70	139.23	212.16	154.70	187.85	127.74		4000047	73590	40
	RADIOLOGY	XR ANKLE 3 VIEW LT		227.00		127.74	140.39	192.95	174.79	158.90	143.01	217.92	158.90	192.95	127.74		4000048	73600	40
	RADIOLOGY	XR ANKLE 3 VIEW RT		227.00		127.74	140.39	192.95	174.79	158.90	143.01	217.92	158.90	192.95	127.74		4000048	73600	40
	RADIOLOGY	XR ANKLE RT		106.00		127.74	140.39	90.10	81.62	74.20	66.78	101.76	74.20	140.39	66.78		4000049	73610	40
	RADIOLOGY	XR ANKLE LT		106.00		127.74	140.39	90.10	81.62	74.20	66.78	101.76	74.20	140.39	66.78		4000049	73610	40
	RADIOLOGY	XR FOOT 3 VIEW LT		193.00		127.74	140.39	164.05	148.61	135.10	121.59	185.28	135.10	164.05	121.59		4000050	73620	40
	RADIOLOGY	XR FOOT 3 VIEW RT		193.00		127.74	140.39	164.05	148.61	135.10	121.59	185.28	135.10	164.05	121.59		4000050	73620	40
	RADIOLOGY	XR FOOT LT		110.00		127.74	140.39	93.50	84.70	77.00	69.30	105.60	77.00	140.39	69.30		4000051	73630	40
	RADIOLOGY	XR FOOT RT		110.00		127.74	140.39	93.50	84.70	77.00	69.30	105.60	77.00	140.39	69.30		4000051	73630	40
	RADIOLOGY	XR OS CALCIS RT		181.00		127.74	140.39	153.85	139.37	126.70	114.03	173.76	126.70	153.85	114.03		4000052	73650	40
	RADIOLOGY	XR OS CALCIS LT		181.00		127.74	140.39	153.85	139.37	126.70	114.03	173.76	126.70	153.85	114.03		4000052	73650	40
	RADIOLOGY	XR TOES LT		177.00		127.74	140.39	150.45	136.29	123.90	111.51	169.92	123.90	150.45	111.51		4000053	73660	40
	RADIOLOGY	XR TOES RT		177.00		127.74	140.39	150.45	136.29	123.90	111.51	169.92	123.90	150.45	111.51		4000053	73660	40
	RADIOLOGY	XR KUB		187.00		127.74	140.39	158.95	143.99	130.90	117.81	179.52	130.90	158.95	117.81		4000054	74018	40
	RADIOLOGY	XR ABDOMEN 2V		289.00		127.74	140.39	245.65	222.53	202.30	182.07	277.44	202.30	245.65	127.74		4000055	74019	40
	RADIOLOGY	US CHEST		470.00		257.72	283.25	399.50	361.90	329.00	296.10	451.20	329.00	399.50	257.72		4000056	76604	40
	RADIOLOGY	XR BONE AGE STUDY		266.00		127.74	140.39	226.10	204.82	186.20	167.58	255.36	186.20	226.10	127.74		4000057	77072	40
	RADIOLOGY	BD BONE DENSITY DEXA		332.00		219.62	241.37	282.20	255.64	232.40	209.16	318.72	232.40	282.20	209.16		4000058	77080	40
	RADIOLOGY	XR BONE DENSITY-SINGLE ENERGY XRAY		92.00		219.62	241.37	78.20	70.84	64.40	57.96	88.32	64.40	241.37	57.96		4000059	G0130	40
	DIETARY	INITIAL NUTRITIONAL ASSMT EA 15 MIN		41.00		131.47	144.50	34.85	31.57	28.70	25.83	39.36	28.70	144.50	25.83		3597802	97802	35
LABORATORY SERVICES
	LABORATORY	DRAWING FEE ONLY		29.00		11.21	12.32	24.65	22.33	20.30	18.27	27.84	20.30	24.65	11.21		3000002	36415	30
	LABORATORY	PORT DRAW		144.00		427.28	469.61	122.40	110.88	100.80	90.72	138.24	100.80	469.61	90.72		3000004	36591	30
	LABORATORY	COLL BLOOD FROM CATH VENOUS NOS		97.00		427.28	469.61	82.45	74.69	67.90	61.11	93.12	67.90	469.61	61.11		3000005	36592	30
	LABORATORY	ARTERIAL PUNCTURE		50.00		427.28	469.61	42.50	38.50	35.00	31.50	48.00	35.00	469.61	31.50		3000006	36600	30
	LABORATORY	BASIC METABOLIC PANEL		173.00		56.77	62.40	147.05	133.21	121.10	108.99	166.08	121.10	147.05	56.77		3000008	80048	30
	LABORATORY	ELECTROLYTES PANEL		116.00		56.77	62.40	98.60	89.32	81.20	73.08	111.36	81.20	98.60	56.77		3000010	80051	30
	LABORATORY	COMPREHENSIVE METABOLIC PANEL		239.00		56.77	62.40	203.15	184.03	167.30	150.57	229.44	167.30	203.15	56.77		3000011	80053	30
	LABORATORY	LIPID PANEL		148.00		56.77	62.40	125.80	113.96	103.60	93.24	142.08	103.60	125.80	56.77		3000012	80061	30
	LABORATORY	RENAL FUNCTION PANEL		196.00		56.77	62.40	166.60	150.92	137.20	123.48	188.16	137.20	166.60	56.77		3000013	80069	30
	LABORATORY	LIVER PANEL		153.00		56.77	62.40	130.05	117.81	107.10	96.39	146.88	107.10	130.05	56.77		3000015	80076	30
	LABORATORY	VALPROIC ACID, FREE		139.00		73.21	80.46	118.15	107.03	97.30	87.57	133.44	97.30	118.15	73.21		3000021	80165	30
	LABORATORY	EVEROLIMUS		400.00		73.21	80.46	340.00	308.00	280.00	252.00	384.00	280.00	340.00	73.21		3000856	80169	30
	LABORATORY	HALOPERIDOL		102.00		73.21	80.46	86.70	78.54	71.40	64.26	97.92	71.40	86.70	64.26		3000833	80173	30
	LABORATORY	LITHIUM LEVEL		118.00		73.21	80.46	100.30	90.86	82.60	74.34	113.28	82.60	100.30	73.21		3000027	80178	30
	LABORATORY	AMMONIA		118.00		73.21	80.46	100.30	90.86	82.60	74.34	113.28	82.60	100.30	73.21		3000027	80178	30
	LABORATORY	VANCOMYCIN TROUGH		144.00		73.21	80.46	122.40	110.88	100.80	90.72	138.24	100.80	122.40	73.21		3000042	80202	30
	LABORATORY	VANCOMYCIN PEAK		144.00		73.21	80.46	122.40	110.88	100.80	90.72	138.24	100.80	122.40	73.21		3000042	80202	30
	LABORATORY	VANCOMYCIN RANDOM		144.00		73.21	80.46	122.40	110.88	100.80	90.72	138.24	100.80	122.40	73.21		3000042	80202	30
	LABORATORY	LACOSAMIDE ASSAY		206.00		73.21	80.46	175.10	158.62	144.20	129.78	197.76	144.20	175.10	73.21		3000044	80235	30
	LABORATORY	DEXAMETHASONE		188.00		73.21	80.46	159.80	144.76	131.60	118.44	180.48	131.60	159.80	73.21		3000045	80299	30
	LABORATORY	BUPROPION AND HYDROXYBUPROPION		180.00		73.21	80.46	153.00	138.60	126.00	113.40	172.80	126.00	153.00	73.21		3000045	80299	30
	LABORATORY	RISPERIDONE		180.00		73.21	80.46	153.00	138.60	126.00	113.40	172.80	126.00	153.00	73.21		3000045	80299	30
	LABORATORY	CITALOPRAM, SERUM/PLASMA		200.00		73.21	80.46	170.00	154.00	140.00	126.00	192.00	140.00	170.00	73.21		3000045	80299	30
	LABORATORY	AMANTADINE QUANTITATION THERP DURG NOS		200.00		73.21	80.46	170.00	154.00	140.00	126.00	192.00	140.00	170.00	73.21		3000045	80299	30
	LABORATORY	RAPID URINE DRUG SCREEN		174.00		26.15	28.74	147.90	133.98	121.80	109.62	167.04	121.80	147.90	26.15		3000046	80305	30
	LABORATORY	ALCOHOL		194.00		50.80	55.83	164.90	149.38	135.80	122.22	186.24	135.80	164.90	50.80		3000048	80320	30
	LABORATORY	DRUG SCREEN QUANT AMPHETAMINES 3 OR 4		139.00		26.15	28.74	118.15	107.03	97.30	87.57	133.44	97.30	118.15	26.15		3000051	80325	30
	LABORATORY	ACETAMINOPHEN		135.00		26.15	28.74	114.75	103.95	94.50	85.05	129.60	94.50	114.75	26.15		3000052	80329	30
	LABORATORY	METHYLENEDIOXYAMPHETAMINES		21.00		26.15	28.74	17.85	16.17	14.70	13.23	20.16	14.70	28.74	13.23		3000061	80359	30
	LABORATORY	URINE-MICROSCOPIC ROUTINE		36.00		26.15	28.74	30.60	27.72	25.20	22.68	34.56	25.20	30.60	22.68		3000067	81000	30
	LABORATORY	URINE DIPSTICK		47.00		26.15	28.74	39.95	36.19	32.90	29.61	45.12	32.90	39.95	26.15		3000069	81002	30
	LABORATORY	URINALYSIS W/O MICROSCOPIC		48.00		26.15	28.74	40.80	36.96	33.60	30.24	46.08	33.60	40.80	26.15		3000070	81003	30
	LABORATORY	URINE MICROSCOPIC EXAM		52.00		26.15	28.74	44.20	40.04	36.40	32.76	49.92	36.40	44.20	26.15		3000071	81015	30
	LABORATORY	BHCG, URINE		13.00		26.15	28.74	11.05	10.01	9.10	8.19	12.48	9.10	28.74	8.19		3000072	81025	30
	LABORATORY	HLA-A29 UVEITIS-BIRDSHOT CHORIORETINOPAT		253.00		141.18	155.17	215.05	194.81	177.10	159.39	242.88	177.10	215.05	141.18		3000921	81381	30
	LABORATORY	VAGINITIS PANEL (>/= 14 YEAR)		275.00		141.18	155.17	233.75	211.75	192.50	173.25	264.00	192.50	233.75	141.18		3000896	81515	30
	LABORATORY	KETONE SERUM QUAL		51.00		32.12	35.30	43.35	39.27	35.70	32.13	48.96	35.70	43.35	32.12		3000085	82009	30
	LABORATORY	ALBUMIN		61.00		32.12	35.30	51.85	46.97	42.70	38.43	58.56	42.70	51.85	32.12		3000089	82040	30
	LABORATORY	MICROALBUMIN URINE		101.00		26.15	28.74	85.85	77.77	70.70	63.63	96.96	70.70	85.85	26.15		3000091	82043	30
	LABORATORY	AMYLASE		102.00		32.12	35.30	86.70	78.54	71.40	64.26	97.92	71.40	86.70	32.12		3000101	82150	30
	LABORATORY	TOTAL BILIRUBIN		71.00		32.12	35.30	60.35	54.67	49.70	44.73	68.16	49.70	60.35	32.12		3000108	82247	30
	LABORATORY	BILIRUBIN, DIRECT		55.00		32.12	35.30	46.75	42.35	38.50	34.65	52.80	38.50	46.75	32.12		3000109	82248	30
	LABORATORY	OCCULT BLOOD, FECES-SCREENING		28.00		32.12	35.30	23.80	21.56	19.60	17.64	26.88	19.60	35.30	17.64		3000111	82270	30
	LABORATORY	OCCULT BLOOD 1-3 NOT SCREENING		25.00		32.12	35.30	21.25	19.25	17.50	15.75	24.00	17.50	35.30	15.75		3000113	82272	30
	LABORATORY	VITAMIN D TOTAL		268.00		126.24	138.75	227.80	206.36	187.60	168.84	257.28	187.60	227.80	126.24		3000115	82306	30
	LABORATORY	CALCIUM		83.00		32.12	35.30	70.55	63.91	58.10	52.29	79.68	58.10	70.55	32.12		3000117	82310	30
	LABORATORY	KIDNEY STONE ANALYSIS		41.00		59.76	65.68	34.85	31.57	28.70	25.83	39.36	28.70	65.68	25.83		3000121	82365	30
	LABORATORY	TOTAL CARBON DIOXIDE - CALCULATED		65.00		32.12	35.30	55.25	50.05	45.50	40.95	62.40	45.50	55.25	32.12		3000122	82374	30
	LABORATORY	ENZYMATIC CARBONATE		65.00		32.12	35.30	55.25	50.05	45.50	40.95	62.40	45.50	55.25	32.12		3000122	82374	30
	LABORATORY	TOTAL CARBON DIOXIDE		65.00		32.12	35.30	55.25	50.05	45.50	40.95	62.40	45.50	55.25	32.12		3000122	82374	30
	LABORATORY	24 HOUR URINE CATECHOLAMINES		89.00		47.06	51.72	75.65	68.53	62.30	56.07	85.44	62.30	75.65	47.06		3000126	82384	30
	LABORATORY	CHLORIDE-E		61.00		32.12	35.30	51.85	46.97	42.70	38.43	58.56	42.70	51.85	32.12		3000129	82435	30
	LABORATORY	CHLORIDE		61.00		32.12	35.30	51.85	46.97	42.70	38.43	58.56	42.70	51.85	32.12		3000129	82435	30
	LABORATORY	CREATINE KINASE		108.00		32.12	35.30	91.80	83.16	75.60	68.04	103.68	75.60	91.80	32.12		3000142	82550	30
	LABORATORY	CK-MB		155.00		59.76	65.68	131.75	119.35	108.50	97.65	148.80	108.50	131.75	59.76		3000144	82553	30
	LABORATORY	CREATININE		61.00		32.12	35.30	51.85	46.97	42.70	38.43	58.56	42.70	51.85	32.12		1000812	82565	30
	LABORATORY	CREATININE-E		61.00		32.12	35.30	51.85	46.97	42.70	38.43	58.56	42.70	51.85	32.12		1000812	82565	30
	LABORATORY	CREATININE URINE		73.00		32.12	35.30	62.05	56.21	51.10	45.99	70.08	51.10	62.05	32.12		3000146	82570	30
	LABORATORY	CREATININE, 24 HOUR, URINE		73.00		32.12	35.30	62.05	56.21	51.10	45.99	70.08	51.10	62.05	32.12		3000146	82570	30
	LABORATORY	VITAMIN B 12		131.00		47.06	51.72	111.35	100.87	91.70	82.53	125.76	91.70	111.35	47.06		3000150	82607	30
	LABORATORY	DIHYDROTESTOSTERONE (DHT) SERUM		85.00		47.06	51.72	72.25	65.45	59.50	53.55	81.60	59.50	72.25	47.06		3000912	82642	30
	LABORATORY	FERRITIN		149.00		59.76	65.68	126.65	114.73	104.30	93.87	143.04	104.30	126.65	59.76		3000164	82728	30
	LABORATORY	FOLATE		148.00		59.76	65.68	125.80	113.96	103.60	93.24	142.08	103.60	125.80	59.76		3000165	82746	30
	LABORATORY	PH, VENOUS BLOOD		16.00		59.76	65.68	13.60	12.32	11.20	10.08	15.36	11.20	65.68	10.08		3000169	82800	30
	LABORATORY	VENOUS BLOOD GASES		218.00		126.24	138.75	185.30	167.86	152.60	137.34	209.28	152.60	185.30	126.24		3000170	82803	30
	LABORATORY	ARTERIAL BLOOD GAS		218.00		126.24	138.75	185.30	167.86	152.60	137.34	209.28	152.60	185.30	126.24		3000170	82803	30
	LABORATORY	GLUCOSE		47.00		32.12	35.30	39.95	36.19	32.90	29.61	45.12	32.90	39.95	29.61		3000174	82947	30
	LABORATORY	GLUCOSE -E		47.00		32.12	35.30	39.95	36.19	32.90	29.61	45.12	32.90	39.95	29.61		3000174	82947	30
	LABORATORY	GTT 3-HR		264.00		59.76	65.68	224.40	203.28	184.80	166.32	253.44	184.80	224.40	59.76		3000176	82951	30
	LABORATORY	GTT 3-HR PREGNANT		264.00		59.76	65.68	224.40	203.28	184.80	166.32	253.44	184.80	224.40	59.76		3000176	82951	30
	LABORATORY	GLUCOSE TOLERANCE TEST 4-HR		256.00		59.76	65.68	217.60	197.12	179.20	161.28	245.76	179.20	217.60	59.76		3000176	82951	30
	LABORATORY	GTT 5-HR		264.00		59.76	65.68	224.40	203.28	184.80	166.32	253.44	184.80	224.40	59.76		3000176	82951	30
	LABORATORY	GTT 6-HR		264.00		59.76	65.68	224.40	203.28	184.80	166.32	253.44	184.80	224.40	59.76		3000176	82951	30
	LABORATORY	GLUCOSE TOLERANCE EACH ADDITIONAL HR		79.00		32.12	35.30	67.15	60.83	55.30	49.77	75.84	55.30	67.15	32.12		3000177	82952	30
	LABORATORY	GLUCOSE 6-PHOSPHATE DEHYDROGENASE ENZY		67.00		32.12	35.30	56.95	51.59	46.90	42.21	64.32	46.90	56.95	32.12		3000178	82955	30
	LABORATORY	GLUCOSE-6-PHOSPHATE DEHYDROGENASE		75.00		32.12	35.30	63.75	57.75	52.50	47.25	72.00	52.50	63.75	32.12		3000179	82960	30
	LABORATORY	BLOOD GLUCOSE TEST DEVICE HOME USE		5.00		32.12	35.30	4.25	3.85	3.50	3.15	4.80	3.50	35.30	3.15		3000180	82962	30
	LABORATORY	GAMMA GLUTAMYL TRANSPEPTIDASE		73.00		32.12	35.30	62.05	56.21	51.10	45.99	70.08	51.10	62.05	32.12		3000181	82977	30
	LABORATORY	HEMOGLOBIN ELECTROPHORESIS CASCADE		64.00		59.76	65.68	54.40	49.28	44.80	40.32	61.44	44.80	65.68	40.32		3000188	83020	30
	LABORATORY	HGB FRACT AND QUANT; ELECTROPHORESIS		96.00		59.76	65.68	81.60	73.92	67.20	60.48	92.16	67.20	81.60	59.76		3000188	83020	30
	LABORATORY	GLYCOSYLATED HEMOGLOBIN		95.00		32.12	35.30	80.75	73.15	66.50	59.85	91.20	66.50	80.75	32.12		3000189	83036	30
	LABORATORY	PHOSPHOLIPASE A2 RECEPTOR ANTIBODIES		117.00		59.76	65.68	99.45	90.09	81.90	73.71	112.32	81.90	99.45	59.76		3000196	83516	30
	LABORATORY	GLOMERULAR BASEMENT MEMBRANE AB, IGG		121.00		59.76	65.68	102.85	93.17	84.70	76.23	116.16	84.70	102.85	59.76		3000196	83516	30
	LABORATORY	MYELOPEROXIDASE ANTIBODY		121.00		59.76	65.68	102.85	93.17	84.70	76.23	116.16	84.70	102.85	59.76		3000196	83516	30
	LABORATORY	PARIETAL CELL AB IGG		121.00		59.76	65.68	102.85	93.17	84.70	76.23	116.16	84.70	102.85	59.76		3000196	83516	30
	LABORATORY	PROTEINASE 3 ANTIBOSIES, IGG, SERUM		121.00		59.76	65.68	102.85	93.17	84.70	76.23	116.16	84.70	102.85	59.76		3000196	83516	30
	LABORATORY	IRON		75.00		32.12	35.30	63.75	57.75	52.50	47.25	72.00	52.50	63.75	32.12		3000201	83540	30
	LABORATORY	TOTAL IRON BINDING CAPACITY		106.00		32.12	35.30	90.10	81.62	74.20	66.78	101.76	74.20	90.10	32.12		3000202	83550	30
	LABORATORY	LAC (VITROS)		130.00		59.76	65.68	110.50	100.10	91.00	81.90	124.80	91.00	110.50	59.76		3000204	83605	30
	LABORATORY	Lactate (EPOC)		130.00		59.76	65.68	110.50	100.10	91.00	81.90	124.80	91.00	110.50	59.76		3000204	83605	30
	LABORATORY	LIPASE		113.00		32.12	35.30	96.05	87.01	79.10	71.19	108.48	79.10	96.05	32.12		3000210	83690	30
	LABORATORY	MAGNESIUM		77.00		32.12	35.30	65.45	59.29	53.90	48.51	73.92	53.90	65.45	32.12		3000215	83735	30
	LABORATORY	INTACT PTH II		272.00		99.35	109.19	231.20	209.44	190.40	171.36	261.12	190.40	231.20	99.35		3000232	83970	30
	LABORATORY	PARATHYROID HORMONE		272.00		99.35	109.19	231.20	209.44	190.40	171.36	261.12	190.40	231.20	99.35		3000232	83970	30
	LABORATORY	ALKALINE PHOSPHATASE		72.00		32.12	35.30	61.20	55.44	50.40	45.36	69.12	50.40	61.20	32.12		3000237	84075	30
	LABORATORY	PHOSPHORUS		61.00		32.12	35.30	51.85	46.97	42.70	38.43	58.56	42.70	51.85	32.12		3000239	84100	30
	LABORATORY	POTASSIUM		60.00		32.12	35.30	51.00	46.20	42.00	37.80	57.60	42.00	51.00	32.12		3000242	84132	30
	LABORATORY	POTASSIUM-E		60.00		32.12	35.30	51.00	46.20	42.00	37.80	57.60	42.00	51.00	32.12		3000242	84132	30
	LABORATORY	POTASSIUM, RANDOM URINE		34.00		32.12	35.30	28.90	26.18	23.80	21.42	32.64	23.80	35.30	21.42		3000243	84133	30
	LABORATORY	PROCALCITONIN		129.00		47.06	51.72	109.65	99.33	90.30	81.27	123.84	90.30	109.65	47.06		3000247	84145	30
	LABORATORY	PSA		135.00		59.76	65.68	114.75	103.95	94.50	85.05	129.60	94.50	114.75	59.76		3000250	84153	30
	LABORATORY	FREE PSA		191.00		59.76	65.68	162.35	147.07	133.70	120.33	183.36	133.70	162.35	59.76		3000251	84154	30
	LABORATORY	TOTAL PROTEIN		93.00		32.12	35.30	79.05	71.61	65.10	58.59	89.28	65.10	79.05	32.12		3000252	84155	30
	LABORATORY	PROTEIN ELECTROPHORESIS AND ISOTYPE		161.00		32.12	35.30	136.85	123.97	112.70	101.43	154.56	112.70	136.85	32.12		3000255	84165	30
	LABORATORY	SODIUM		64.00		32.12	35.30	54.40	49.28	44.80	40.32	61.44	44.80	54.40	32.12		3000267	84295	30
	LABORATORY	SODIUM-E		64.00		32.12	35.30	54.40	49.28	44.80	40.32	61.44	44.80	54.40	32.12		3000267	84295	30
	LABORATORY	INSULIN-LIKE GROWTH FACTOR I		129.00		47.06	51.72	109.65	99.33	90.30	81.27	123.84	90.30	109.65	47.06		3000270	84305	30
	LABORATORY	TESTOSTERONE, FREE, SERUM		153.00		47.06	51.72	130.05	117.81	107.10	96.39	146.88	107.10	130.05	47.06		3000273	84402	30
	LABORATORY	THYROGLOBULIN		77.00		47.06	51.72	65.45	59.29	53.90	48.51	73.92	53.90	65.45	47.06		3000276	84432	30
	LABORATORY	FREE T4		109.00		47.06	51.72	92.65	83.93	76.30	68.67	104.64	76.30	92.65	47.06		3000278	84439	30
	LABORATORY	TSH		126.00		47.06	51.72	107.10	97.02	88.20	79.38	120.96	88.20	107.10	47.06		3000279	84443	30
	LABORATORY	AST/SGOT		73.00		32.12	35.30	62.05	56.21	51.10	45.99	70.08	51.10	62.05	32.12		3000282	84450	30
	LABORATORY	ALT/SGPT		89.00		32.12	35.30	75.65	68.53	62.30	56.07	85.44	62.30	75.65	32.12		3000283	84460	30
	LABORATORY	TRANSFERRIN		21.00		59.76	65.68	17.85	16.17	14.70	13.23	20.16	14.70	65.68	13.23		3000284	84466	30
	LABORATORY	TRIGLYCERIDE		82.00		32.12	35.30	69.70	63.14	57.40	51.66	78.72	57.40	69.70	32.12		3000285	84478	30
	LABORATORY	FREE T3		129.00		47.06	51.72	109.65	99.33	90.30	81.27	123.84	90.30	109.65	47.06		3000288	84481	30
	LABORATORY	TROPONIN I		173.00		59.76	65.68	147.05	133.21	121.10	108.99	166.08	121.10	147.05	59.76		3000290	84484	30
	LABORATORY	BUN		58.00		32.12	35.30	49.30	44.66	40.60	36.54	55.68	40.60	49.30	32.12		3000292	84520	30
	LABORATORY	BUN-E		58.00		32.12	35.30	49.30	44.66	40.60	36.54	55.68	40.60	49.30	32.12		3000292	84520	30
	LABORATORY	UREA NITROGEN URINE		16.00		32.12	35.30	13.60	12.32	11.20	10.08	15.36	11.20	35.30	10.08		3000293	84540	30
	LABORATORY	URIC ACID		75.00		32.12	35.30	63.75	57.75	52.50	47.25	72.00	52.50	63.75	32.12		3000294	84550	30
	LABORATORY	URIC ACID OTHER SOURCE (URINE)		84.00		32.12	35.30	71.40	64.68	58.80	52.92	80.64	58.80	71.40	32.12		3000295	84560	30
	LABORATORY	VITAMIN NOT OTHERWISE SPECIFIED		125.00		59.76	65.68	106.25	96.25	87.50	78.75	120.00	87.50	106.25	59.76		3000885	84591	30
	LABORATORY	BHCG QUANTITATIVE		146.00		47.06	51.72	124.10	112.42	102.20	91.98	140.16	102.20	124.10	47.06		3000303	84702	30
	LABORATORY	BHCG, SERUM QUALITATIVE		116.00		32.12	35.30	98.60	89.32	81.20	73.08	111.36	81.20	98.60	32.12		3000304	84703	30
	LABORATORY	CBC W/ AUTO DIFF		115.00		27.64	30.38	97.75	88.55	80.50	72.45	110.40	80.50	97.75	27.64		3000311	85025	30
	LABORATORY	RED BLOOD CELL (RBC) AUTOMATED		15.00		27.64	30.38	12.75	11.55	10.50	9.45	14.40	10.50	30.38	9.45		3000313	85041	30
	LABORATORY	RETICULOCYTE AUTOMATED		58.00		27.64	30.38	49.30	44.66	40.60	36.54	55.68	40.60	49.30	27.64		3000315	85045	30
	LABORATORY	FACTOR VIII ACTIVITY ASSAY		271.00		29.88	32.84	230.35	208.67	189.70	170.73	260.16	189.70	230.35	29.88		3000322	85240	30
	LABORATORY	D-DIMER		145.00		29.88	32.84	123.25	111.65	101.50	91.35	139.20	101.50	123.25	29.88		3000330	85379	30
	LABORATORY	FIBRINOGEN		30.00		29.88	32.84	25.50	23.10	21.00	18.90	28.80	21.00	32.84	18.90		3000331	85384	30
	LABORATORY	LUPUS ANTICOAG PROFILE TECHNICAL INTERP		46.00		29.88	32.84	39.10	35.42	32.20	28.98	44.16	32.20	39.10	28.98		3000332	85390	30
	LABORATORY	PROTIME W/ INR		52.00		29.88	32.84	44.20	40.04	36.40	32.76	49.92	36.40	44.20	29.88		3000337	85610	30
	LABORATORY	RUSSEL VIPER VENOM DILUTED		258.00		29.88	32.84	219.30	198.66	180.60	162.54	247.68	180.60	219.30	29.88		3000339	85613	30
	LABORATORY	ESR		88.00		27.64	30.38	74.80	67.76	61.60	55.44	84.48	61.60	74.80	27.64		3000340	85651	30
	LABORATORY	ESR AUTOMATED		88.00		27.64	30.38	74.80	67.76	61.60	55.44	84.48	61.60	74.80	27.64		3000898	85652	30
	LABORATORY	APTT		72.00		29.88	32.84	61.20	55.44	50.40	45.36	69.12	50.40	61.20	29.88		3000344	85730	30
	LABORATORY	ANTINEUTROPHIL CYTOPLASMIC TITER EA AB		121.00		40.34	44.33	102.85	93.17	84.70	76.23	116.16	84.70	102.85	40.34		3000877	86037	30
	LABORATORY	C-REACTIVE PROTEIN		110.00		40.34	44.33	93.50	84.70	77.00	69.30	105.60	77.00	93.50	40.34		3000353	86140	30
	LABORATORY	DS DNA ANTIBODIES WITH REFLEX, IGG		27.00		40.34	44.33	22.95	20.79	18.90	17.01	25.92	18.90	44.33	17.01		3000363	86225	30
	LABORATORY	JO 1 ANTIBODIES SCREEN, IGG, SERUM		91.00		40.34	44.33	77.35	70.07	63.70	57.33	87.36	63.70	77.35	40.34		3000364	86235	30
	LABORATORY	DEAMINATED GLIADIN AB, IG		85.00		40.34	44.33	72.25	65.45	59.50	53.55	81.60	59.50	72.25	40.34		3000866	86258	30
	LABORATORY	MONO SCREEN		77.00		40.34	44.33	65.45	59.29	53.90	48.51	73.92	53.90	65.45	40.34		3000369	86308	30
	LABORATORY	TETANUS/DIPHTHERIA ANTIBODY PANEL X 2		211.00		40.34	44.33	179.35	162.47	147.70	132.93	202.56	147.70	179.35	40.34		3000370	86317	30
	LABORATORY	IMMUNOASSAY FOR INFECTIOUS AGENT ANTB, Q		211.00		40.34	44.33	179.35	162.47	147.70	132.93	202.56	147.70	179.35	40.34		3000370	86317	30
	LABORATORY	DIHYDRORHODAMINE (DHR)FLOW CYTOME BL X 2		325.00		106.82	117.40	276.25	250.25	227.50	204.75	312.00	227.50	276.25	106.82		3000890	86352	30
	LABORATORY	LYMPHOCYTE PROLIFERATION TO MITOGENS, BL		325.00		106.82	117.40	276.25	250.25	227.50	204.75	312.00	227.50	276.25	106.82		3000893	86353	30
	LABORATORY	TRANSGLUTAMINASE TISSUE ANTIBODY		71.00		40.34	44.33	60.35	54.67	49.70	44.73	68.16	49.70	60.35	40.34		3000148	86364	30
	LABORATORY	RA FACTOR (RHEUMATOID ARTHRITIS)QUAL		64.00		40.34	44.33	54.40	49.28	44.80	40.32	61.44	44.80	54.40	40.32		3000383	86430	30
	LABORATORY	LYME DISEASE ANTIBODY, IMMUNOBLOT, SERUM		82.00		40.34	44.33	69.70	63.14	57.40	51.66	78.72	57.40	69.70	40.34		3000391	86617	30
	LABORATORY	LYME DISEASE (BORRELIA BURGDORFERI) IgG		73.50		40.34	44.33	62.48	56.60	51.45	46.31	70.56	51.45	62.48	40.34		3000392	86618	30
	LABORATORY	LYME DISEASE (BORRELIA BURGDORFERI) IgM		73.50		40.34	44.33	62.48	56.60	51.45	46.31	70.56	51.45	62.48	40.34		3000392	86618	30
	LABORATORY	EPSTEIN-BARR VIRUS (EBV) AB, IgM		121.00		40.34	44.33	102.85	93.17	84.70	76.23	116.16	84.70	102.85	40.34		3000401	86665	30
	LABORATORY	EPSTEIN-BARR VIRUS (EBV) AB, IgG		121.00		40.34	44.33	102.85	93.17	84.70	76.23	116.16	84.70	102.85	40.34		3000401	86665	30
	LABORATORY	EPSTEIN-BARR ANTIBODY VIRUS		121.00		40.34	44.33	102.85	93.17	84.70	76.23	116.16	84.70	102.85	40.34		3000401	86665	30
	LABORATORY	HELICOPACTOR PYLORI IgG AB SERUM		155.00		40.34	44.33	131.75	119.35	108.50	97.65	148.80	108.50	131.75	40.34		3000403	86677	30
	LABORATORY	HERPES SIMPLEX TYPE 1		61.00		40.34	44.33	51.85	46.97	42.70	38.43	58.56	42.70	51.85	38.43		3000407	86695	30
	LABORATORY	HERPES SIMPLEX TYPE 2		31.00		40.34	44.33	26.35	23.87	21.70	19.53	29.76	21.70	44.33	19.53		3000408	86696	30
	LABORATORY	HEPATITIS B CORE ANTIBODY, IGM, SERUM		113.00		40.34	44.33	96.05	87.01	79.10	71.19	108.48	79.10	96.05	40.34		3000412	86705	30
	LABORATORY	MUMPS VIRUS ANTIBODY IGM AND IGG		308.00		40.34	44.33	261.80	237.16	215.60	194.04	295.68	215.60	261.80	40.34		3000417	86735	30
	LABORATORY	MUMPS VIRUS ANTIBODY IGM, SERUM		308.00		40.34	44.33	261.80	237.16	215.60	194.04	295.68	215.60	261.80	40.34		3000417	86735	30
	LABORATORY	MYCOPLASMA PNEUMONIAE, IGG ANTIBODY		129.00		40.34	44.33	109.65	99.33	90.30	81.27	123.84	90.30	109.65	40.34		3000418	86738	30
	LABORATORY	SYPHILIS SCREENING-TREPONEMA PALLIDUM		68.00		40.34	44.33	57.80	52.36	47.60	42.84	65.28	47.60	57.80	40.34		3000883	86780	30
	LABORATORY	WEST NILE VIRUS		86.00		40.34	44.33	73.10	66.22	60.20	54.18	82.56	60.20	73.10	40.34		3000431	86789	30
	LABORATORY	CROSSMATCH (COMPATIBILITY TEST)		297.00		150.15	165.02	252.45	228.69	207.90	187.11	285.12	207.90	252.45	150.15		3086920	86920	30
	LABORATORY	SPECIMEN CONCENTRATION		104.00		34.36	37.77	88.40	80.08	72.80	65.52	99.84	72.80	88.40	34.36		3000443	87015	30
	LABORATORY	CULTURE BACTERIAL FECES (STOOL)		143.00		34.36	37.77	121.55	110.11	100.10	90.09	137.28	100.10	121.55	34.36		3000445	87045	30
	LABORATORY	CAMPYLOBACTER ANTIGEN		98.00		34.36	37.77	83.30	75.46	68.60	61.74	94.08	68.60	83.30	34.36		3000446	87046	30
	LABORATORY	CULTURE ANAEROBE IDENT EACT		184.00		34.36	37.77	156.40	141.68	128.80	115.92	176.64	128.80	156.40	34.36		3000449	87076	30
	LABORATORY	CULTURE ID AEROBIC ORGANISM ID		77.00		34.36	37.77	65.45	59.29	53.90	48.51	73.92	53.90	65.45	34.36		3000450	87077	30
	LABORATORY	URINE CULTURE CC		75.00		34.36	37.77	63.75	57.75	52.50	47.25	72.00	52.50	63.75	34.36		3000452	87086	30
	LABORATORY	CULTURE BACTERIAL URINE-COLONY CNT		116.00		34.36	37.77	98.60	89.32	81.20	73.08	111.36	81.20	98.60	34.36		3000452	87086	30
	LABORATORY	URINE CULTURE		75.00		34.36	37.77	63.75	57.75	52.50	47.25	72.00	52.50	63.75	34.36		3000453	87088	30
	LABORATORY	CULTURE FUNGI DEFINITIVE ID EA; YEAST		85.00		34.36	37.77	72.25	65.45	59.50	53.55	81.60	59.50	72.25	34.36		3000455	87106	30
	LABORATORY	AFB CULTURE		54.00		34.36	37.77	45.90	41.58	37.80	34.02	51.84	37.80	45.90	34.02		3000457	87116	30
	LABORATORY	CULTURE IMMUNOLOGIC METHOD		62.00		34.36	37.77	52.70	47.74	43.40	39.06	59.52	43.40	52.70	34.36		3000458	87147	30
	LABORATORY	OVA AND PARASITES DIRECT SMEARS		110.00		34.36	37.77	93.50	84.70	77.00	69.30	105.60	77.00	93.50	34.36		3000463	87177	30
	LABORATORY	SUSCEPTIBILITY STUDIES, ANTIMICRO AGENT		65.00		34.36	37.77	55.25	50.05	45.50	40.95	62.40	45.50	55.25	34.36		3000925	87181	30
	LABORATORY	SENSITIVITIES (ALL)		131.00		34.36	37.77	111.35	100.87	91.70	82.53	125.76	91.70	111.35	34.36		3000464	87186	30
	LABORATORY	INFLUENZAE A AND B		127.00		34.36	37.77	107.95	97.79	88.90	80.01	121.92	88.90	107.95	34.36		3000487	87400	30
	LABORATORY	RAPID STREP/THROAT CULTURE		63.00		34.36	37.77	53.55	48.51	44.10	39.69	60.48	44.10	53.55	34.36		3000491	87430	30
	LABORATORY	BORRELIA MIYAMOTOI DETECTION PCR, BLOOD		125.00		89.64	98.52	106.25	96.25	87.50	78.75	120.00	87.50	106.25	78.75		3000760	87478	30
	LABORATORY	IADNA CHLAMYDIA PNEU AMPL PROBE TQ		283.00		89.64	98.52	240.55	217.91	198.10	178.29	271.68	198.10	240.55	89.64		3000493	87486	30
	LABORATORY	CHLAMYDIA TRACHOMATIS, PCR		134.00		89.64	98.52	113.90	103.18	93.80	84.42	128.64	93.80	113.90	84.42		3000494	87491	30
	LABORATORY	C DIFF PCR		155.00		89.64	98.52	131.75	119.35	108.50	97.65	148.80	108.50	131.75	89.64		3000495	87493	30
	LABORATORY	INFLUENZA A AND B PCR		125.00		243.52	267.65	106.25	96.25	87.50	78.75	120.00	87.50	267.65	78.75		3000499	87502	30
	LABORATORY	HSV BLOOD PCR		124.00		89.64	98.52	105.40	95.48	86.80	78.12	119.04	86.80	105.40	78.12		3000504	87529	30
	LABORATORY	HSV 1&2 NON-BLOOD QUALITATIVE PCR		124.00		89.64	98.52	105.40	95.48	86.80	78.12	119.04	86.80	105.40	78.12		3000504	87529	30
	LABORATORY	HIV 1 AMP PROBE TECH INCLUDES REVERSE TR		27.00		89.64	98.52	22.95	20.79	18.90	17.01	25.92	18.90	98.52	17.01		3000860	87535	30
	LABORATORY	HIV 2 AMP PROVE TECH INCLUDES REVERSE TR		512.00		89.64	98.52	435.20	394.24	358.40	322.56	491.52	358.40	435.20	89.64		3087538	87538	30
	LABORATORY	NEISSERIA GONORRHOEAE, PCR		123.00		89.64	98.52	104.55	94.71	86.10	77.49	118.08	86.10	104.55	77.49		3000508	87591	30
	LABORATORY	IADNA RESP PROBE REV TRNSCR 12-25		676.00		243.52	267.65	574.60	520.52	473.20	425.88	648.96	473.20	574.60	243.52		3000511	87633	30
	LABORATORY	RSV PCR		283.00		89.64	98.52	240.55	217.91	198.10	178.29	271.68	198.10	240.55	89.64		3000909	87634	30
	LABORATORY	SARS-COV-2 RT-PCR		155.00		89.64	98.52	131.75	119.35	108.50	97.65	148.80	108.50	131.75	89.64		3000512	87635	30
	LABORATORY	SARS-COV-2/FLUAB/RSV		563.00		89.64	98.52	478.55	433.51	394.10	354.69	540.48	394.10	478.55	89.64		3000613	87637	30
	LABORATORY	MRSA PCR, NASAL-INFECTION CONTROL TEST		-		89.64	98.52	-	-	-	-	-	-	98.52	-		3000513	87641	30
	LABORATORY	MRSA PCR, NASAL		64.00		89.64	98.52	54.40	49.28	44.80	40.32	61.44	44.80	98.52	40.32		3000513	87641	30
	LABORATORY	STREP A PCR		103.00		89.64	98.52	87.55	79.31	72.10	64.89	98.88	72.10	98.52	64.89		3000514	87651	30
	LABORATORY	GROUP A STREP NUCLEIC ACID AMP THROAT		103.00		89.64	98.52	87.55	79.31	72.10	64.89	98.88	72.10	98.52	64.89		3000514	87651	30
	LABORATORY	TRICHOMONAS VAGINALIS, PCR		155.00		89.64	98.52	131.75	119.35	108.50	97.65	148.80	108.50	131.75	89.64		3000515	87661	30
	LABORATORY	RSV PCR (DC)		283.00		89.64	98.52	240.55	217.91	198.10	178.29	271.68	198.10	240.55	89.64		3000516	87798	30
	LABORATORY	INFECTIOUS AGENT DETE AMPLIFIED PROBE TE		125.00		89.64	98.52	106.25	96.25	87.50	78.75	120.00	87.50	106.25	78.75		3000516	87798	30
	LABORATORY	INFECTIOUS AGENT DETEC BY AMPLIFIED PROB		125.00		89.64	98.52	106.25	96.25	87.50	78.75	120.00	87.50	106.25	78.75		3000516	87798	30
	LABORATORY	STREPTOCOCCUS GROUP A RAPID STREP		76.00		34.36	37.77	64.60	58.52	53.20	47.88	72.96	53.20	64.60	34.36		3000520	87880	30
	LABORATORY	NOS ASSAY W/OPTIC (SHIGA TOXIN 1)		94.00		34.36	37.77	79.90	72.38	65.80	59.22	90.24	65.80	79.90	34.36		3000521	87899	30
	LABORATORY	LEGIONELLA ANTIGEN URINE		94.00		34.36	37.77	79.90	72.38	65.80	59.22	90.24	65.80	79.90	34.36		3000521	87899	30
	LABORATORY	HCV GENOTYPE		250.00		141.18	155.17	212.50	192.50	175.00	157.50	240.00	175.00	212.50	141.18		3000502	87902	30
	LABORATORY	CULTURE SPUTUM		48.00		176.29	193.76	40.80	36.96	33.60	30.24	46.08	33.60	193.76	30.24		3000539	89220	30
	LABORATORY	PHLEBOTOMY		146.00		427.28	469.61	124.10	112.42	102.20	91.98	140.16	102.20	469.61	91.98		3000543	99195	30
	LABORATORY	THIOPURINE METHYLTRANSFERASE (TPMT)		375.00		332.42	365.35	318.75	288.75	262.50	236.25	360.00	262.50	365.35	236.25		3000897	0034U	30
	LABORATORY	PSA SCREEN TOTAL (MEDICARE)		135.00		40.34	44.33	114.75	103.95	94.50	85.05	129.60	94.50	114.75	40.34		3000545	G0103	30
	LABORATORY	DRUG TEST ANY NUMBER OF DRUG CLASS		94.00		112.80	123.97	79.90	72.38	65.80	59.22	90.24	65.80	123.97	59.22		3000552	G0659	30
SLEEP STUDY
	SLEEP STUDY	SLEEP STD AIRFLOW HRT RATE02 SAT EFFORT		650.00		622.25	683.89	552.50	500.50	455.00	409.50	624.00	455.00	683.89	409.50		800002	95806	8
	SLEEP STUDY	POLYSOM 6>YRS SLEEP 4> ADDL PARAM ATTND		2,839.00		2,718.33	2,987.62	2,413.15	2,186.03	1,987.30	1,788.57	2,725.44	1,987.30	2,987.62	1,788.57		800003	95810	8
	SLEEP STUDY	POLYSOM 6>YRS SLEEP W/CPAP 4> ADDL PARAM		3,123.00		2,718.33	2,987.62	2,654.55	2,404.71	2,186.10	1,967.49	2,998.08	2,186.10	2,987.62	1,967.49		800004	95811	8
EVALUATION & MANAGEMENT SERVICES
	RHC PSYCHIATRY	PSYCHOTHERAPY, 30 MIN		105.00		88.50	88.50	77.78	284.52		284.52		70.00	284.52	70.00		7600003	90832	76
	RHC PSYCHIATRY	PSYCHOTHERAPY, 45 MIN		155.00		116.70	116.70	102.73	284.52		284.52		70.00	284.52	70.00		7600004	90834	76
	RHC PSYCHIATRY	PSYCHOTHERAPY, 60 MIN		211.00		172.90	172.90	151.33	284.52		284.52		70.00	284.52	70.00		7600005	90837	76
	RHC PSYCHIATRY	FAMILY PSYCHOHERAPY, NOT INCL PATIENT 50 MIN		189.00		110.60	110.60	98.84	284.52		284.52		70.00	284.52	70.00		7690846	90846	76
	RHC PSYCHIATRY	FAMILY PSYCHOHERAPY, INCL PATIENT 50 MIN		208.25		115.30	115.30	103.08	284.52		284.52		70.00	284.52	70.00		7690847	90847	76
	RHC CLINIC	NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 30 MIN		138.00		135.60	135.60	100.54	284.52		284.52		70.00	284.52	70.00		7500413	99203	75
	RHC CLINIC	NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 45 MIN		232.00		203.20	203.20	150.15	284.52		284.52		70.00	284.52	70.00		7500414	99204	75
	RHC CLINIC	NEW PATIENT OFFICE OF OTHER OUTPATIENT VISIT, TYPICALLY 60 MIN		299.00		268.30	268.30	198.29	284.52		284.52		70.00	284.52	70.00		7500415	99205	75
	RHC CLINIC	PATIENT OFFICE CONSULTATION, TYPICALLY 40 MIN		195.00		136.00	136.00	131.78	284.52		284.52		70.00	284.52	70.00		7500440	99243	75
	RHC CLINIC	PATIENT OFFICE CONSULTATION, TYPICALLY 60 MIN		272.00		193.50	193.50	188.67	284.52		284.52		70.00	284.52	70.00		7500441	99244	75
	RHC CLINIC	INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (18-39 YEARS)		228.00		189.80	189.80	134.46	284.52		284.52		70.00	284.52	70.00		7500466	99385	75
	RHC CLINIC	INITIAL NEW PATIENT PREVENTIVE MEDICINE EVALUATION (40-64 YEARS)		200.00		218.50	218.50	155.18	284.52		284.52		70.00	284.52	70.00		7500467	99386	75