hospital_name last_updated_on version hospital_location hospital_address license_number|NV "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."
Carson Valley Health 3/18/2024 2.0.0 Carson Valley Health "1107 US HWY 395 North, Gardnerville, NV 89410" 3986ruh24 TRUE
description Revenue ID code|1 code|1|type code|2 code|2|type setting standard_charge|gross standard_charge|discounted_cash standard_charge|Aetna|PPO|negotiated_dollar standard_charge|Aetna|PPO|negotiated_percentage standard_charge|Aetna|PPO|negotiated_algorithm standard_charge|Aetna|PPO|methodology additional_payer_notes|Aetna|PPO standard_charge|Aetna_medicare|HMO|negotiated_dollar standard_charge|Aetna_medicare|HMO|negotiated_percentage standard_charge|Aetna_medicare|HMO|negotiated_algorithm standard_charge|Aetna_medicare|HMO|methodology additional_payer_notes|Aetna_medicare|HMO standard_charge|Anthem_BCBS|PPO|negotiated_dollar standard_charge|Anthem_BCBS|PPO|negotiated_percentage standard_charge|Anthem_BCBS|PPO|negotiated_algorithm standard_charge|Anthem_BCBS|PPO|methodology additional_payer_notes|Anthem_BCBS|PPO standard_charge|Anthem_Pathway|HMO|negotiated_dollar standard_charge|Anthem_Pathway|HMO|negotiated_percentage standard_charge|Anthem_Pathway|HMO|negotiated_algorithm standard_charge|Anthem_Pathway|HMO|methodology additional_payer_notes|Anthem_Pathway|HMO standard_charge|Atrio_St._Mary's|HMO|negotiated_dollar standard_charge|Atrio_St._Mary's|HMO|negotiated_percentage standard_charge|Atrio_St._Mary's|HMO|negotiated_algorithm standard_charge|Atrio_St._Mary's|HMO|methodology additional_payer_notes|Atrio_St._Mary's|HMO standard_charge|Cigna_Behavioral_Health|PPO|negotiated_dollar standard_charge|Cigna_Behavioral_Health|PPO|negotiated_percentage standard_charge|Cigna_Behavioral_Health|PPO|negotiated_algorithm standard_charge|Cigna_Behavioral_Health|PPO|methodology additional_payer_notes|Cigna_Behavioral_Health|PPO standard_charge|Cigna_Great_West|PPO|negotiated_dollar standard_charge|Cigna_Great_West|PPO|negotiated_percentage standard_charge|Cigna_Great_West|PPO|negotiated_algorithm standard_charge|Cigna_Great_West|PPO|methodology additional_payer_notes|Cigna_Great_West|PPO standard_charge|Hometown_Health|PPO|negotiated_dollar standard_charge|Hometown_Health|PPO|negotiated_percentage standard_charge|Hometown_Health|PPO|negotiated_algorithm standard_charge|Hometown_Health|PPO|methodology additional_payer_notes|Hometown_Health|PPO standard_charge|Hometown_Health_lease|PPO|negotiated_dollar standard_charge|Hometown_Health_lease|PPO|negotiated_percentage standard_charge|Hometown_Health_lease|PPO|negotiated_algorithm standard_charge|Hometown_Health_lease|PPO|methodology additional_payer_notes|Hometown_Health_lease|PPO standard_charge|Northern_NV_Laborers_Operators_Engineers_Electrical_Workers|PPO|negotiated_dollar standard_charge|Northern_NV_Laborers_Operators_Engineers_Electrical_Workers|PPO|negotiated_percentage standard_charge|Northern_NV_Laborers_Operators_Engineers_Electrical_Workers|PPO|negotiated_algorithm standard_charge|Northern_NV_Laborers_Operators_Engineers_Electrical_Workers|PPO|methodology additional_payer_notes|Northern_NV_Laborers_Operators_Engineers_Electrical_Workers|PPO standard_charge|Medicare|negotiated_dollar standard_charge|Medicare|negotiated_percentage standard_charge|Medicare|negotiated_algorithm standard_charge|Medicare|methodology additional_payer_notes|Medicare standard_charge|Prominence_Commerical|PPO|negotiated_dollar standard_charge|Prominence_Commerical|PPO|negotiated_percentage standard_charge|Prominence_Commerical|PPO|negotiated_algorithm standard_charge|Prominence_Commerical|PPO|methodology additional_payer_notes|Prominence_Commerical|PPO standard_charge|Prominence_Medicare|HMO|negotiated_dollar standard_charge|Prominence_Medicare|HMO|negotiated_percentage standard_charge|Prominence_Medicare|HMO|negotiated_algorithm standard_charge|Prominence_Medicare|HMO|methodology additional_payer_notes|Prominence_Medicare|HMO standard_charge|Silversummit|PPO|negotiated_dollar standard_charge|Silversummit|PPO|negotiated_percentage standard_charge|Silversummit|PPO|negotiated_algorithm standard_charge|Silversummit|PPO|methodology additional_payer_notes|Silversummit|PPO standard_charge|Wellcare|negotiated_dollar standard_charge|Wellcare|negotiated_percentage standard_charge|Wellcare|negotiated_algorithm standard_charge|Wellcare|methodology additional_payer_notes|Wellcare standard_charge|UHC_Affiliates|PPO|negotiated_dollar standard_charge|UHC_Affiliates|PPO|negotiated_percentage standard_charge|UHC_Affiliates|PPO|negotiated_algorithm standard_charge|UHC_Affiliates|PPO|methodology additional_payer_notes|UHC_Affiliates|PPO standard_charge|UHC_Medicare|HMO|negotiated_dollar standard_charge|UHC_Medicare|HMO|negotiated_percentage standard_charge|UHC_Medicare|HMO|negotiated_algorithm standard_charge|UHC_Medicare|HMO|methodology additional_payer_notes|UHC_Medicare|HMO standard_charge|min standard_charge|max "additional_generic_notes
"
HCHG CVMC ROOM/CARE - PRIVATE (0110) 110 110 rc 772001 local inpatient 3161 2212.7 87 percent of total billed charges 3264 per diem 12225 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($12225.00 base*'rw')+((los-'trim"")*3400.00pd))" 9500 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($9500.00 base*'rw')+((los-'trim"")*3400.00pd))" 3264 per diem not applicable to this contract 90 percent of total billed charges 5750 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 3500 per diem" 6100 per diem "surgery day 1-8000, medical day 1-6100 subsequent days are 4025 per diem" 4181.57 per diem 3264 per diem 6726.69 per diem 31 percent of total billed charges 79 percent of total billed charges 3427.2 per diem 5408 per diem "surgery day one-7488, medical day one-5408 subsequent days are 4160 per diem" 3264 per diem 3264 12225
HCHG CVMC ROOM/CARE - SWING BED (0120) 120 120 RC 772004 local inpatient 2303 1612.1 87 percent of total billed charges 2496 per diem 3353 per diem 3353 per diem 2496 per diem not applicable to this contract 90 percent of total billed charges 3500 per diem 4025 per diem 2705.72 per diem 2496 per diem 2866.15 per diem 31 percent of total billed charges 79 percent of total billed charges 2620.8 per diem 5408 per diem "surgery day one-7488, medical day one-5408 subsequent days are 4160 per diem" 2496 per diem 2496 5408
HCHG CVMC ROOM/CARE - SEMI PRIVATE (0120) 120 120 RC 772002 local inpatient 3010 2107 87 percent of total billed charges 3264 per diem 12225 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($12225.00 base*'rw')+((los-'trim"")*3400.00pd))" 9500 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($9500.00 base*'rw')+((los-'trim"")*3400.00pd))" 3264 per diem not applicable to this contract 90 percent of total billed charges 5750 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 3500 per diem" 6100 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 4025 per diem" 4181.57 per diem 3264 per diem 6726.69 per diem 31 percent of total billed charges 79 percent of total billed charges 3427.2 per diem 5408 per diem "surgery day one-7488, medical day one-5408 subsequent days are 4160 per diem" 3264 per diem 3264 12225
HCHG CVMC ROOM/CARE - SEMI PRIVATE TELEMETRY (0120) 120 772003 rc 772003 local inpatient 3737 2615.9 87 percent of total billed charges 3264 per diem 12225 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($12225.00 base*'rw')+((los-'trim"")*3400.00pd))" 9500 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($9500.00 base*'rw')+((los-'trim"")*3400.00pd))" 3264 per diem not applicable to this contract 90 percent of total billed charges 5750 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 3500 per diem" 6100 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 4025 per diem" 4181.57 per diem 3264 per diem 6726.69 per diem 31 percent of total billed charges 79 percent of total billed charges 3427.2 per diem 5408 per diem "surgery day one-7488, medical day one-5408 subsequent days are 4160 per diem" 3264 per diem 3264 12225
HCHG ROOM/CARE - ICU (200) 200 200 RC 770022 local inpatient 4383 3068.1 87 percent of total billed charges 3264 per diem 12225 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($12225.00 base*'rw')+((los-'trim"")*3400.00pd))" 9500 MS-DRG other "if los is>(175%*'gmlos')=trim, then allow (($9500.00 base*'rw')+((los-'trim"")*3400.00pd))" 3264 per diem not applicable to this contract 90 percent of total billed charges 5750 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 4400 per diem" 6100 per diem "surgery day 1-6000, medical day 1-5750 subsequent days are 4025 per diem" 4181.57 per diem 3264 per diem 6726.69 per diem 31 percent of total billed charges 79 percent of total billed charges 3427.2 per diem 5408 per diem "surgery day one-7488, medical day one-5408 subsequent days are 4160 per diem" 3264 per diem 3264 12225
"HCHG BLADE, GIGLI SAW" 229 272 RC 500078 local both 497 347.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ALBUTEROL MDI (PER PUFF) 250 0173-0682-24 NDC 310116 local both 2.48 1.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COMBIVENT MDI (PER PUFF) 250 0597-0024-02 NDC 310114 local both 2.89 2.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ATROVENT MDI (PER PUFF) 250 0597-0087-17 NDC 310115 local both 2.89 2.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FLOVENT 110MCG MDI (PER PUFF) 250 66993-079-96 NDC 310120 local both 13.41 9.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IPRATROPIUM BROMIDE INHAL SOL 0.5MG 250 60687-394-79 NDC 310122 local both 32.27 22.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALBUTEROL SULFATE INHAL SOL 2.5MG 250 76204-200-01 NDC 310123 local both 33.9 23.73 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG 3% HYPERTONIC SALINE 150ML 250 0338-0064-03 NDC 310124 local both 36.05 25.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC XOPENES LEVALBUTEROL 0.63/0.31MG 250 76204-800-11 NDC 310117 local both 47.02 32.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC RHO(D)IMMUNE GLOBULIN(RHIG)HUMAN MINI-DOSE 250 90385 cpt 351006 local both 48.21 33.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MUCOMYST/MUCOSIL/ACETYCYSTEINE 10% 250 0517-7604-01 NDC 310118 local both 51.59 36.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PULMICORT RESPULES 0.5MG/2ML 250 0093-681-19 NDC 310113 local both 61.81 43.27 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC LIDOCAINE HCL 4% 50ML 250 J2001 HCPCS 308248 local both 74.73 52.31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC LEXISCAN, PER 1MG" 250 J2785 HCPCS 5271905 local both 365.66 255.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC RHOGRAM 250 90384 cpt 350610 local both 420.3 294.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CONTRAST/LOW OSMOLAR 300-399MG-OMNIPAQUE 255 Q9967 HCPCS 4401004 local both 2.56 1.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VISIPAQUE 300-399 MG/ML PER ML 255 Q9967 HCPCS 4401017 local both 8.82 6.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION GAD CONTRAST PER ML 255 A9579 HCPCS 4410179 local both 18.03 12.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IONIC CONTRAST 200 255 Q9966 HCPCS 4410518 local both 30.68 21.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CONTRAST, IS0VUE-ALL" 255 Q9966 HCPCS 5270001 local both 243.06 170.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV PRE FILLED SYRINGE .9% NACL 10ML 258 8290-3065-46 NDC 309688 local both 2 1.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SOL SOD CHL 0.9% 10ML VIAL 258 0409-4888-02 NDC 309691 local both 3.32 2.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 500ML 258 J7060 HCPCS 5271906 local both 7.6 5.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .45% NACL 1000ML 258 0338-0043-04 NDC 5271915 local both 8.49 5.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 1000 ML 5% DEXTROSE 258 J7070 HCPCS 310031 local both 9.1 6.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 1000 ML DEXTROSE 5%.9% NACL 258 J7042 HCPCS 310033 local both 9.1 6.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 1000 ML DEXTROSE 5% .45% NACL 258 J7042 HCPCS 310032 local both 9.19 6.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG .9% NACL 1000 ML 258 J7030 HCPCS 310034 local both 9.46 6.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 1000 ML LACTATED RINGERS 258 J7120 HCPCS 310030 local both 10.52 7.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5%DEX .45%NACL 40MEQ 1000ML 258 0338-0675-04 NDC 310020 local both 11.14 7.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROS .45 NACL 1000ML 258 J7042 HCPCS 330907 local both 13.27 9.29 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 500ML GLASS BTL 258 J7060 HCPCS 5271907 local both 21.48 15.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NORMAL SALINE 15ML/3ML 258 J7050 HCPCS 310119 local both 33.38 23.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 500ML 258 J7060 HCPCS 310049 local both 36.15 25.31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV LACTATED RINGER 500ML 258 J7120 HCPCS 310064 local both 36.45 25.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE .45% NACL 500ML 258 J7042 HCPCS 330955 local both 36.45 25.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 100ML IN 150ML 258 J7060 HCPCS 330956 local both 36.53 25.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 1000ML 258 J7070 HCPCS 310050 local both 37.33 26.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IV 10% DEXTROSE 500ML 258 0338-0023-03 NDC 309623 local both 37.5 26.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE LR 1000ML 258 0338-0125-03 NDC 309687 local both 37.73 26.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 1000ML 258 J7030 HCPCS 309669 local both 39.06 27.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROS .25% NACL 1000ML 258 J7042 HCPCS 310051 local both 39.33 27.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIGATION SOLUTION 3000CC 258 0338-0047-27 NDC 5270003 local both 44.12 30.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE .9% NACL 1000ML 258 J7042 HCPCS 310057 local both 52.97 37.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROS .45 NACL 1000ML 258 J7042 HCPCS 310054 local both 54.62 38.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5%DEX 20%NACL 20MEQ 1000ML 258 J7042 HCPCS 309663 local both 56.77 39.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEX.45%NACL 20MEQ 1000ML 258 J7042 HCPCS 310055 local both 59.83 41.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 500ML 258 J7040 HCPCS 310074 local both 61.06 42.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE .45% NACL 500ML 258 J7042 HCPCS 310053 local both 61.07 42.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9%NACL 40MEQ KCL 1000ML 258 J7030 HCPCS 309672 local both 62.1 43.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IV .9% NACL 500ML 258 J7040 HCPCS 309610 local both 62.29 43.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 250 ML 258 J7050 HCPCS 310073 local both 62.31 43.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 250 ML 258 J7050 HCPCS 330972 local both 63.48 44.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 100ML 258 0038-0049-48 NDC 310072 local both 63.5 44.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 1000ML 258 J7030 HCPCS 310075 local both 63.73 44.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .45% NACL 1000ML 258 J7030 HCPCS 310069 local both 66.69 46.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 250ML 258 J7060 HCPCS 330975 local both 69.88 48.92 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV LACTATED RINGER 1000ML 258 J7120 HCPCS 310065 local both 70.56 49.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 50ML 258 0338-0049-41 NDC 309626 local both 70.72 49.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 250ML 258 0338-0049-02 NDC 310070 local both 71.41 49.99 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 1000ML 258 J7070 HCPCS 330978 local both 72.87 51.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE .9% NACL 1000ML 258 J7042 HCPCS 330979 local both 72.97 51.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEX.45%NACL 20MEQ 1000ML 258 J7042 HCPCS 309664 local both 73 51.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .45% NACL 1000ML 258 J7030 HCPCS 309668 local both 73.59 51.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .45% NACL 20MEQ KCL 1000ML 258 J7030 HCPCS 309671 local both 76.29 53.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .45% NACL 20MEQ KCL 1000ML 258 J7030 HCPCS 310077 local both 76.29 53.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9%NACL 40MEQ KCL 1000ML 258 J7030 HCPCS 310078 local both 76.91 53.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 20MEQ KCL 1000ML 258 J7030 HCPCS 310076 local both 77.13 53.99 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEX .9 NACL 20MEQ 1000ML 258 J7042 HCPCS 310056 local both 79.91 55.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEX .9 NACL 20MEQ 1000ML 258 J7042 HCPCS 309665 local both 80.36 56.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 20MEQ KCL 1000ML 258 J7030 HCPCS 309670 local both 83.45 58.42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIGATION SOLUTION 1000CC 258 0338-0048-04 NDC 5270002 local both 91.38 63.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 100ML IN 150ML 258 J7060 HCPCS 330902 local both 109.6 76.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV LACTATED RINGER 3000ML 258 J7120 HCPCS 310063 local both 117.57 82.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 250ML 258 J7060 HCPCS 330905 local both 121.77 85.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV .9% NACL 250 ML 258 J7050 HCPCS 307886 local both 121.77 85.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE .45% NACL 500M 258 J7042 HCPCS 330917 local both 159.26 111.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IV LACTATED RINGER 1000ML 258 J7120 HCPCS 330921 local both 169.65 118.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE 1000ML 258 J7070 HCPCS 330920 local both 169.65 118.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROSE .9%NACL 1000ML 258 J7042 HCPCS 330919 local both 169.65 118.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV 5% DEXTROS.45%NACL 1000ML 258 J7042 HCPCS 330918 local both 169.65 118.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF THERAPY-HYDRATION EA ADDHR 260 96361 cpt 304073 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX-PRO-DX IV PSH SAME DRG 260 96376 cpt 304127 local both 184 128.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION-DIAG/THERAP-SQ/IM 260 96372 cpt 304123 local both 194 135.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX-PRO-DX IV PUSH SNGL/INITIAL 260 96374 cpt 304122 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF THERAPY-TH/DIAG-CONC < 1HR 260 96368 cpt 304074 local both 205 143.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX-PRO-DX IV PUSH NEW DRG 260 96375 cpt 304125 local both 216 151.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF THERAPY/DIAG ADD HR 260 96366 cpt 304076 local both 227 158.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COLLECT BLOOD FROM PICC 260 36592 cpt 310029 local both 281 196.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COLLECT BLOOD VENOUS DEVICE 260 36591 cpt 310028 local both 281 196.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF THERAPY-TH/DIAG-SEQ < 1HR 260 96367 cpt 304077 local both 410 287 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF THERAPY-HYDRATION 31-60MIN 260 96360 cpt 304072 local both 620 434 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF THERAPY-TH/DIAG-INIT < 1HR 260 96365 cpt 304075 local both 637 445.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SWABSTICK PVP IODINE PREP 3/PK 270 A4247 HCPCS 307022 local both 1.94 1.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRESS ADAPTIC 3X3 270 270 RC 5270004 local both 5.69 3.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRESS ADAPTIC 3X9 270 270 RC 5270005 local both 19.14 13.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYDROGEL SKINTEGRITY 1OZ 270 A6248 HCPCS 503533 local both 22 15.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WC HYDROGEL SKINTEGRITY 1OZ 270 A6248 HCPCS 305067 local both 22 15.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RESTRAINT/LIMB DISP 270 270 RC 309619 local both 25.43 17.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALGINATE CAL MAXORB-EXTRA 4X4IN 270 A6196 HCPCS 503530 local both 25.46 17.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRESS STERISTRP 270 270 RC 5270006 local both 25.91 18.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CATHETER, ROBINSON-ALL" 270 270 RC 5270011 local both 52.29 36.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC VELCRO WRIST SPLINT 270 270 RC 309628 local both 57.19 40.03 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CATHETER FOLEY ALL 270 270 RC 5270009 local both 69.39 48.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CANNULA 270 270 RC 309629 local both 72.1 50.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BONE WAX 270 270 RC 5270022 local both 75.79 53.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CHOLANGIOGRAM CATHETER, ALL" 270 270 RC 5270016 local both 79.9 55.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TED HOSE-ALL 270 270 RC 5270018 local both 94.54 66.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MONOFILAMENT WIRE/ALL GAUGES 270 C1713 HCPCS 5270023 local both 111.72 78.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RESTRAINT/CHEST 270 270 RC 309618 local both 114.15 79.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GUIDE WIRE-ALL 270 C1713 HCPCS 5270015 local both 139.32 97.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SKIN GLUE 270 270 RC 309620 local both 163.52 114.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ORTHO SHOE 270 270 RC 309637 local both 173.3 121.31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FORCE FIBER SUTURE/INDIV NEEDLED (TAPERED) SIZE 2 270 270 RC 5270026 local both 189.16 132.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GELFILM OPTHALMIC DRESSING 270 270 RC 5270014 local both 191.09 133.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ENDOCLOSE SUTURING DEVICE 270 270 RC 5270013 local both 295.44 206.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CATHETER, IRRIGATING" 270 270 RC 5270010 local both 332.85 233 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BUR-ALL 270 270 RC 5270017 local both 378.13 264.69 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION SPRING-LOADED NUT 270 270 RC 5271734 local both 398.71 279.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESSING BIOBRANE 5X5 270 270 RC 501777 local both 437.42 306.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STRYKER IRRIGATOR 270 270 RC 5270025 local both 659.48 461.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INDWELLING SLIT CATHETER KIT 270 270 RC 5271281 local both 717.75 502.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLIP EXTERNAL FIXATION DYNAMIZATION 4 MED COMBO 270 270 RC 5271736 local both 781.34 546.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC POST EXTERNAL FIXATION 30DEG OUTRIGGER 8MM 270 270 RC 5271749 local both 786.55 550.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MR SAFE DYNAMIZ CLIP 270 270 RC 5271735 local both 830.1 581.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC POST EXTERNAL FIXATION OURTIGGER 11MM MR 270 270 RC 5271737 local both 833.43 583.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC POST EXTERNAL FIXATION 90DEG OUTRIGGER POST 8MM 270 270 RC 5271738 local both 859.48 601.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC POST EXTERNAL FIXATION OUTRIGGER POST 11MM MR SAF 270 270 RC 5271750 local both 916.78 641.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STAPLER ENDOCLIP 5MM 270 270 RC 5270012 local both 1460.11 1022.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP OPEN 270 270 RC 5271757 local both 1635.61 1144.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ROD EXTERNAL FIXATION ATTACHMENT 4 MED MULTI-PIN 270 270 RC 5271739 local both 1688.66 1182.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ARTHROTEK ONE-STEP GUIDE PINS 270 C1713 HCPCS 5270024 local both 1843.13 1290.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP ADJUSTABLE 270 270 RC 5271753 local both 1845.99 1292.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRUG DELIVERY SYSTEM <=5 ML 270 A4306 HCPCS 5270027 local both 1865.79 1306.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MR SAFE ROD ATTACH 270 270 RC 5271751 local both 1915.91 1341.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MEDIUM PIN 6POS 270 270 RC 5271740 local both 2006.82 1404.77 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MR SAFE LG PIN 4POS 270 270 RC 5271741 local both 2070.78 1449.55 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FIBRIN SEALANT/2.0ML/TISSEAL 270 270 RC 5270019 local both 2118.21 1482.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MR SAFE LG PIN 6POS 270 270 RC 5271742 local both 2125.69 1487.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP OPEN COMPRESSOR 270 270 RC 5271912 local both 2341.09 1638.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION COMBO MEDIUM 270 270 RC 5271743 local both 2433.35 1703.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION SMALL ADJUSTABLE 270 270 RC 5271744 local both 2534.74 1774.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ORTHOSORB ARTHROSCOPE PINS 270 C1713 HCPCS 5270008 local both 2551.73 1786.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION COMBO 8/11MM 270 270 RC 5271745 local both 2800.45 1960.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP UNIVERSAL 270 270 RC 5271754 local both 3020.71 2114.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MR SAFE TUBE-TO-TUBE 270 270 RC 5271746 local both 3087.14 2161 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP TRANSVERSE 270 270 RC 5271755 local both 3087.14 2161 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION 270 270 RC 5271747 local both 3204.65 2243.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP UNIV JOINT FOR 2 TUBES 270 270 RC 5271756 local both 3359.84 2351.89 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION ADJUSTABLE 270 270 RC 5271748 local both 3538.15 2476.71 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC AGEE WRIST JACK 270 270 RC 5270007 local both 6259.81 4381.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC EXTERNAL FIXATOR ADJUSTIBLE LARGE 270 270 RC 5271752 local both 13865.19 9705.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ACE 4"" NON-STERILE" 271 A6449 HCPCS 307024 local both 4.68 3.28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ACE 6"" NON-STERILE" 271 A6450 HCPCS 307025 local both 6.63 4.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG COBAN 2"" BLUE, NON-STERILE" 271 A6453 HCPCS 307007 local both 6.89 4.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG COBAN 4"" TAN NON-STERILE" 271 A6454 HCPCS 307026 local both 12.29 8.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC O2 PER HR BY NASAL/MASK 271 271 RC 310104 local both 35 24.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VISCOPASTE UNNAS TYPE 271 A6261 HCPCS 307157 local both 38.18 26.73 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COFLEX 2 LAYER TLC 271 A6441 HCPCS 302401 local both 86.71 60.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG TELFA, ISLAND 2"" X 3-1/4""" 272 A6219 HCPCS 307020 local both 0.62 0.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ABD PAD 8""X10""" 272 A6253 HCPCS 307021 local both 1.68 1.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,TEGADERM 2.375"" X 2.75""" 272 A6257 HCPCS 338942 local both 1.86 1.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ADAPTIC 3"" X 3""" 272 A6222 HCPCS 303310 local both 2 1.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG KLING CONFORM 4""" 272 A6446 HCPCS 307023 local both 2.12 1.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WATER 10ML FOR INJ/STERIL 272 272 RC 309692 local both 2.21 1.55 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ROLL-SOFT CONFORMING 4""" 272 272 RC 305382 local both 3 2.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, XEROFORM 1"" X 8""" 272 A6222 HCPCS 338950 local both 3.36 2.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING XEROFORM 1"" X 8""" 272 272 RC 310043 local both 3.45 2.42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, XEROFORM 5"" X 9""" 272 A6223 HCPCS 338951 local both 3.8 2.66 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,PETROLEUM GAUZE 1""X 8""" 272 A6222 HCPCS 338946 local both 3.89 2.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING XEROFORM 5"" X 9""" 272 272 RC 309677 local both 3.89 2.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ADAPTIC 3"" X 8""" 272 A6222 HCPCS 303311 local both 4 2.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ADAPTIC 3"" X 16""" 272 A6222 HCPCS 307010 local both 4.6 3.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG KERLIX, STERILE LG, 4.5"" X 4.1""" 272 A6446 HCPCS 307014 local both 4.77 3.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, COVRSITE 4"" X 4""" 272 A6220 HCPCS 338933 local both 4.77 3.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING COVERSITE 4"" X 4""" 272 A6219 HCPCS 309164 local both 4.77 3.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,PETROLEUM GAUZE 3""X 18""" 272 A6224 HCPCS 338947 local both 5.04 3.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, TEGADERM 4"" X 4.75""" 272 A6258 HCPCS 338939 local both 5.57 3.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SCRUB SPONGE E-Z 4% 272 A6402 HCPCS 301019 local both 5.75 4.03 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SPONGE,GAUZE,STER,2X2,2/PK" 272 A6402 HCPCS 305302 local both 6 4.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, VASELINE 3"" X 9""" 272 A6223 HCPCS 338948 local both 6.01 4.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING SOFT CLOTH 3""X10""" 272 272 RC 309674 local both 7.47 5.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, SOFT CLOTH 3""X10""" 272 272 RC 310081 local both 7.47 5.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, 3M SOFT CLOTH ADH 3""X10""" 272 A6220 HCPCS 338944 local both 7.87 5.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC GAUZE VASELINE 1/2"" X 72""" 272 272 RC 309679 local both 7.87 5.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, COVRSITE 6"" X 6""" 272 A6219 HCPCS 338934 local both 8.66 6.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING COVERSITE 6"" X 6""" 272 A6219 HCPCS 309165 local both 8.91 6.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, TEGADERM 6"" X 8""" 272 A6258 HCPCS 338941 local both 11.23 7.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, FLEXIGEL STRANDS PER GRAM" 272 A6262 HCPCS 338935 local both 11.43 8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, VASELINE .5"" X 72""" 272 A6223 HCPCS 338949 local both 11.58 8.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC TEGADERM, SMALL" 272 A6257 HCPCS 5270040 local both 12.68 8.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TEGADERM 272 A6257 HCPCS 309635 local both 12.71 8.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC GAUZE VASELINE 3"" X 9"" OVERWRP" 272 272 RC 310041 local both 12.91 9.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG 1/4"" PLAIN PACKING NUGAUZE" 272 A6407 HCPCS 307027 local both 12.99 9.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG 1/2"" PLAIN PACKING NUGAUZE" 272 A6407 HCPCS 307152 local both 13.08 9.16 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, TEGADERM 4"" X 10""" 272 A6258 HCPCS 338940 local both 13.26 9.28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG 1/4"" IODOFORM PACKING" 272 A6407 HCPCS 307153 local both 13.52 9.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TEGADERM LARGE 272 A6258 HCPCS 5270039 local both 14.39 10.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, ALGISITE PER 6 INCHES" 272 A6199 HCPCS 338932 local both 14.41 10.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, SOLOSITE GEL PER OZ" 272 A6248 HCPCS 338936 local both 15.03 10.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ALLEVYN 2"" X 2"" ADHESIVE" 272 A6209 HCPCS 307012 local both 15.11 10.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TEGADERM LG 272 A6258 HCPCS 309636 local both 15.96 11.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG 1/2"" IODOFORM PACKING" 272 A6266 HCPCS 307154 local both 16.18 11.33 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG FOAM-NON ADHESIVE 4X4""" 272 A6212 HCPCS 302765 local both 16.62 11.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ALLEVYN LIFE 4"" X 4"" ADHESIVE" 272 A6212 HCPCS 307011 local both 16.62 11.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTILOCK DRESSING 272 A6251 HCPCS 302402 local both 16.97 11.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDEMENT TRAY 272 A4550 HCPCS 307155 local both 17.15 12.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, SILVASORB STRANDS, 1GM" 272 A6262 HCPCS 338953 local both 17.25 12.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, FLEXIGEL SHEET, 2"" X 2""" 272 A6242 HCPCS 338937 local both 17.32 12.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COVRSITE PLUS 4X4 272 272 RC 309638 local both 18.03 12.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ADAPTIC TOUCH NON-ADHERING SILICONE DRESSING 3X4 1/4 272 A6206 HCPCS 360830 local both 18.21 12.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, ALLEVYN 3"" X 3""" 272 A6212 HCPCS 338925 local both 19.36 13.55 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INTRASITE GEL FILLER 15GM 272 A6261 HCPCS 307156 local both 21.48 15.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH HYDROGEL DRESSING WOUND COVER 4 X 4 272 A6242 HCPCS 5070047 local both 22 15.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, REPLICARE 3.5""X5.5""" 272 A6235 HCPCS 338929 local both 22.19 15.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COMPRESSION STOCKING-KNEE HIGH 272 272 RC 343752 local both 22.54 15.78 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG .9% NACL 250ML BOTTLE 272 272 RC 310066 local both 22.57 15.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRSSNG ADH FM 5 5/8X5 5/8 272 A6212 HCPCS 306604 local both 23.05 16.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLLAGEN PURACOL 2X2 272 A6021 HCPCS 503853 local both 23.65 16.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, FLEXIGEL SHEET,4""X4""" 272 A6242 HCPCS 338938 local both 23.69 16.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ALLEVYN LIFE 6"" X 6""" 272 A6212 HCPCS 303308 local both 25 17.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DRESSING-CA ALGINATE ROPE 12""" 272 A6199 HCPCS 303489 local both 25.36 17.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, ALGISITE 4"" X 4""" 272 A6196 HCPCS 338931 local both 25.46 17.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, ALLEVYN 5"" X 5""" 272 A6213 HCPCS 338926 local both 25.63 17.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG HYDROCOLLOID 4X4""" 272 A6235 HCPCS 305007 local both 25.91 18.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 3-WAY CATHETER 272 A4355 HCPCS 309156 local both 26.09 18.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING ALGISITE 4"" X 4""" 272 A6196 HCPCS 309158 local both 26.55 18.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TAPE UMBILICAL COTTON 272 272 RC 5271787 local both 27.05 18.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG .9% NACL 250ML BOTTLE 272 272 RC 309681 local both 29.21 20.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COVRSITE 6X6 272 272 RC 309639 local both 29.59 20.71 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG WATER STERILE 500ML 272 272 RC 309685 local both 30.25 21.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PICC/CENTRAL LINE DRESSING CHANGE KIT 272 A4649 HCPCS 307018 local both 30.94 21.66 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,MAXORB AG SILVER ALGINATE" 272 A6196 HCPCS 338952 local both 32.53 22.77 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESSING MEDIHONEY 2.8X2.8IN SHEET ADH HCS 272 A6237 HCPCS 501847 local both 33.41 23.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, REPLICARE 4"" X 4""" 272 A6234 HCPCS 338930 local both 34.38 24.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING ALLEVYN 5"" X 5""" 272 A6214 HCPCS 309162 local both 35.11 24.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WATER 10ML FOR INJ/STERIL 272 272 RC 310045 local both 35.43 24.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG WATER STERILE 500ML 272 272 RC 310060 local both 36.92 25.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG .9% NACL 500ML BOTTLE 272 272 RC 309682 local both 38.23 26.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG WATER STERILE 1000ML 272 272 RC 309683 local both 38.73 27.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG GEL,MEDIHONEY 0.5 OZ" 272 A6240 HCPCS 309699 local both 39 27.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IODOSORB FLEX 4/6 272 A6262 HCPCS 501992 local both 39.25 27.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, TEGADERM ABS,4"" X 4""" 272 A6203 HCPCS 338943 local both 39.95 27.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYDROGEL SILVER 3 0Z. 272 A6248 HCPCS 306251 local both 39.98 27.99 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING REPLICARE 4"" X 4""" 272 A6234 HCPCS 309167 local both 42.48 29.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SALINE FLUSH 272 A4216 HCPCS 309151 local both 42.78 29.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG WATER STERILE 2000ML 272 272 RC 309684 local both 43.75 30.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYDROGEL WOUND DRESSING 3.75X3.75 272 A6242 HCPCS 305557 local both 44 30.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MARATHON SKIN PROTECTANT 272 A6250 HCPCS 302400 local both 44.2 30.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ACTICOAT FLEX-7 2"" X 2""" 272 A6206 HCPCS 307008 local both 44.28 31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,MEPIFORM,SOFT SILICONE 2X3" 272 A4649 HCPCS 338956 local both 44.28 31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BONE WAX 2.5G 272 272 RC 5271770 local both 45.34 31.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEMOCLIPS-SM 272 272 RC 5270072 local both 46.23 32.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYDROGEL 3 OZ 272 A6248 HCPCS 303824 local both 47 32.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COMPRESSION STOCKING-THIGH HIGH 272 272 RC 342753 local both 47.02 32.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ALLEVYN LIFE SACRUM SMALL 272 A6213 HCPCS 303309 local both 48 33.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLIP FIXING DEVICE ENDO 272 272 RC 503105 local both 49 34.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG .9% NACL 500ML BOTTLE 272 272 RC 310067 local both 49.7 34.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG WATER STERILE 1000ML 272 272 RC 310061 local both 50.35 35.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG .9% NACL 1000ML BOTTLE 272 272 RC 310068 local both 50.35 35.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DRESSING, SILVASORB GEL 0.25OZ" 272 A6248 HCPCS 305071 local both 51.86 36.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING ALLEVYN 7"" X 7""" 272 A6214 HCPCS 309163 local both 53 37.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRESSING ALLEVYN SACRUM 272 A6213 HCPCS 5271795 local both 53 37.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,ALLEVYN SACRUM 6""X6""" 272 A6213 HCPCS 338928 local both 53.03 37.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,BIOPATCH DISK 2.5CM" 272 A6209 HCPCS 338957 local both 53.65 37.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE/BUTTON TENDON REPAIR 272 272 RC 5271771 local both 54 37.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SUTURE, ALL COMMON" 272 272 RC 309630 local both 54.78 38.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SILVERCEL 1"" X 12""" 272 A6196 HCPCS 307017 local both 56.75 39.73 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE 272 272 RC 5271784 local both 57.95 40.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, ALLEVYN 6"" X 6""" 272 A6213 HCPCS 338927 local both 59.13 41.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING ACTICOAT 4"" X 4""" 272 272 RC 338955 local both 59.4 41.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DRESSING PROMOGRAN W/O SILVER 4.34""" 272 A6021 HCPCS 303326 local both 60 42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING UNNA BOOT 4""X10'" 272 272 RC 309675 local both 62.16 43.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, UNNA BOOT 4""X10'" 272 272 RC 310079 local both 62.16 43.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING ACTICOAT 4"" X 4""" 272 A9270 HCPCS 309173 local both 62.93 44.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DRESSING,HYDROFERA BLUE 4X4" 272 A6209 HCPCS 338959 local both 63.4 44.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTIFOAM HEEL DRESSING 272 A6210 HCPCS 302247 local both 64 44.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE 272 272 RC 5271772 local both 65.57 45.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLLAGEN PURACOL AG WITH SILVER 2X2 272 A6021 HCPCS 503854 local both 67 46.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC OP-SITE DRESSING LARGE 272 272 RC 5270034 local both 67.04 46.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRESSING BIOPATCH ANTIMICROBIAL 272 272 RC 310082 local both 68.53 47.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BIOSTEP 2X2 SHEET 272 A6021 HCPCS 342750 local both 69.03 48.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG REPLICARE SACRUM 7"" X 8""" 272 A6235 HCPCS 307016 local both 71.69 50.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESSING MEDIHONEY 2.4X2.4IN SHEET NON ADH 272 A6234 HCPCS 501845 local both 75 52.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ABDOMINAL BINDER 272 272 RC 342751 local both 79.55 55.69 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESSING PRMOGRN PRISMA MATRIX 4X4 272 A6021 HCPCS 303307 local both 80 56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING,SILVASORB SHEET,4""X4""" 272 A6242 HCPCS 338954 local both 81.58 57.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESSING MEDIHONEY 4.3 X4.3 IN SHEET NON ADH 272 A6235 HCPCS 501846 local both 82 57.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEMOCLIPS-MED 272 272 RC 5270071 local both 83.17 58.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IODOSORB GEL 272 A6261 HCPCS 501991 local both 86.89 60.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SAW BLADE SAGITTAL AGGRESSIVE 272 272 RC 503997 local both 88.48 61.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESS, SM BURN" 272 272 RC 309633 local both 89.88 62.92 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, COBAN 2 COMPRESSION" 272 272 RC 310080 local both 95.68 66.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DURAFIBER AG 4"" X 4""" 272 A6196 HCPCS 307013 local both 99.44 69.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG GEL,MEDIHONEY 1.5 OZ" 272 A6240 HCPCS 309698 local both 102 71.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESSING POWDER ARGLAES PER GM 272 A6262 HCPCS 343007 local both 102.09 71.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEMCLIP CARTRIDGE 272 272 RC 5270033 local both 109.97 76.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEMOCLIPS-MED/LD 272 272 RC 5270069 local both 110.84 77.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IRRIG .9 NACL 1000ML BOTTLE 272 272 RC 309624 local both 112.98 79.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MONOCRYL 4-0 PS-2 272 272 RC 5271758 local both 113.32 79.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEMOCLIPS-LG 272 272 RC 5270070 local both 113.58 79.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ACTICOAT FLEX-7 4"" X 5""" 272 A6206 HCPCS 307009 local both 120.92 84.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SILVASORB GEL 1.5 OZ. TUBE 272 272 RC 310040 local both 127.28 89.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IV SOLUSET 272 272 RC 309622 local both 132.87 93.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESSING, SILVASORB GEL 1.5OZ" 272 A6248 HCPCS 338945 local both 133.74 93.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPSITE FLEXIFIX FILM 272 A6257 HCPCS 307015 local both 134.62 94.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRESS MED BURN 272 272 RC 309632 local both 134.72 94.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FIBERWIRE 2 SUTURE 272 272 RC 5270056 local both 159.11 111.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CAP PROTECTIVE 11MM TUBES&RODS 272 272 RC 5271759 local both 161.05 112.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SUTURE SURGITIE 2/0 21"" 5CM" 272 272 RC 5271911 local both 167.85 117.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE WIRE FIBERWIRE 272 272 RC 5271761 local both 168.47 117.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SUTURE, QUILL" 272 272 RC 502779 local both 169 118.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ENDOSTITCH SUTURE REFIL 272 272 RC 5270042 local both 172.89 121.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DRESS, LG BURN" 272 272 RC 309631 local both 179.53 125.67 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TRACH DISP INNER CANNULA 272 272 RC 309634 local both 179.53 125.67 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CASTELLANI PANT 1 OZ 272 272 RC 305072 local both 181.2 126.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE 272 272 RC 5271777 local both 186.06 130.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE 272 272 RC 5271781 local both 190.13 133.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE 272 272 RC 5271778 local both 197.18 138.03 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEM-O-LOK 272 272 RC 5270074 local both 201.75 141.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE 272 272 RC 5271776 local both 204.45 143.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DILATOR, SERIAL PEEL AWAY 22-*" 272 272 RC 4410472 local both 206 144.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC FIBERLOOP 4-0 20"" W/NEEDLE" 272 272 RC 5271914 local both 210.61 147.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG STENT, SHEATH INTRO" 272 C1894 HCPCS 4410296 local both 223.86 156.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUTURE WIRE 272 272 RC 5271794 local both 225.14 157.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SKIN STAPLES 272 272 RC 309621 local both 226.68 158.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE TK-5 TITANIUM TOP KNOT 272 272 RC 5271765 local both 254.19 177.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SUTURE WIRE FIBERWIRE #5 38""" 272 272 RC 5271762 local both 261.45 183.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CONCEPT SHUTTLE-RELAY SUTURE 272 272 RC 5270044 local both 266.27 186.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG GUIDE WIRE, HYDROPHILIC HYBRID" 272 C1769 HCPCS 4410477 local both 276.78 193.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SUTURE PDS II 2-0 STP 10 27""" 272 272 RC 5271929 local both 286.07 200.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SPIKED WASHERS 272 C1713 HCPCS 5270036 local both 312.03 218.42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SUTURE WIRE FIBERWIRE #2 38""" 272 272 RC 5271763 local both 312.29 218.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC HEMOSTAT SURGICEL 2"" X 3""" 272 272 RC 5271785 local both 314.32 220.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CAP PROTECTIVE-PINS 272 272 RC 5271760 local both 330.08 231.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE WIRE FIBERSTICK #2 272 272 RC 5271764 local both 334.07 233.85 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STAPLES RELOAD 272 272 RC 5270066 local both 380.77 266.54 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BLADE, OSCILLATING" 272 272 RC 500082 local both 396 277.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXTRA SUTURE 272 272 RC 303747 local both 459 321.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PORT-A-CATH INTRODUCER SET 272 272 RC 5270043 local both 468.39 327.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ON Q PAINBUSTER COMPONENT, TUNNELING" 272 C1887 HCPCS 5271901 local both 508.37 355.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISP ENTRY NEEDLE 272 272 RC 303456 local both 516 361.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC HEMOSTAT SURGICEL 4"" X 8""" 272 272 RC 5271786 local both 574.02 401.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CATH, COMPLIANT OCCL BALLOON" 272 C2628 HCPCS 4410475 local both 588.13 411.69 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUTURE NICE LOOP SZ.5 WHITE/GREEN 272 272 RC 501784 local both 595.69 416.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUTURE NICE LOOP SZ.5 GREEN 272 272 RC 501783 local both 595.69 416.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DACRON POUCH-MEDTRONIC 272 272 RC 5270075 local both 617.31 432.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GIA RELOADS 272 272 RC 5270067 local both 644.64 451.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ARISTA ABSORBABLE HEMOSTAT 1GM 272 272 RC 5271910 local both 718.98 503.29 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 18 GUAGE SUTURE WIRE 272 272 RC 5270061 local both 775.85 543.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FIBERTAPE-SUTURE FOR INTERNAL ROTATOR CUFF REPAIRS 272 272 RC 5270062 local both 777.09 543.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC EXPRESSO SUTURES NEEDLES 272 272 RC 5270063 local both 819.94 573.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CATHETER CV 7FR 3-LUMEN POWER 272 A4300 HCPCS 5271298 local both 864.57 605.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WOUND SUCTION DISPOSABLE INCL DRESS ALL ACCESS 272 A9272 HCPCS 503857 local both 959.9 671.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FLEX NECK PERITONEAL DIALYSIS CATHETER 272 C1750 HCPCS 5270060 local both 978.12 684.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ENDOSTITCH 272 272 RC 5270030 local both 1065.74 746.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FLOSEAL 272 272 RC 5270068 local both 1088.61 762.03 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ORTHOSORB ABSORBABLE PIN 272 C1713 HCPCS 5270035 local both 1170.49 819.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GIA STAPLER 272 272 RC 5270032 local both 1179.37 825.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ADEPT ADHESION REDUCTION SOLUTION 272 272 RC 5270065 local both 1208.73 846.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SMART PORT CT LP W/6.5FR CATH 272 272 RC 5271945 local both 1262.52 883.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SMART PORT CT W/8FRCATHETER 272 272 RC 5271944 local both 1262.52 883.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TEMP PACING KIT 272 272 RC 302892 local both 1346 942.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INTRATHECAL CATHETER PUMP SEGMENT REVISION KIT 272 272 RC 5270073 local both 1553.86 1087.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LASER FIBER FLEXIVA PULSE ID 500 MICRON 272 C1773 HCPCS 504001 local both 1590.54 1113.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STAPLER/ENDOHERNIA/UNVRSL/4.0 272 272 RC 5270029 local both 1757.96 1230.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC OASIS ULTRA TRI-LAYER MATRIX 272 Q4124 HCPCS 501993 local both 1776.92 1243.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PREVENA WOUND MANAGEMENT SYSTEM 272 A4649 HCPCS 5271299 local both 1922.91 1346.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DERMA-CLOSE KIT, SURGICAL STAPLE" 272 272 RC 5270059 local both 1942.32 1359.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TOURNIER 5.0 MM INSITE BIO FORCE FIBER SUTURE 272 272 RC 5270064 local both 2191.59 1534.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CATHETER, GUIDING-ON-Q PAINBUSTER W/SILVERSOAKER" 272 C1887 HCPCS 5271733 local both 2272.53 1590.77 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ABSTACK-AUTOSUTURE 272 272 RC 5270031 local both 2326.91 1628.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ELECTROPHYSIOLOGY, DIAG" 272 C1730 HCPCS 4410516 local both 2341.51 1639.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE LESS CATHETER 272 272 RC 5270076 local both 2699.84 1889.89 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NECK COLLAR 274 L0120 HCPCS 304418 local both 27.22 19.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHOULDER IMMOBILIZER 274 L3677 HCPCS 309519 local both 59.31 41.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG ORTHOTIC HEEL LIFT 274 L3332 HCPCS 304706 local both 67.48 47.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WRIST SPLINT 274 L3908 HCPCS 330981 local both 81.35 56.95 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG GEL ANKLE CONTROL ORTHOSIS PREFAB 274 L4350 HCPCS 302040 local both 101 70.7 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CERVICAL COLLAR PHILLY 274 L0140 HCPCS 309498 local both 106.07 74.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FINGER SPLINT 274 L3929 HCPCS 330904 local both 116.91 81.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG FINGER ORTHOTIC,PIP/DIP" 274 L3925 HCPCS 305138 local both 116.91 81.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ELBOW BRACE 274 L3760 HCPCS 310093 local both 116.91 81.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DYNAMIC FINGER SPLINT 274 L3929 HCPCS 330909 local both 134.72 94.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LONGIT ARCH SUPPORT 274 L3040 HCPCS 309518 local both 137.27 96.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CUSTOM ARCH SUPPORT 274 L3010 HCPCS 309513 local both 137.27 96.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC WRIST HAND FINGER ORTHOSIS, W/O JOINT, PREFABRICATED" 274 L3807 HCPCS 309529 local both 151.33 105.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC ELBOW ORTHOSIS, ELASTIC, PREFABRICATED" 274 L3960 HCPCS 310094 local both 151.33 105.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SPLINT FINGER 274 L3807 HCPCS 309527 local both 200.56 140.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG NON PNEUM WALK BOOT PRE OTS 274 L4387 HCPCS 302707 local both 207 144.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KNEE IMMOBILIZER CHILD 274 L1820 HCPCS 309508 local both 208.16 145.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PALMER 274 L3931 HCPCS 304725 local both 209.09 146.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHORT THUMB SPICA (CUSTOM) 274 L3808 HCPCS 330929 local both 209.09 146.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WALKING BOOT/SHORT - ALL SIZES 274 L4360 HCPCS 330934 local both 217.15 152.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KNEE IMMOBILIZER ADULT 274 L1820 HCPCS 309507 local both 231.16 161.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CUSTOM WRIST COCK UP 274 L3908 HCPCS 330941 local both 269.43 188.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WALKING BOOT-XLARGE 274 L4360 HCPCS 330942 local both 274.26 191.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LONG ARM SPLINT 274 L3982 HCPCS 309534 local both 336.91 235.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LONG THUMB SPICA (CUSTOM) 274 L3808 HCPCS 330952 local both 336.91 235.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DYNAMIC SPLINT 274 L3806 HCPCS 309525 local both 373.12 261.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG KNEE BRACE 274 L1832 HCPCS 309599 local both 517 361.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG ANKLE BRACE, ALL" 274 L1930 HCPCS 302061 local both 580.66 406.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KNEE BRACE/HINGED POST-OP 274 L1810 HCPCS 5270077 local both 830.41 581.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHOULDER BRACE 274 L3678 HCPCS 310095 local both 898.37 628.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CUSTOM POST OP HIP ABDUCTION 274 L1685 HCPCS 5271908 local both 4284.86 2999.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LENS SUPPLY (ONLY) 276 C1780 HCPCS 5270078 local both 32.5 22.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ASTIGMATISM CORRECTING IOL 276 V2787 HCPCS 5270081 local both 732.91 513.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LENS/POSTERIOR CHAMBER INTRAOCULAR 276 V2632 HCPCS 5270079 local both 954.95 668.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MULTIFOCAL INTRAOCULAR LENS 276 V2788 HCPCS 5270080 local both 1294.7 906.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CRYSTALENS/PREBYOPIA CORRECTING FUNCTION 276 V2788 HCPCS 5270082 local both 1530.1 1071.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC K-WIRE THREADED 278 C1769 HCPCS 5271927 local both 44.73 31.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CATH, STRAIGHT/ROBINSON" 278 C1758 HCPCS 310017 local both 52.46 36.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC METACARPOPHALANGEAL K-WIRE 278 C1713 HCPCS 5270086 local both 54 37.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BRAUN EPIDURAL CATHETER SET:20 278 278 RC 5270540 local both 60.39 42.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CROSS DRIVE SCREW 2.0X11MM 278 C1713 HCPCS 5270449 local both 69.07 48.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHO MINI SCREW #25-672-09-1 278 C1713 HCPCS 5270452 local both 69.07 48.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KIT-FEMALE CATH 278 C1758 HCPCS 310019 local both 72.32 50.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOGNATHIC SCREW #25-679-05 278 C1713 HCPCS 5270399 local both 72.71 50.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOGNATHIC SCREW #25-676-05 278 C1713 HCPCS 5270393 local both 72.71 50.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOGNATHIC SCREW #25-679-07 278 C1713 HCPCS 5270398 local both 72.71 50.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC K-WIRE 278 C1769 HCPCS 5271652 local both 76.37 53.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOGNATHIC SCREW #25-678-07 278 C1713 HCPCS 5270394 local both 79.99 55.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOGNATHIC SCREW #25-678-05 278 C1713 HCPCS 5270395 local both 79.99 55.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOGNATHIC SCREW #25-673-05 278 C1713 HCPCS 5270451 local both 79.99 55.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MINI 4 HOLE PLATE #25-550-04 278 C1713 HCPCS 5270453 local both 107.25 75.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW 3.5MM-ALL 278 C1713 HCPCS 5270114 local both 107.43 75.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LP PLATE STRAIGHT 4 HOLE 278 C1713 HCPCS 5270444 local both 112.71 78.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LP PLATE L-SHAPE/4 HOLE SHORT 278 C1713 HCPCS 5270446 local both 112.71 78.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ZIMMER CORTICAL SCREW 2.0X12 278 C1713 HCPCS 5270538 local both 113.78 79.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW 2.7MM ALL 278 C1713 HCPCS 5270415 local both 113.84 79.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS SCREW 4.0MM-ALL 278 C1713 HCPCS 5270115 local both 115.69 80.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW 2.0 ALL SIZES-ZIMMER 278 C1713 HCPCS 5270264 local both 116.94 81.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTICAL 4.5X14-75MM 278 C1713 HCPCS 5270126 local both 119.82 83.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTICAL 2.0X10-18MM 278 C1713 HCPCS 5270124 local both 130.25 91.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTICAL 1.5X6-16MM 278 C1713 HCPCS 5270123 local both 130.25 91.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4-HOLE PLATE #50-321-04 278 C1713 HCPCS 5270400 local both 132.69 92.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS SCREW 4.0/THREAD SYN 278 C1713 HCPCS 5270482 local both 138.53 96.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5 CORTEX SCREW(SELF-TAPPING) ALL SIZES-SYNTHES 278 C1713 HCPCS 5270306 local both 153.8 107.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KWIRE TROC PT 1.6 X 150MM 278 C1769 HCPCS 5271651 local both 159.1 111.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-3.5MM SCREW LCP SHFT 278 C1713 HCPCS 5271354 local both 171.04 119.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5 CORTEX SCREW-DHS SET 278 C1713 HCPCS 5270190 local both 180.56 126.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC K-WIRE 16MM SS 278 C1769 HCPCS 5271653 local both 181.56 127.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH SURGIPRO MONOFILAMENT 1"" X 4""" 278 C1781 HCPCS 5272101 local both 184.68 129.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTEX SCREW 2.0 ALL SIZES 278 C1713 HCPCS 5270258 local both 187.4 131.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES CORTEX SCREW 3.5-ALL 278 C1713 HCPCS 5270479 local both 189.58 132.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTEX SLFTAP 278 C1713 HCPCS 5271830 local both 191.73 134.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC STEINMAN PIN- ALL 278 C1713 HCPCS 5270104 local both 194.45 136.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER-IMPLANT 278 C1713 HCPCS 5271367 local both 197.68 138.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC ATRIUM, PROLITE MESH 3X6" 278 C1781 HCPCS 5270385 local both 207.56 145.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER 10.0MM 278 C1713 HCPCS 5271364 local both 209.16 146.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER 278 C1713 HCPCS 5270343 local both 217.87 152.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTICAL 4.5X80-120MM 278 C1713 HCPCS 5270125 local both 218.92 153.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER-IMPLANT METAL 13.0MM 278 C1713 HCPCS 5271368 local both 218.96 153.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LP PLATE L-SHAPE/4 HOLE-LONG 278 C1713 HCPCS 5270445 local both 227.21 159.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER 278 C1713 HCPCS 5270428 local both 231.66 162.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH SURGIPRO MONOFILAMENT 3"" X 5""" 278 C1781 HCPCS 5272102 local both 232.62 162.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 6 HOLE PLATE #50-330-06 278 C1713 HCPCS 5270424 local both 236.3 165.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 6 HOLE PLATE #50-331-06 278 C1713 HCPCS 5270423 local both 236.3 165.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH SURGIPRO MONOFILAMENT 4"" X 6""" 278 C1781 HCPCS 5272103 local both 240.02 168.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG OASIS SKIN MATRIX PER SQUARE CM 278 Q4102 HCPCS 343159 local both 245.71 172 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES PROTECTIVE CAPS FOR 6.0MM FIXATION PINS 278 C1713 HCPCS 5270218 local both 247.48 173.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS BONE SCREW 6.5 32MM 278 C1713 HCPCS 5270360 local both 254.18 177.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS SCREW 3X12-14 278 C1713 HCPCS 5270344 local both 254.19 177.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS SCREW 4X14-22 278 C1713 HCPCS 5270345 local both 254.19 177.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW 3.5X14 278 C1713 HCPCS 5270346 local both 254.19 177.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-6.5MM CANC SCREW 278 C1713 HCPCS 5271361 local both 256.51 179.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTEX SCREW 2.7MM 278 C1713 HCPCS 5270465 local both 259.65 181.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC CORTEX SCREWS, ALL SIZES" 278 C1713 HCPCS 5270234 local both 262.46 183.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC K-WIRE TROCAR 278 C1769 HCPCS 5271928 local both 265.17 185.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-6.5MM CANC SCREW 278 C1713 HCPCS 5271362 local both 276.12 193.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PRE STEPPED CHIN PLATE 5MM 278 C1713 HCPCS 5270448 local both 281.75 197.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ONE THIRD TUBULAR 7 HOLE PLATE 278 C1713 HCPCS 5270413 local both 281.81 197.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-6.5MM CANC BONE SCREW FULL THR 278 C1713 HCPCS 5271363 local both 290.5 203.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW COMPRESSING ALL SIZES 278 C1713 HCPCS 5270122 local both 290.76 203.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ONE THIRD TUBULAR 6 HOLE PLATE 278 C1713 HCPCS 5270414 local both 298.84 209.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PIN STEINMAN TRACTION 278 C1713 HCPCS 5271564 local both 318.6 223.02 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,PROTECTIVE CAPS FOR 6.0MM FIXATION PINS" 278 C1713 HCPCS 5270215 local both 321.72 225.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW DHS/DCS COMP SCREW 36MM 278 C1713 HCPCS 5271554 local both 321.87 225.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DHS COMPRESSION SCREW 278 C1713 HCPCS 5271809 local both 321.87 225.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH SURGIPRO MONOFILAMENT 6"" X 6""" 278 C1781 HCPCS 5272104 local both 332.33 232.63 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG ARROW INTRODUCER (PERCUTAN KIT) 278 C1894 HCPCS 310018 local both 336.65 235.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TENSION BAND PIN 278 C1713 HCPCS 5271644 local both 341.34 238.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW #22-673-07 278 C1713 HCPCS 5270455 local both 351.49 246.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW #25-673-11 278 C1713 HCPCS 5270456 local both 351.49 246.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC STRAIGHT PLATE 17 HOLE 278 C1713 HCPCS 5270447 local both 354.47 248.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG ALLOFUSE DBM PUTTY 1.0CC/PER 0.5CC 278 C9359 HCPCS 370035 local both 363.12 254.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG ALLOFUSE DBM PUTTY 2.5CC/PER 0.5CC 278 C9359 HCPCS 370036 local both 363.12 254.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHO SCREW #25-678-04 278 C1713 HCPCS 5270493 local both 367.47 257.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG K-WIRE 278 C1713 HCPCS 5072201 local both 382 267.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC KLS-SCREW, TITANIUM ALLOY" 278 C1713 HCPCS 5270480 local both 384.92 269.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 11 HOLE PLATE #50-280-03 278 C1713 HCPCS 5270396 local both 390.82 273.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 11-HOLE PLATE #50-282-03 278 C1713 HCPCS 5270397 local both 390.82 273.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 11 HOLE MM PLATE #50-282-00 278 C1713 HCPCS 5270421 local both 399.92 279.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 11 HOLE MM PLATE #50-280-00 278 C1713 HCPCS 5270422 local both 399.92 279.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES TITANIUM LOCKING SCREWS 4.0 MM FOR IM NAILS 278 C1713 HCPCS 5270318 local both 407.1 284.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE 1/4 TUBULAR 6 HOLE 278 C1713 HCPCS 5270085 local both 437.28 306.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG STIFF GLIDEWIRE .035"" 180CM" 278 C1769 HCPCS 4410604 local both 461 322.7 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW 278 C1713 HCPCS 5270130 local both 479.32 335.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACUMED 3.5MM X 20.0 MM SCREW 278 C1713 HCPCS 5270527 local both 479.32 335.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACUMED 3.5MM X 16.0MM SCREW 278 C1713 HCPCS 5270528 local both 479.32 335.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW CORTICAL SCREW 278 C1713 HCPCS 5271628 local both 479.32 335.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACUMED 3.0-3.5 X 16-45 NON LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271799 local both 493.85 345.7 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEMA CARTIOD PATCH VASCULAR 278 C1768 HCPCS 5270261 local both 498.78 349.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC COMP RVS SHLDR STEINMAN PIN 9""" 278 C1713 HCPCS 5271309 local both 516.07 361.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SCHANZ SCREWS, ALL SIZES" 278 C1713 HCPCS 5270235 local both 517.82 362.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ZIMMER-5 HOLE PLATE 278 C1713 HCPCS 5271803 local both 530.01 371.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW CANCELLOUS SCREW 278 C1713 HCPCS 5271629 local both 537.42 376.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTEX ST 278 C1713 HCPCS 5271930 local both 540.11 378.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TRIMED-CORTICAL SCREWS 278 C1713 HCPCS 5271807 local both 544.68 381.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL HEX SCREW 3.2MM 278 C1713 HCPCS 5270245 local both 544.69 381.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VANGRD SSK FEMORAL STEM SCREW 278 C1713 HCPCS 5271308 local both 551.95 386.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING BONE SCREW 278 C1713 HCPCS 5270131 local both 559.21 391.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACUMED 3.5MM X 14.0MM SCREW 278 C1713 HCPCS 5270526 local both 559.21 391.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ENDO HERNIA STAPLER REFILL 278 278 RC 5270089 local both 559.34 391.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW NON-LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271624 local both 566.47 396.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM END CAP FOR ENDERNAIL 278 C1713 HCPCS 5270519 local both 567.2 397.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER AO SPIKED 8 X 3.2 SMALL 278 C1713 HCPCS 5271365 local both 568.65 398.06 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BAR(CARBON FIBER ROD) 120MM 278 C1713 HCPCS 5270239 local both 591.31 413.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PIN STEIMANN 278 C1713 HCPCS 5271565 local both 591.53 414.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PEG SMOOTH/ ALL SIZES 278 C1713 HCPCS 5270469 local both 599.16 419.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PEG PARTIAL THREAD-ALL 278 C1713 HCPCS 5270440 local both 599.16 419.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW-ALL (DEPUY) 278 C1713 HCPCS 5270441 local both 599.16 419.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW #25-677-08 278 C1713 HCPCS 5270457 local both 599.16 419.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW #25-677-10 278 C1713 HCPCS 5270458 local both 599.16 419.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW PEGS/ ALL SIZES 278 C1713 HCPCS 5270468 local both 599.16 419.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ 278 C1713 HCPCS 5271566 local both 601.33 420.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC PROSTHESIS, BREAST IMPLANT" 278 A4648 HCPCS 5270105 local both 606 424.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW NON-LOCK GOLD 278 C1713 HCPCS 5271932 local both 610.06 427.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL LAG SCREW 3.2MM 278 C1713 HCPCS 5270246 local both 617.31 432.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PEEL AWAY SUPRAPUBIC CATHETER 278 C2627 HCPCS 302524 local both 628 439.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 2.5MM CANCELLOUS SCREW 278 C1713 HCPCS 5270113 local both 631.15 441.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH-ATRIUM 6X6 278 C1781 HCPCS 5270091 local both 639.09 447.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHREX FASTAK II SPEAR 278 C1713 HCPCS 5270411 local both 639.09 447.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTICAL SCREW 278 C1713 HCPCS 5271630 local both 639.1 447.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REVERSE STEINMAN PIN 278 C1713 HCPCS 5270330 local both 645.55 451.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW NO-TOG CORTICAL SCREW 278 C1713 HCPCS 5271631 local both 646.36 452.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SPDE PT 278 C1713 HCPCS 5271567 local both 660.16 462.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW CANCELLOUS SCREW 278 C1713 HCPCS 5271632 local both 668.15 467.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC PARIETEX MESH, PLUG AND PATCH" 278 C1781 HCPCS 5271884 local both 694.53 486.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE NAIL 278 C1713 HCPCS 5271312 local both 694.53 486.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PLUG PATCH 8CM 278 C1781 HCPCS 5272077 local both 696.78 487.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VANGRD XL BONE NAIL 278 C1713 HCPCS 5271313 local both 697.2 488.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC DEPUY DISTAL RADIUS SET, PEGS-NON LOCKING, ALL SIZES" 278 C1713 HCPCS 5270182 local both 698.28 488.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW LOCKING ST T8 278 C1713 HCPCS 5271933 local both 698.58 489.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES CONICAL SCREW ALL SIZES 278 C1713 HCPCS 5270475 local both 699.39 489.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SMOOTH/THREADED PEG ALL SIZES 278 C1713 HCPCS 5270504 local both 699.39 489.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW LOCKG HEXALOBE SCREW 278 C1713 HCPCS 5271626 local both 700.32 490.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271825 local both 700.32 490.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX ANATOMICAL 15CM X 10CM 278 C1781 HCPCS 5272078 local both 702.34 491.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES-LOCKING SCREW 2.0MM-ALL 278 C1713 HCPCS 5270254 local both 708.81 496.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG STENT, URETERAL 8 X 28" 278 C2617 HCPCS 4410300 local both 718.92 503.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW AEQ REV COMP SCREW 278 C1713 HCPCS 5271615 local both 718.98 503.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REVERSED COMPRESSION SCREW (4.5 X 18-26MM) 278 C1713 HCPCS 5271816 local both 718.98 503.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CANCELLOUS CHIPS 5.0CC 278 C1763 HCPCS 370037 local both 726.25 508.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO-CORTICAL POST 278 C1713 HCPCS 5271620 local both 726.25 508.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW TAP-LOC SCREW 278 C1713 HCPCS 5271634 local both 729.25 510.48 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SPIKED WASHER 278 C1713 HCPCS 5270083 local both 730.3 511.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG SHEATH LASER LEAD EXTRACT 278 C2629 HCPCS 306407 local both 732.63 512.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW LOCKING CORTICAL SCREW 278 C1713 HCPCS 5271633 local both 733.51 513.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES LOCKING SCREW 2.7MM ALL 278 C1713 HCPCS 5270262 local both 737.87 516.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW NON-LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271625 local both 740.77 518.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES, SCHANZ SCREW BLUNTED TROCAR POINT 200MM" 278 C1713 HCPCS 5270214 local both 750.67 525.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CEMENT PLUG BIO-PLUG 278 278 RC 5271793 local both 752.4 526.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CONNECTIVE TISSUE (HUMAN) TISSEEL GLUE KIT 2ML ONLY 278 C1762 HCPCS 5271649 local both 757.44 530.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW UNICORTICAL DNP-A 278 C1713 HCPCS 5271613 local both 758.19 530.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW ACL INT 278 C1713 HCPCS 5271616 local both 761.09 532.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KYPHX HV-R BONE CEMENT 278 C1713 HCPCS 5270450 local both 763.95 534.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL LOCKING BAR 278 C1713 HCPCS 5271306 local both 763.98 534.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC EXPLOR IMPLANT LOCKING SCREW 278 C1713 HCPCS 5271311 local both 763.98 534.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 6.5MM CANCELLOUS SCREW-ALL 278 C1713 HCPCS 5270111 local both 766.38 536.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACUMED-2.7-3.0 X 10-18 NON LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271798 local both 769.82 538.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET MODULAR TIBIAL LOCKING BAR 278 C1776 HCPCS 5270176 local both 774.11 541.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH SURGIPRO MONOFILAMENT 14"" X 9""" 278 C1781 HCPCS 5272105 local both 775.48 542.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW VC LOCKING 2.4 278 C1713 HCPCS 5271934 local both 777.29 544.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW LOCKING BLUE 2.5 278 C1713 HCPCS 5271935 local both 781.34 546.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PEG LOCKING 278 C1713 HCPCS 5271609 local both 784.34 549.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE FRAG PLATE PEG FT 278 C1713 HCPCS 5271611 local both 784.34 549.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTICAL 278 C1713 HCPCS 5271612 local both 784.34 549.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES 5.0 STEINMANN PIN W/CENTRAL THREAD, 200MM" 278 C1713 HCPCS 5270219 local both 786.25 550.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES, 5.0MM STEINMANN PIN W/CENTRAL THREAD 200MM" 278 C1713 HCPCS 5270213 local both 786.25 550.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,6.0MM TRANSFIXATION PIN 225MM" 278 C1713 HCPCS 5270216 local both 791.95 554.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING SCREW 3.5X14-16 278 C1713 HCPCS 5270347 local both 798.87 559.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PIN STEINMAN CEN THRD 278 C1713 HCPCS 5271602 local both 802.18 561.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOW PROFILE SELF TAPING SCREW 278 C1713 HCPCS 5271797 local both 805.08 563.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH-HERNIA PLUG SMALL 278 C1781 HCPCS 5270410 local both 806.98 564.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PIN TRANSFIXATION 6.0X225MM 278 C1713 HCPCS 5271833 local both 807.39 565.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH ATRIUM-CENTRIFX MESH 9CMX15.5CM 278 C1781 HCPCS 5271886 local both 810.28 567.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH CENTRIFX 4.1"" X 6.3"" MED" 278 C1713 HCPCS 5271622 local both 810.28 567.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH-HERNIA PLUG MEDIUM 278 C1781 HCPCS 5270409 local both 823.88 576.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3/8-24 APICAL HOLE PLUG 1//CUP 278 278 RC 5271788 local both 827.65 579.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH PLUG PARIETEX 6CM 278 C1781 HCPCS 5271197 local both 829.52 580.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ZIMMER CANNULATED SCREW 4.0ALL 278 C1713 HCPCS 5270117 local both 830.8 581.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING SCREW 2.4MM 278 C1713 HCPCS 5270466 local both 830.8 581.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCREW SCHNZ TROCR 278 C1713 HCPCS 5271571 local both 833.43 583.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SCREW, CANN. INTERFERENCE" 278 C1713 HCPCS 5271845 local both 835.18 584.63 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CONNECTIVE TISSUE (HUMAN) TISSEEL GLUE W/DUPLOJECT 278 C1762 HCPCS 5271648 local both 838.81 587.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REGENERATION BONE PASTE 278 C9359 HCPCS 5270142 local both 839.22 587.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ATRIUM CENTRIFX 10.5 X 16CM 278 C1781 HCPCS 5271727 local both 839.22 587.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH-HERNIA PLUG LARGE 278 C1781 HCPCS 5270408 local both 840.84 588.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC ON-Q PAINBUSTER COMPONENT, EXPANSION" 278 C1887 HCPCS 5271900 local both 845 591.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271623 local both 845 591.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW LOCKING HEXALOBE SCREW 278 C1713 HCPCS 5271627 local both 845.01 591.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CORTEX LCKG SLFTAP 278 C1713 HCPCS 5271831 local both 845.01 591.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OPTIONAL ACET APICAL PLUG 278 278 RC 5271789 local both 845.01 591.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WASHER AO SPIKED 278 C1713 HCPCS 5271366 local both 848.54 593.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET SCREW 4.5 X 3.5 278 C1713 HCPCS 5270525 local both 853.11 597.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW TI GLENOID SCREW LP 278 C1713 HCPCS 5271304 local both 856.58 599.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TI BONE SCREW LP 278 C1713 HCPCS 5271303 local both 856.58 599.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CENTRAL SCREW 6.5 MM (20-25MM) 278 C1713 HCPCS 5270331 local both 868.16 607.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO CEMENT PLUG 278 C1713 HCPCS 5270161 local both 868.16 607.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TI END CAP FOR TFN 278 C1713 HCPCS 5271791 local both 868.16 607.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC TITAN ANCHOR, MEDTRONIC NEUROSTIMULATOR" 278 C1713 HCPCS 5270323 local both 868.17 607.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET COBALT HV BONE CEMENT 278 C1713 HCPCS 5270536 local both 868.49 607.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES LOCKING SCREW 3.5-ALL 278 C1713 HCPCS 5270476 local both 870.77 609.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM CATHETER CONNECTOR FOR PD FLEX NECK CATHETER 278 C1788 HCPCS 5270143 local both 873.94 611.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FIXED LOCKING SCREW 4.75MM (25-45MM) 278 C1713 HCPCS 5270334 local both 877.06 613.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC NON LOCKING SCREW 4.75MM (20-30MM) 278 C1713 HCPCS 5270332 local both 877.06 613.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MENISCAL ARROW #10 278 C1713 HCPCS 5271294 local both 885.52 619.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LUMENS/MUTI-MED CV CATHETER 278 C1750 HCPCS 5270539 local both 886.26 620.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MICROPLATE L RT LONG 25-315-85 278 C1713 HCPCS 5270495 local both 891.29 623.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW 3.0 X 28 MM 278 C1713 HCPCS 5270327 local both 896.46 627.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT AEQ REV II RETROVERSION ROD 278 C1776 HCPCS 5271720 local both 897.1 627.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC 6MM HALF PIN, EXTERNAL FIXATION" 278 C1713 HCPCS 5270199 local both 900.35 630.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW 278 C1713 HCPCS 5271339 local both 901.15 630.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW PERIART LOCKING 278 C1713 HCPCS 5271370 local both 901.15 630.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC EVICEL FIBRIN SEALANT (HUMAN) 1ML 278 C1762 HCPCS 5270377 local both 901.21 630.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CANNULATED FULL TH 12-65 278 C1713 HCPCS 5270116 local both 902.88 632.02 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH MYCROMESH 5CM X 10CM X1MM 278 C1781 HCPCS 5271730 local both 902.89 632.02 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VERSA-DIAL SHOULDER SYSTEM STANDARD ADAPTER 278 C1776 HCPCS 5270335 local both 903.77 632.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SD SS 278 C1713 HCPCS 5271568 local both 906.36 634.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TI END CAP T40 278 C1713 HCPCS 5271347 local both 914.46 640.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TUBULAR 1/3 3 HOLE 278 C1713 HCPCS 5271465 local both 932.4 652.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW 5.0MM CANN PART TH 42.70 278 C1713 HCPCS 5270119 local both 933.17 653.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW 5.0 CANN FULL TH 12.65 278 C1713 HCPCS 5270118 local both 933.17 653.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MINI QUICK ANCHOR PLUS (#2/0 SUTURE) DEPUY 278 C1713 HCPCS 5270293 local both 934.71 654.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC XTENDOBUTTON FIXATION DEVICE 278 C1713 HCPCS 5271936 local both 943.4 660.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW 7.0MM CANN 16MM 30-130 278 C1713 HCPCS 5270120 local both 953.82 667.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW 7.0 CANN 32MM TH 40-120 278 C1713 HCPCS 5270121 local both 953.82 667.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MICROPLATE L RT LONG 25-331-85 278 C1713 HCPCS 5270491 local both 954.95 668.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MICROPLATE L LT LONG 25-330-85 278 C1713 HCPCS 5270492 local both 954.95 668.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW COMP RVS SCREW 278 C1713 HCPCS 5271305 local both 954.98 668.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW PERIART CON CANN 278 C1713 HCPCS 5271341 local both 958.45 670.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW FIXED LOCKING SCREW 278 C1713 HCPCS 5271307 local both 960.76 672.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 1/3 TUBULAR PLATE 6 HOLES 278 C1713 HCPCS 5270473 local both 961.32 672.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHREX BI-CORTICAL POST 278 C1713 HCPCS 5270425 local both 967.67 677.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIODESIGN-SURGISIS STAPLE LINE REINFORCEMENT 278 C1781 HCPCS 5270243 local both 972.34 680.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 1/3 TUBULAR PLATE-7 HOLES 278 C1713 HCPCS 5270486 local both 986.78 690.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL CENTRALIZER 278 C1713 HCPCS 5270159 local both 990.86 693.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEX SS CRLG BUTTON-S 278 C1713 HCPCS 5271345 local both 1000.12 700.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CRLG POS PIN 278 C1713 HCPCS 5271572 local both 1000.12 700.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC IMPLANT CHONDRAL DART 278 C1713 HCPCS 5271598 local both 1001.28 700.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHREX CHONDRAL DART 18MM 278 C1713 HCPCS 5270513 local both 1005.89 704.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW NUT 5.0MM 278 C1713 HCPCS 5271369 local both 1010.54 707.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SD TI 278 C1713 HCPCS 5271592 local both 1010.54 707.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES TITANIUM LOCKING SCREWS-ALL 278 C1713 HCPCS 5270433 local both 1012.74 708.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MINI BIOSUTURE TAK 2.5MM 278 C1713 HCPCS 5271824 local both 1012.85 709 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SD SS 278 C1713 HCPCS 5271569 local both 1020.96 714.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CARBON FIBER 8MM 278 C1713 HCPCS 5271579 local both 1026.16 718.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT DISTAL CENTRALIZER 278 C1776 HCPCS 5271675 local both 1030.22 721.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OCULAR IMPLANT ASSIST DEVICE 278 C1783 HCPCS 5270134 local both 1041.79 729.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW AEQ REV LOCK SCREW 278 C1713 HCPCS 5271614 local both 1041.79 729.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PARIETEX MESH TECT 1510A 278 C1781 HCPCS 5270521 local both 1046.01 732.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ORTHOSORBABLE PIN #84-1070 278 C1713 HCPCS 5270514 local both 1047.85 733.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM END CAP FOR HINDFOOT ARTHRODESIS NAILS 278 C1713 HCPCS 5270362 local both 1048.97 734.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ENDO GIA 30-3.5 DLU REFILL 278 248 RC 5270087 local both 1061.62 743.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CATH PICC SOLO INTEGRATED 5FR 278 C1751 HCPCS 4410379 local both 1072.27 750.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE TUBULAR 1/3 4 HOLE 278 C1713 HCPCS 5271293 local both 1078.25 754.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC STAPLER/ENDOCLIP 10MM 278 C1760 HCPCS 5270090 local both 1081.6 757.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CENTRAL SCREW-BIOMET 278 C1713 HCPCS 5270267 local both 1082.3 757.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM LOCK SCREWS-IM NAILS 6.0MM (SYNTHES) 278 C1713 HCPCS 5270374 local both 1086.24 760.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4MM TI LOCK SCREW 278 C1713 HCPCS 5271350 local both 1086.24 760.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CANCELLOUS CHIPS 15CC 278 C1763 HCPCS 370038 local both 1089.37 762.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SD DD 278 C1713 HCPCS 5271570 local both 1093.88 765.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE BOLT 4.9MM TI LOCK BOLT 278 C1713 HCPCS 5271591 local both 1093.88 765.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FIXED LOCKING SCREW-BIOMET 278 C1713 HCPCS 5270268 local both 1093.89 765.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 5.0MM TI LOCK SCREW W/T25 278 C1713 HCPCS 5271351 local both 1099.09 769.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACL INTERFERENCE SCREW 9MM-ALL 278 C1713 HCPCS 5270417 local both 1101.39 770.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TUNNELOC INTERF SCREW 7MMX20MM 278 C1713 HCPCS 5270512 local both 1101.4 770.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PEG MULTI-DIR THREAD 278 C1713 HCPCS 5271610 local both 1105.46 773.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW ACUTWIST ACUTK COMP SCREW 278 C1713 HCPCS 5271635 local both 1105.46 773.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD 8MM CARBON FIBER 278 C1713 HCPCS 5271580 local both 1114.72 780.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW BIO-INTERFERENCE SCREW 278 C1713 HCPCS 5271619 local both 1122.82 785.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW 5.0MM TI LOCK SCREW HR 278 C1713 HCPCS 5271590 local both 1128.03 789.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-4.0MM CANN SCREW LNG THRD/50MM 278 C1713 HCPCS 5271356 local both 1128.84 790.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW PERIART LOCK CANN 278 C1713 HCPCS 5271340 local both 1144.81 801.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CEMENT RESTRICTOR 8-15 MM 278 C1713 HCPCS 5270223 local both 1145.68 801.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH 6.3 X 4 XL WITH SLIT 278 C1781 HCPCS 5270524 local both 1146.78 802.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VERSA-DIAL SHOULDER ADAPTER 278 C1776 HCPCS 5271666 local both 1151.76 806.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL POST CENTRALIZER 11MM 278 C1776 HCPCS 5271876 local both 1151.76 806.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP 1/3 TUBLR PLATE W/ COLLAR 278 C1713 HCPCS 5271290 local both 1156.39 809.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES CANNULATED SCREW 4.0 ALL 278 C1713 HCPCS 5270472 local both 1158.68 811.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 2.5 HEADLESS SCREW 278 C1713 HCPCS 5270325 local both 1165.4 815.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE STRAIGHT 1.3MM 6H 278 C1713 HCPCS 5271937 local both 1165.94 816.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SD TI 278 C1713 HCPCS 5271593 local both 1166.81 816.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CATH, CORONARY LASER" 278 C1885 HCPCS 4410453 local both 1170.61 819.43 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES-T-PLATE 2 HOLES HEAD, 8 HOLE SHAFT" 278 C1713 HCPCS 5270259 local both 1171.44 820.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM STRT PLATE 6 HL 278 C1713 HCPCS 5271546 local both 1174.72 822.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEADED SCREW 2.0 X 12MM 278 C1713 HCPCS 5270354 local both 1174.91 822.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEADED SCREW 2.0 X 16 MM 278 C1713 HCPCS 5270353 local both 1174.91 822.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REVERSED LOCKING SCREW (4.5X 20) 278 C1713 HCPCS 5271813 local both 1174.91 822.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REVERSED LOCKING SCREW (4.5X 35) 278 C1713 HCPCS 5271814 local both 1174.91 822.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANNULATED SCREW 4.5MM-ALL 278 C1713 HCPCS 5270499 local both 1177.77 824.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 200 MM BAR/EXTERNAL FIXATION 278 C1713 HCPCS 5270197 local both 1181.41 826.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES, CARBON FIBER ROD 400MM" 278 C1713 HCPCS 5270212 local both 1181.64 827.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 4 HOLE 59 278 C1713 HCPCS 5271390 local both 1181.71 827.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REUNITE ORTHO SCREW 2.5X2.5MM 278 C1713 HCPCS 5270490 local both 1184.13 828.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CONNECTIVE TISSUE (HUMAN) TISSEEL GLUE KIT 4ML ONLY 278 C1762 HCPCS 5271650 local both 1191.11 833.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM LC-DCP PLATE 8 HL/51MM 278 C1713 HCPCS 5271515 local both 1192.2 834.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARROW TRIPLELUMEN CATH 278 C1751 HCPCS 310370 local both 1195.52 836.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TUBULAR 1/3 12H/141MM 278 C1713 HCPCS 5271466 local both 1198.06 838.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEADLESS SCREW 2.5 X 22MM 278 C1713 HCPCS 5270352 local both 1200.35 840.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEADLESS SCREW 2.5X20 278 C1713 HCPCS 5270349 local both 1200.36 840.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TRIMED-VOLAR BUTTRESS PIN 278 C1713 HCPCS 5271804 local both 1204.24 842.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TRIMED-DORSAL BUTTRESS PIN 278 C1713 HCPCS 5271805 local both 1204.24 842.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES 11.0MM CARBON FIBER ROD,400MM" 278 C1776 HCPCS 5270217 local both 1206.19 844.33 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 1.5MM CNDLR PLATE 7 HL/36MM 278 C1713 HCPCS 5271542 local both 1213.18 849.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ENDOBUTTON CL ULTRA 35MM 278 C1713 HCPCS 5271283 local both 1219.78 853.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP BONE PLATE 9 HOLE 278 C1713 HCPCS 5270288 local both 1221.34 854.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES 5.0 CANNULATED SCREWS 278 C1713 HCPCS 5270313 local both 1224.68 857.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM LC-DCP PLATE 4 HL/35MM 278 C1713 HCPCS 5271550 local both 1230.66 861.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES LC-DCP 2.4 MM PLATE 4 HOLE 278 C1713 HCPCS 5271817 local both 1230.66 861.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEADED SCREW 2.5X20 278 C1713 HCPCS 5270348 local both 1232.79 862.95 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-4.0MM CANN SCREW SHRT 278 C1713 HCPCS 5271355 local both 1234.52 864.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 1.5MM STRT PLATE 6 HL 278 C1713 HCPCS 5271819 local both 1234.52 864.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OSTEORAPTOR 2.9 SUTURE ANCHOR 278 C1713 HCPCS 5271302 local both 1235.32 864.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE ANCHOR OSTEORAPTOR 278 C1713 HCPCS 5271821 local both 1235.32 864.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW SCHNZ SD TI 278 C1713 HCPCS 5271594 local both 1239.73 867.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 5MM TI LOCK SCREW DC T25 278 C1713 HCPCS 5271352 local both 1250.15 875.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LUPINE BR ANCHOR W/ORTHOCOD 278 C1713 HCPCS 5270092 local both 1254.73 878.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 5 HOLE 72 278 C1713 HCPCS 5271391 local both 1255.13 878.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PRO GRIP LAP 15CM X 10CM 278 C1781 HCPCS 5272079 local both 1257.04 879.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MANDIBLE TRAUMA TITANIUM CORTEX SCREWS 278 C1713 HCPCS 5271801 local both 1262.51 883.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 250MM BAR/EXTERNAL FIXATION 278 C1713 HCPCS 5270198 local both 1271.92 890.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC Y-PLATE 3 HOLE HEAD 8 HOLE SHAFT 278 C1713 HCPCS 5270295 local both 1277.93 894.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ENDOBUTTON CL ULTRA PAC 1.2 278 C1713 HCPCS 5271282 local both 1278.05 894.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANTI-ADHESION FILM-SEPRAFILM MEMBRANE 278 C1781 HCPCS 5270107 local both 1284.86 899.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW REFLECTION CANC. 6.5 X 4 278 C1713 HCPCS 5271646 local both 1287.49 901.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FASTAK SUTURE ANCHOR 278 C1713 HCPCS 5270100 local both 1291.04 903.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW BIO COMP INT.8X23MM 278 C1713 HCPCS 5271603 local both 1302.24 911.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SCREW, BIO-COMP RETROSCREW 9MM" 278 C1713 HCPCS 5271844 local both 1302.24 911.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CARBON FIBER 278 C1713 HCPCS 5271574 local both 1304.08 912.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC STANDARD ADAPTER SHOULDER JOINT DEVICE 278 C1776 HCPCS 5270180 local both 1306.7 914.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REUNITE ORTHO SCREW 278 C1713 HCPCS 5270132 local both 1308.01 915.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC HEADLESS COMPRESSION SCREWS, 3.0MM" 278 C1713 HCPCS 5270522 local both 1309.13 916.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW HEADLESS COMP 278 C1713 HCPCS 5271846 local both 1317.48 922.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM LC-DCP PLATE 4 HL/27MM 278 C1713 HCPCS 5271511 local both 1317.87 922.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MENISCUS ARROW 278 C1713 HCPCS 5270102 local both 1320.02 924.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 6 HOLE 85 278 C1713 HCPCS 5271392 local both 1335.54 934.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW AFFIXUS CORTICAL 278 C1713 HCPCS 5271842 local both 1342.75 939.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE 1.3MM 3H-HEAD/8H SHAFT 278 C1713 HCPCS 5271939 local both 1343.04 940.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CYMETRA ASSEMBLY 2CC 278 C1762 HCPCS 5270501 local both 1346.02 942.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP-T-PLATE 4H HEAD/ 3H 278 C1713 HCPCS 5271456 local both 1349.53 944.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CANCELLOUS CHIPS 15CC ""CROUTON""" 278 C1762 HCPCS 501785 local both 1351.43 946 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/3H 50MM RIGHT 278 C1713 HCPCS 5271447 local both 1353.03 947.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM STRT PLATE 6 HL 278 C1713 HCPCS 5271543 local both 1354.33 948.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DHS PLATE-LAG SCREWS 12.7 MM ALL LENGHTS 278 C1713 HCPCS 5270189 local both 1356.52 949.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG ICONIX 2 ANCHOR, 2.3 MM" 278 C1713 HCPCS 5272115 local both 1359.63 951.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG ICONIX 1 ANCHOR, 1.4 MM" 278 C1713 HCPCS 500153 local both 1359.63 951.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC RETRO SCREW-ARTHREX 278 C1713 HCPCS 5270265 local both 1359.63 951.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KLS-FRACTURE PLATE CURVED SHORT 278 C1713 HCPCS 5270139 local both 1360.11 952.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOABSORBABLE SCREW 278 C1713 HCPCS 5270511 local both 1360.11 952.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM ELASTIC ENDERNAIL 278 C1713 HCPCS 5270520 local both 1363.14 954.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OPEN ADJUSTABLE CLAMP-MEDIUM 278 C1713 HCPCS 5270237 local both 1368.45 957.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX SKIRT ROUND 8CM 278 C1781 HCPCS 5272080 local both 1375.87 963.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS BONE CHIPS 15CC 278 C1763 HCPCS 5270500 local both 1388.75 972.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MEMODYN STAPLE 12MM X 10 MM 278 C1713 HCPCS 5270489 local both 1388.75 972.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM LC-DCP PLATE 6 HL/51MM 278 C1713 HCPCS 5271551 local both 1391.49 974.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 7 HOLE 98 278 C1713 HCPCS 5271393 local both 1394.98 976.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 4H/4H 56MM RIGHT 278 C1713 HCPCS 5271448 local both 1398.48 978.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 4H 278 C1713 HCPCS 5271457 local both 1398.48 978.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE ANCHOR HEALICOIL SA PK 5.5MM 278 C1713 HCPCS 5271645 local both 1398.48 978.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC H-PLATE EXTENDED 1.3MM 278 C1713 HCPCS 5271940 local both 1402.08 981.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DEPUY SMALL BONE FIXATION SYSTEM 1.6MM 278 C1713 HCPCS 5270263 local both 1402.36 981.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW ACL INT 278 C1713 HCPCS 5271617 local both 1406.42 984.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH, SYMBOTEX, COMP, 15 CM X 10 CM" 278 C1781 HCPCS 5272112 local both 1407.49 985.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MINI PUSHLOCK 278 C1713 HCPCS 5270169 local both 1413.24 989.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PRO GRIP LAP 15CM X 10 CM 278 C1781 HCPCS 5272081 local both 1413.28 989.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 7.3 MM CANNULATED SCREW 278 C1713 HCPCS 5270224 local both 1416.38 991.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REABSORBABLE SCREW/BIOMET-ARTH 278 C1713 HCPCS 5270093 local both 1417.88 992.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ON-Q PUMP DUAL 40MLX4ML/HR 278 C1887 HCPCS 5271903 local both 1417.99 992.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 1.5MM PLATE 3 HL HEAD/ 8 HL 278 C1713 HCPCS 5271539 local both 1422.05 995.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW TRIGEN NAIL CAP 0MM 278 C1713 HCPCS 5271913 local both 1423.78 996.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CONDYLAR PLATE-SYNTHES 278 C1713 HCPCS 5270272 local both 1430.73 1001.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET 2.8X17MM ORTHOSCREW 278 C1713 HCPCS 5270532 local both 1438.81 1007.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PCOX ROUND 12CM 278 C1781 HCPCS 5272082 local both 1448.32 1013.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO-PUSHLOCK 278 C1713 HCPCS 5270443 local both 1452.82 1016.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC BIOSURE SCREWS,SMITH AND NEPHEW,ALL SIZES" 278 C1713 HCPCS 5270191 local both 1455.34 1018.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CLIK ANCHOR-BOSTON SCIENTIFIC 278 C1713 HCPCS 5270384 local both 1456.75 1019.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE ANCHOR JUGGERKNOT 1.4 MM SHORT 278 C1713 HCPCS 5271601 local both 1456.75 1019.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIORAPTOR 1 SUTURE ANCHOR 278 C1713 HCPCS 5270497 local both 1458.39 1020.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW BIOSURE HA 8MMX25MM 278 C1713 HCPCS 5271941 local both 1458.51 1020.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 8 HOLE 111 278 C1713 HCPCS 5271394 local both 1464.91 1025.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE STRAIGHT 1.3MM 12H 278 C1713 HCPCS 5271942 local both 1466.03 1026.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 4 HOLES/80MM 278 C1713 HCPCS 360831 local both 1475 1032.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANCHOR BIO SWIVELOCK ANCHOR 4.75MM 278 C1713 HCPCS 5271604 local both 1476.11 1033.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANCHOR BIO-SWIVELOCK TENODESIS 278 C1713 HCPCS 5271843 local both 1476.17 1033.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AUTOFIX COMPRESSION SCREW 278 C1713 HCPCS 5270370 local both 1481.66 1037.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW INT ACL 278 C1713 HCPCS 5271618 local both 1481.66 1037.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM T-PLATE 2 HL HEAD/ 8 HL 278 C1713 HCPCS 5271544 local both 1484.55 1039.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 1.5MM 278 C1713 HCPCS 5271540 local both 1484.55 1039.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PCO VENTRAL PATCH 4.6CM 278 C1781 HCPCS 5272083 local both 1485.34 1039.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW DHS/DCS ONE-STEP LAG SCREW 14M 278 C1713 HCPCS 5271553 local both 1485.88 1040.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS 4-10MM 15CC 278 C1763 HCPCS 5270094 local both 1487.4 1041.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC ANCHOR, 5.0 ALL THREAD BIOMET" 278 C1713 HCPCS 5270266 local both 1491.71 1044.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,CARBON FIBER ROD 200MM" 278 C1713 HCPCS 5270209 local both 1492.74 1044.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,CARBON FIBER ROD 150MM" 278 C1713 HCPCS 5270208 local both 1492.74 1044.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC S&N 25MM ENDOBUTTON 278 C1713 HCPCS 5270506 local both 1492.96 1045.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC S&N 30MM ENDOBUTTON W/LOOP SUT 278 C1713 HCPCS 5270510 local both 1492.96 1045.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CEMENT RESTRICTOR 24MM DIA 278 C1713 HCPCS 5271792 local both 1493.23 1045.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CEMENT RESTRICTOR (24MM) 278 C1713 HCPCS 5271909 local both 1493.23 1045.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES CANNULATED SCREW 6.5-ALL 278 C1713 HCPCS 5270483 local both 1496.38 1047.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM LC-DCP PLATE 8 HL/67MM 278 C1713 HCPCS 5271552 local both 1499.87 1049.91 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP BONE PLATE 5 HOLE 278 C1713 HCPCS 5270286 local both 1500.17 1050.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VERSALOK ANCHOR 278 C1713 HCPCS 5270516 local both 1504.13 1052.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW PERIAR CANN 278 C1713 HCPCS 5271344 local both 1512.22 1058.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/3H 52MM OBLIQU R 278 C1713 HCPCS 5271449 local both 1517.35 1062.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/3H 52MM OBLIQU L 278 C1713 HCPCS 5271474 local both 1520.84 1064.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 9 HOLE 124 278 C1713 HCPCS 5271395 local both 1524.34 1067.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CARBON FIBER 278 C1713 HCPCS 5271300 local both 1526.22 1068.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG BOSTON SCIENTIFIC MUSTANG .035 BALLOONS 278 C1725 HCPCS 4410474 local both 1526.29 1068.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TWIN FIX SUTURE ANCHOR 5.0 278 C1713 HCPCS 5270487 local both 1527.66 1069.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CONNECTIVE TISSUE (HUMAN) GRAFT TUTOPLAST PERICARDIAL 278 C1762 HCPCS 5271856 local both 1533.75 1073.63 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TRIMED-WIRE PLATES 278 C1713 HCPCS 5271806 local both 1534.44 1074.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 4H HEAD/ 5H 278 C1713 HCPCS 5271458 local both 1534.83 1074.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO-FULLTHREADED CORKSCREW-ALL 278 C1713 HCPCS 5270442 local both 1538.29 1076.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/5H 67MM RIGHT 278 C1713 HCPCS 5271450 local both 1538.3 1076.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANCHOR SUPER GII ANCHOR 278 C1713 HCPCS 5271605 local both 1546.09 1082.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC QUICKANCHOR SUPER PLUS DS 278 C1713 HCPCS 5271822 local both 1546.09 1082.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM LC-DCP PLATE 6 HL/39MM 278 C1713 HCPCS 5271512 local both 1547.06 1082.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC DHS PLATE-SHORT BARREL, ALL SIZES" 278 C1713 HCPCS 5270188 local both 1547.27 1083.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HELICAL BLADE IMPLANT 11.0MM TI HELICAL BLADE 125MM 278 C1713 HCPCS 5271820 local both 1547.65 1083.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OSTEORAPTOR 2.3 CVRD UB COB/BL 278 C1713 HCPCS 5271921 local both 1549.98 1084.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 1.5MM STRT PLATE 12 HL 278 C1713 HCPCS 5271541 local both 1552.27 1086.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.0 BIO-SUTURE TAK/ ANCHOR] 278 C1713 HCPCS 5270412 local both 1559.74 1091.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 10 HOLE 137 278 C1713 HCPCS 5271396 local both 1569.79 1098.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM CNDLR PLATE 7 HL/39MM 278 C1713 HCPCS 5271513 local both 1573.1 1101.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC IMPLANT PIN TRIM-IT DRILL PIN 278 C1713 HCPCS 5271597 local both 1574.26 1101.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM 278 C1713 HCPCS 5271547 local both 1575.71 1103 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 5 HOLES/98MM 278 C1713 HCPCS 360832 local both 1577.56 1104.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT COMPONENT-COMPR FX HMRL POS SLV 278 C1776 HCPCS 5271656 local both 1580.05 1106.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MENISCAL CINCH-ARTHREX 278 C1776 HCPCS 5270315 local both 1584.93 1109.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/4H 63MM OBLIQU R 278 C1713 HCPCS 5271451 local both 1587.27 1111.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/4H 63MM OBLIQU L 278 C1713 HCPCS 5271475 local both 1594.26 1115.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIORAPTOR 2.3 ANCHOR 278 C1713 HCPCS 5270260 local both 1597.41 1118.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DOUBLE LEAD THREAD SCREW 5X36MM 278 C1713 HCPCS 5271827 local both 1597.41 1118.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW TI DBL CORTICAL 278 C1713 HCPCS 5271835 local both 1597.41 1118.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,CARBON FIBER ROD 250MM" 278 C1713 HCPCS 5270210 local both 1600.99 1120.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHREX BIO-TRANSFIX PIN 278 C1713 HCPCS 5270427 local both 1602.37 1121.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TI END CAP TIB NAIL 278 C1713 HCPCS 5271348 local both 1604.36 1123.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT SHLDR PC HYB GLENOID POST POLY 278 C1776 HCPCS 5271661 local both 1608.99 1126.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PARIETEX MESH PC09 278 C1781 HCPCS 5270517 local both 1615.22 1130.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MTF-CANCELLOUS CHIPS (CROUTON) 3OCC 278 C1763 HCPCS 5270256 local both 1618.85 1133.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM LCP-DCP PLATE 12 HL/71MM 278 C1713 HCPCS 5271514 local both 1619.99 1133.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.0MM PLATE 3 HL HEAD/ 8 HL 278 C1713 HCPCS 5271545 local both 1619.99 1133.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 2 HOLE 33 278 C1713 HCPCS 5271388 local both 1625.19 1137.63 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CARBON FIBER 278 C1713 HCPCS 5271301 local both 1635.61 1144.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 11 HOLE 150 278 C1713 HCPCS 5271397 local both 1637 1145.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET HAMMERTOE IMPLANT/2.5MM 278 C1713 HCPCS 5270531 local both 1642.55 1149.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIORAPTOR 2 SUTURE ANCHOR 278 C1713 HCPCS 5270496 local both 1645.01 1151.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW CAPTURED INT. HEX 278 C1713 HCPCS 5271839 local both 1649.5 1154.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE ANCHOR 6.5MM BIOCORKSCREW 278 C1713 HCPCS 5270432 local both 1655.24 1158.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/5H 74MM OBLIQU R 278 C1713 HCPCS 5271452 local both 1657.2 1160.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG JUGGERKNOT 2.9MM DBL LOADED 278 C1713 HCPCS 5271955 local both 1658.75 1161.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MICRONIZED ALLODERM TISSUE 278 C1762 HCPCS 5270437 local both 1661.62 1163.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-7.0MM CANN SCREW 16MM THRD 278 C1713 HCPCS 5271357 local both 1661.66 1163.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 12 HOLE 163 278 C1713 HCPCS 5271398 local both 1664.19 1164.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/5H 74MM OBLIQU L 278 C1713 HCPCS 5271476 local both 1664.19 1164.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC EVICEL FIBRIN SEALANT(HUMAN) 2ML 278 C1762 HCPCS 5270378 local both 1668.89 1168.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ON-Q C-BLOCK 278 C1887 HCPCS 5271902 local both 1670.4 1169.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PIN CRIMP POS SS STERILE 278 C1713 HCPCS 5271346 local both 1672.08 1170.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM T-PLATE 2 HL HEAD/ 8 HL 278 C1713 HCPCS 5271548 local both 1672.08 1170.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH, SYMBOTEX, COMP, ROUND 9CM" 278 C1781 HCPCS 5272110 local both 1681.97 1177.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HEADED SCREW 4.0 X 22MM 278 C1713 HCPCS 5270351 local both 1684.23 1178.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ATRIUM V-PATCH SMALL 278 C1781 HCPCS 5271729 local both 1685.94 1180.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ATRIUM V-PATCH 6.4 X 6.4 278 C1781 HCPCS 5271726 local both 1685.94 1180.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HERBERT BONE SCREW 3MMX18MM 278 C1713 HCPCS 5270460 local both 1687.08 1180.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 3 HOLE 46 278 C1713 HCPCS 5271389 local both 1687.7 1181.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PORT A CATH/OPTILOCK 278 C1788 HCPCS 5270420 local both 1687.83 1181.48 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW PERIART LOCK CANN 278 C1713 HCPCS 5271342 local both 1693.26 1185.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 7.3MM CANN LOCK SCREW 278 C1713 HCPCS 5271343 local both 1693.26 1185.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR 4"" X 6"" OBLONG" 278 C1781 HCPCS 5271895 local both 1704.49 1193.14 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM 278 C1713 HCPCS 5271549 local both 1721.56 1205.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 6H 278 C1713 HCPCS 5271459 local both 1723.62 1206.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 6H 278 C1713 HCPCS 5271478 local both 1730.62 1211.43 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HUMAN BONE GRAFTING MATERIAL CANCELLOUS CRUSHED 1-4MM 278 C1762 HCPCS 5271647 local both 1748.1 1223.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG BIO-COMP TENODESIS SCREW 4MMX10MM 278 C1713 HCPCS 5272074 local both 1748.1 1223.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 4""X6"" & 5""X5"" OBLONG" 278 C1781 HCPCS 5271889 local both 1752.95 1227.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG ANCHOR FAST FIX 360 CURVE NEEDLE 278 C1713 HCPCS 501776 local both 1755.87 1229.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET COBALT HV BONE CEMENT 278 C1713 HCPCS 5270158 local both 1758.24 1230.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC RETRO SCREW 278 C1713 HCPCS 5270429 local both 1769.82 1238.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANNULATED DELTA BIO SCREW 278 C1713 HCPCS 5270426 local both 1769.82 1238.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL RETRO SCREW 278 C1713 HCPCS 5270430 local both 1769.82 1238.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GROSHONG IMPLANTABLE CATHETER 278 A4301 HCPCS 5270484 local both 1772.07 1240.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC S&N SUTURE ANCHOR 5.5MM 278 C1713 HCPCS 5270530 local both 1782.6 1247.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 6 HOLES/116MM 278 C1713 HCPCS 360842 local both 1782.71 1247.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 6H 278 C1713 HCPCS 5271460 local both 1786.52 1250.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 4H/6H 78MM RIGHT 278 C1713 HCPCS 5271453 local both 1793.55 1255.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/7H 96MM OBLIQU R 278 C1713 HCPCS 5271454 local both 1800.54 1260.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5 MM HEADLESS COMPRESSION SCREW/LONG THREAD 34MM 278 C1713 HCPCS 5270225 local both 1800.6 1260.42 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/7H 96MM OBLIQU L 278 C1713 HCPCS 5271477 local both 1804.05 1262.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 8 HOLE PLATE #51-110-08 278 C1713 HCPCS 5270454 local both 1814.4 1270.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 5.5 BIO CORKSCREW SUTURE ANCHO 278 C1713 HCPCS 5270099 local both 1814.41 1270.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TWIN FX SUTURE ANCHOR W/DIA 5. 278 C1713 HCPCS 5270488 local both 1821.79 1275.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANCHOR MINI QUICK MITEK 278 C1713 HCPCS 5270109 local both 1827.14 1279 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG ARGON OPTION ELITER AC/POP IVC FILTER 278 C1880 HCPCS 4410129 local both 1831.54 1282.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PCO VENTRAL 6.6 CM 278 C1781 HCPCS 5272084 local both 1831.58 1282.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 4 HL/56M 278 C1713 HCPCS 5271516 local both 1839 1287.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PARIETEX SKIRT 15CM X 10CM 278 C1781 HCPCS 5272085 local both 1840.59 1288.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CALAXO SCREW 11MMX30MM 278 C1713 HCPCS 5270461 local both 1846.22 1292.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CALAXO SCREW 12MMX35MM 278 C1713 HCPCS 5270463 local both 1846.22 1292.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CALAXO SCREW 11MMX35MM 278 C1713 HCPCS 5270478 local both 1846.23 1292.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FASTIN ROTATOR CUFF ANCHOR 6.5MM 278 C1713 HCPCS 5270515 local both 1846.25 1292.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE ANCHOR TWINFIX 5.5 278 C1713 HCPCS 5271285 local both 1846.27 1292.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 5H/70 278 C1713 HCPCS 5271517 local both 1852.98 1297.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM DIST RAD L-PLATE/-90 2/3 278 C1713 HCPCS 5271501 local both 1859.98 1301.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO-TENODESIS SCREW-ALL 278 C1713 HCPCS 5270419 local both 1878.05 1314.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHREX PEEK TENO SCREW 5.5X8.0 278 C1713 HCPCS 5270507 local both 1878.06 1314.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FAST FIX CURVED ABSORB ANCHOR 278 C1713 HCPCS 5270505 local both 1879.72 1315.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE DEG DHS PLATE-STD BRL 278 C1713 HCPCS 5271556 local both 1880.18 1316.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,ATTACHMENT FOR LARGE MULTI PIN CLAMP" 278 C1713 HCPCS 5270204 local both 1881.44 1317.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 7 HOLES/134MM 278 C1713 HCPCS 360843 local both 1892.37 1324.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 8H 278 C1713 HCPCS 5271461 local both 1894.94 1326.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 8H 278 C1713 HCPCS 5271479 local both 1901.93 1331.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC POWER PORT MRI 9.5FR CATHETER 278 C1788 HCPCS 5271899 local both 1919.02 1343.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATELET RICH PLASMA 278 C9250 HCPCS 5270257 local both 1922.91 1346.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG TIGHTROPE SYNDESMOSIS 278 C1713 HCPCS 501778 local both 1922.91 1346.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM LCP DIST RAD PLATE 278 C1713 HCPCS 5271499 local both 1922.91 1346.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM LCP DIST RAD PLATE ST/5H 278 C1713 HCPCS 5271498 local both 1925.01 1347.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 7 HOLES/134MM 278 C1713 HCPCS 360834 local both 1934.79 1354.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 6 HOLES/116MM 278 C1713 HCPCS 360833 local both 1947 1362.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM DIST RAD L-PLATE 278 C1713 HCPCS 5271502 local both 1954.37 1368.06 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MEDIUM PIN 4POS 278 C1713 HCPCS 5271790 local both 1957.87 1370.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS 4-10MM 30CC 278 C1763 HCPCS 5270095 local both 1972.75 1380.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 13 HOLE 176 278 C1713 HCPCS 5271399 local both 1996.33 1397.43 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 4.5"" ROUND" 278 C1781 HCPCS 5271888 local both 2000.21 1400.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 1.0 MM CABLE W/CRIMP 278 C1713 HCPCS 5270326 local both 2003.32 1402.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CABLE TI CABLE W/ CRIMP 750MM 278 C1713 HCPCS 5271595 local both 2003.32 1402.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 2.4MM LCP DIST RAD T-PLATE 4H 278 C1713 HCPCS 5271500 local both 2006.82 1404.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROTATOR CUFF QUICK ANCHOR 278 C1713 HCPCS 5270103 local both 2017.87 1412.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH, SYMBOTEX, COMP, ROUND 15 CM" 278 C1781 HCPCS 5272111 local both 2026.47 1418.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANCHOR ROTATOR CUFF MITEK 278 C1713 HCPCS 5270110 local both 2026.7 1418.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TRIMED-RADIAL COLUMN PIN PLATE 278 C1713 HCPCS 5271808 local both 2039.45 1427.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 8 HOLES/152MM 278 C1713 HCPCS 360835 local both 2044.5 1431.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES TITANIUM SPIRAL BLADE FOR HUMERAL NAILS(34-54MM) 278 C1713 HCPCS 5270319 local both 2057.32 1440.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE ANCHOR BIO SWIVELOCK 278 C1713 HCPCS 5270157 local both 2057.51 1440.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TUTOPLAST PERICARDIUM 278 C1762 HCPCS 5270251 local both 2058.88 1441.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ATRIUM V-PATCH MECH LG (8CM X 8CM) 278 C1781 HCPCS 5271728 local both 2114.61 1480.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 140 DEG DHS PLATE-STD BRL 4 HL 278 C1713 HCPCS 5271557 local both 2122.19 1485.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GLENOID POST-SHOULDER JOINT DEVICE 278 C1776 HCPCS 5270181 local both 2124.02 1486.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TRUFIT PLUG 9MM 278 248 RC 5270462 local both 2136.51 1495.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANCELLOUS BONE CHIPS-30CC 278 C1763 HCPCS 5270477 local both 2136.54 1495.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 6H/84 278 C1713 HCPCS 5271518 local both 2143.17 1500.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 9 HOLES/170MM 278 C1713 HCPCS 360836 local both 2143.52 1500.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC POWER PORT 278 C1788 HCPCS 5271898 local both 2152.1 1506.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MANDIBLE TRAUMA 2.0MM TITANIUM ADAPTION PLATE 278 C1713 HCPCS 5271802 local both 2155.99 1509.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL FIBULA PLATE 7 HOLE LCP 278 C1713 HCPCS 5270324 local both 2159.87 1511.91 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE UNI LOCK TROCH 131MM 278 C1713 HCPCS 5271321 local both 2182.06 1527.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE TROCHANTER STAB. 278 C1713 HCPCS 5271832 local both 2205.71 1544 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC STANDARD ACUTRAK 2 BONE SCREW, ACUMED 22 MM" 278 C1713 HCPCS 5270380 local both 2225.91 1558.14 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC COMBINATION CLAMP-MEDIUM 278 C1713 HCPCS 5270236 local both 2226.54 1558.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LAB SCREW TI NAIL 278 C1713 HCPCS 5271923 local both 2232.13 1562.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 4H HEAD/ 7H 278 C1713 HCPCS 5271462 local both 2237.56 1566.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SMALL FRAG LOCKING PLATE HF-Y 278 C1713 HCPCS 5270503 local both 2243.37 1570.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM HELICAL BLADE 80MM-120MM 278 C1713 HCPCS 5270144 local both 2246.82 1572.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE T 3H/7H 87MM RIGHT 278 C1713 HCPCS 5271455 local both 2248.05 1573.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 7H/98 278 C1713 HCPCS 5271519 local both 2251.55 1576.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH, SYMBOTEX, COMP, 20 CM X 15 CM" 278 C1781 HCPCS 5272113 local both 2257.88 1580.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM SPIRAL BLADE FOR RETROGRADE FEMORAL NAIL 278 C1713 HCPCS 5270363 local both 2262.27 1583.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CONNECTIVE TISSUE (HUMAN) AMNIOGRAFT 2.0 X 1.5 CM SIZE B 278 C1762 HCPCS 5271857 local both 2311.37 1617.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES-LOCKING CALCANEAL PLATE-SHORT 278 C1713 HCPCS 5270253 local both 2312.15 1618.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH PARITEX COMPOSITE OPT ROUND 15CM 278 C1781 HCPCS 5271894 local both 2313.31 1619.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 8 HOLES/152MM 278 C1713 HCPCS 360844 local both 2316.85 1621.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PCOX 20CM X 15CM 278 C1781 HCPCS 5272086 local both 2323.38 1626.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 10 HOLES/188MM 278 C1713 HCPCS 360837 local both 2327.45 1629.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL FIBULA PLATE-11 HOLE-SYNTHES 278 C1713 HCPCS 5270307 local both 2343.22 1640.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 8H/112 278 C1713 HCPCS 5271520 local both 2349.44 1644.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PCO VENTRAL PATCH 8.6CM 278 C1781 HCPCS 5272087 local both 2352.63 1646.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BAR TO BAR CLAMP/EXTERNAL FIXATION SET 278 C1713 HCPCS 5270194 local both 2362.86 1654 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC 6 MM BAR TO PIN CLAMP, EXTERNAL FIXATION" 278 C1713 HCPCS 5270195 local both 2363.44 1654.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FIBULA PLATE 2.7/3.5 MM 4 HOLE-SYNTHES 278 C1713 HCPCS 5270276 local both 2376.63 1663.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR 6"" X 8"" OBLONG" 278 C1781 HCPCS 5271896 local both 2380.33 1666.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 9H/126 278 C1713 HCPCS 5271521 local both 2401.89 1681.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ORTHOSORBABLE PIN LONG 278 C1713 HCPCS 5271621 local both 2408.49 1685.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AMBIODRY ALLOGRAFT 1X2CM 278 C1762 HCPCS 5270389 local both 2410.55 1687.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 10H/140 278 C1713 HCPCS 5271522 local both 2433.35 1703.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES LARGE OPEN ADJUSTABLE CLAMP 278 C1713 HCPCS 5270203 local both 2435.93 1705.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 3H 278 C1713 HCPCS 5271847 local both 2436.85 1705.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HELICAL BLADE FOR TROCH NAIL 278 C1713 HCPCS 5270371 local both 2451.69 1716.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC DEPUY DISTAL RADIUS SET, FRAGMENT PLATES, ALL" 278 C1713 HCPCS 5270183 local both 2452.39 1716.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC IMPLANT PORT W/GROSHONG CATH 278 A4301 RC 5270308 local both 2453.87 1717.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 4H 278 C1713 HCPCS 5271848 local both 2476.47 1733.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES LARGE OPEN ADJUSTABLE CLAMP 278 C1713 HCPCS 5270220 local both 2478.8 1735.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC LOCKING CALCANEAL PLATE-LONG, SYNTHES" 278 C1713 HCPCS 5270305 local both 2493.95 1745.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE DEG DHS PLATE-STD BRL 278 C1713 HCPCS 5271555 local both 2501.72 1751.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 11 HOLES/206MM 278 C1713 HCPCS 360838 local both 2507.82 1755.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 9 HOLES/170MM 278 C1713 HCPCS 360845 local both 2507.82 1755.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 5H 278 C1713 HCPCS 5271849 local both 2509.49 1756.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HELICAL BLADE IMPLANT 11.0MM TI 278 C1713 HCPCS 5271586 local both 2520.76 1764.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AXOGUARD NERVE CONNECTOR 278 C9352 HCPCS 5271904 local both 2525.03 1767.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH ACCUMESH ROUND 15CM 278 C1781 HCPCS 5272098 local both 2541.5 1779.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 6H 278 C1713 HCPCS 5271850 local both 2549.11 1784.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ENDO GIA 30 STAPLER 278 278 RC 5270088 local both 2552.29 1786.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 11H/155 278 C1713 HCPCS 5271523 local both 2555.72 1789 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC COMBINATION CLAMP 8.0MM/11MM 278 C1713 HCPCS 5270238 local both 2562.48 1793.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC EVICEL FIBRIN SEALANT(HUMAN) 5ML 278 C1762 HCPCS 5270379 local both 2576.38 1803.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC PEEK SUTURE TAK, 3MM SUTURE ANCHOR" 278 C1713 HCPCS 5270185 local both 2577.09 1803.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 7H 278 C1713 HCPCS 5271851 local both 2585.44 1809.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 14 HOLE 189 278 C1713 HCPCS 5271400 local both 2597.67 1818.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 4H HEAD/ 8H 278 C1713 HCPCS 5271463 local both 2601.17 1820.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP T-PLATE 3H HEAD/ 8H 278 C1713 HCPCS 5271464 local both 2611.66 1828.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 9H 278 C1713 HCPCS 5271852 local both 2621.76 1835.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHREX-TIGHTROPE AND SYDESMOSIS SINGLE USE REPAIR KT 278 C1713 HCPCS 5270250 local both 2622.1 1835.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE RECON 3.5MM 12H/168 278 C1713 HCPCS 5271524 local both 2643.12 1850.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW FEMORAL TROCHLEA 20MM 278 C1713 HCPCS 5271919 local both 2645.45 1851.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC 5 MM BAR TO PIN CLAMP, EXTERNAL FIXATION" 278 C1713 HCPCS 5270196 local both 2647.43 1853.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 11H 278 C1713 HCPCS 5271853 local both 2661.38 1862.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PORT-A-CATH/TITANIUM 278 C1788 HCPCS 5270098 local both 2663.78 1864.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 13H 278 C1713 HCPCS 5271854 local both 2694.4 1886.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 12 HOLES/224MM 278 C1713 HCPCS 360839 local both 2695.29 1886.7 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 10 HOLES/188MM 278 C1713 HCPCS 360846 local both 2695.29 1886.7 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CURVD CARBN FIBR 11 X 213M 278 C1713 HCPCS 5271575 local both 2695.57 1886.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 15 HOLE 202 278 C1713 HCPCS 5271401 local both 2699.06 1889.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC INTRATHECAL CATHETER-MEDTRONIC INDURA 278 E0785 HCPCS 5270382 local both 2699.84 1889.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OSTEOTOMY COMPRESSION PLATE 278 C1713 HCPCS 5270244 local both 2699.84 1889.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MENISCAL BEARING MED 3MM THICK 278 C1776 HCPCS 5270329 local both 2700.38 1890.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ALLODERM-ACELLULAR DERMAL GRAFT 3CMX7CM 278 C1762 HCPCS 5270106 local both 2709.12 1896.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HELICAL BLADE IMPLANT 11.0MM TI 75MM 278 C1713 HCPCS 5271587 local both 2713.05 1899.14 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GLAUCOMA IMPLANT 278 L8612 HCPCS 5270252 local both 2715.38 1900.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TUBULAR HOOK PLATE-3 HOLE 278 C1713 HCPCS 5270342 local both 2719.26 1903.48 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HELICAL BLADE IMPLANT 11.0MM TI 130MM 278 C1713 HCPCS 5271596 local both 2720.04 1904.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 4 H 278 C1713 HCPCS 5271531 local both 2727.03 1908.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP DFP 2.7/3.5MM 15H 278 C1713 HCPCS 5271855 local both 2734.02 1913.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PRO OSTEON BONE GFT SUBSTITUTE 278 C1762 HCPCS 5270494 local both 2735.54 1914.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MODULAR HEAD COMPONENT 278 C1776 HCPCS 5270152 local both 2747.5 1923.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 13 HL/18 278 C1713 HCPCS 5271525 local both 2779.47 1945.63 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LAG SCREW SOLID FIXED 90MM 278 C1713 HCPCS 5271826 local both 2781.42 1946.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE F3 FRAG 278 C1713 HCPCS 5271607 local both 2785.3 1949.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PCOX ROUND 20CM 278 C1781 HCPCS 5272106 local both 2787.79 1951.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PARIETEX MESH-PC0151005 278 C1781 HCPCS 5270518 local both 2815.12 1970.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL RADIUS PLATE 8 HEAD/3 SHAFT 278 C1713 HCPCS 5270358 local both 2820.26 1974.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 16 HOLE 215 278 C1713 HCPCS 5271402 local both 2824.92 1977.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PARIETEX SKIRT 20CM X 15CM 278 C1781 HCPCS 5272088 local both 2836.31 1985.42 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 6"" X 8""" 278 C1781 HCPCS 5271731 local both 2837.94 1986.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 6"" X 8"" OBLONG" 278 C1781 HCPCS 5271890 local both 2837.94 1986.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FINGER JOINT IMPLANTS W/GROMETS (SIZE 4-6) 278 C1776 HCPCS 5270359 local both 2838.79 1987.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 11 HOLES/206MM 278 C1713 HCPCS 360847 local both 2872.16 2010.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 14 HL/19 278 C1713 HCPCS 5271526 local both 2887.86 2021.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHROSURFACE-FIXATION STUD 278 C1713 HCPCS 5271314 local both 2925.15 2047.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CLAMP EXTERNAL FIXATION MEDIUM MULTI-PIN 4POS 278 C1713 HCPCS 5271573 local both 2947.29 2063.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PATELLA BUTTON 20MM 278 C1713 HCPCS 5271920 local both 2948.46 2063.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 6 H 278 C1713 HCPCS 5271532 local both 2950.79 2065.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET ALL POLY PATELLA BUTTON 37X10 278 C1713 HCPCS 5270156 local both 2956.01 2069.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH ACCUMESH 20CM X 15CM 278 C1781 HCPCS 5272100 local both 2957.12 2069.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CURVD CARBN FIBR 11 X 425M 278 C1713 HCPCS 5271576 local both 2964.77 2075.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DVRA SHORT RIGHT PLATE 278 C1713 HCPCS 5270439 local both 2969.73 2078.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 6 HOLE SMALL LOCKING CLAVICLE PLATE 278 C1713 HCPCS 5270129 local both 2969.81 2078.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING CLAVICLE PLATE 8 HOLES 278 C1713 HCPCS 5270529 local both 2969.81 2078.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,LARGE COMBINATION CLAMP" 278 C1713 HCPCS 5270206 local both 2992.74 2094.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AMBIODRY ALLOGRAFT 2X3CM 278 C1762 HCPCS 5270390 local both 3019.52 2113.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 14 HOLES/260MM 278 C1713 HCPCS 360840 local both 3024.29 2117 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 12 HOLES/224MM 278 C1713 HCPCS 360848 local both 3045.46 2131.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD CR STEM HOUSING 278 C1776 HCPCS 5271680 local both 3103.84 2172.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 16 HL/22 278 C1713 HCPCS 5271527 local both 3129.09 2190.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC CONTACT EXTENSION KIT (55CM, 8 CONTACT) NEUROSTIM COMP" 278 C1883 HCPCS 5270367 local both 3138.81 2197.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SCREW AFFIXUS LAG 278 C1713 HCPCS 5271841 local both 3146.57 2202.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PORT-A-CATH/DUAL LUMEN TITANIUM 278 C1788 HCPCS 5270101 local both 3156.78 2209.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 10 HL 278 C1713 HCPCS 5271382 local both 3159.45 2211.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE DVR ANATOMIC 278 C1713 HCPCS 5271606 local both 3160.08 2212.06 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO AMNIOGRAFT W/ TISSEAL (D) 278 C1762 HCPCS 5270431 local both 3165.06 2215.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL RADIUS PLATE / 4 HOLE 278 C1713 HCPCS 5270467 local both 3166.28 2216.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL RADIUS PLATE 5/3 HOLES 278 C1713 HCPCS 5270498 local both 3166.36 2216.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 18 HOLE 241 278 C1713 HCPCS 5271403 local both 3167.55 2217.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 8 H 278 C1713 HCPCS 5271533 local both 3202.51 2241.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFTON DBM PUTTY/ 5CC 278 C1763 HCPCS 5270508 local both 3204.81 2243.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LOCKING DELTOID HOOK PLATE-3 HOLE 278 C1713 HCPCS 5270341 local both 3204.84 2243.39 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 14 278 C1713 HCPCS 5271536 local both 3207.75 2245.43 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 11 HL 278 C1713 HCPCS 5271383 local both 3213.43 2249.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 20 HL/28 278 C1713 HCPCS 5271529 local both 3236.16 2265.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CURVD CARBN FIBR 11 X 638M 278 C1713 HCPCS 5271577 local both 3237.48 2266.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT BIOMET A STD PATELLA 278 C1776 HCPCS 5271687 local both 3243.69 2270.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC STANDARD PATELLAR-BIOMET 278 C1776 HCPCS 5271867 local both 3243.69 2270.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE VADR 2COL 2.4MM 278 C1713 HCPCS 5271948 local both 3246.89 2272.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHROSURFACE-ANATOMIC PATELLA 278 C1776 HCPCS 5271714 local both 3263.11 2284.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP SUPERIOR CLAVICLE PLATE 7 HOLE-SYNTHES 278 C1713 HCPCS 5270386 local both 3267.41 2287.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 18 HL/25 278 C1713 HCPCS 5271528 local both 3277.57 2294.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SYNTHES,LARGE MULTI-PIN CLAMP-6 POSITION" 278 C1713 HCPCS 5270205 local both 3286.42 2300.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE 2.5 DR WATERSHED LEFT 278 C1713 HCPCS 5271949 local both 3298.98 2309.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG TIGHTROPE KNOTLESS SYNDESMOSIS 278 C1713 HCPCS 501779 local both 3301.96 2311.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DISTAL BICEPS REPAIR IMPLANT SYSTEM-ARTHREX 278 C1713 HCPCS 5270247 local both 3301.96 2311.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT M2A HI-C MODULAR HEAD 278 C1776 HCPCS 5271690 local both 3311.61 2318.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 2.4MM VA-LCP TWO COLUMN VOLAR DISTAL RADIAL PLATE 278 C1713 HCPCS 5271810 local both 3312.87 2319.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACUMED-OLECRANON PLATE 5 HOLE 278 C1713 HCPCS 5271800 local both 3321.38 2324.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE DISTAL CLAV PLATE 278 C1713 HCPCS 5271639 local both 3340.02 2338.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 16 HOLES/296MM 278 C1713 HCPCS 360850 local both 3351.67 2346.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 10 278 C1713 HCPCS 5271534 local both 3356.35 2349.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP RECON PLATE 22 HL/30 278 C1713 HCPCS 5271530 local both 3358.33 2350.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 5.0MM ALLTHREAD TI ANCHOR 278 C1713 HCPCS 5270227 local both 3371.55 2360.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP DIST RAD PLATE VOLAR 3H 278 C1713 HCPCS 5271599 local both 3373.83 2361.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE VOLAR DIST RAD 278 C1713 HCPCS 5271496 local both 3375.51 2362.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PATELLA SERIES A STANDARD 34MM X 8.5MM 278 C1776 HCPCS 5270301 local both 3375.76 2363.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE OLECRANON PLATE 278 C1713 HCPCS 5271640 local both 3377.9 2364.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 278 C1713 HCPCS 5271641 local both 3393.69 2375.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM BROAD LCP PLATE 14 HOLES/260MM 278 C1713 HCPCS 360849 local both 3395.66 2376.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH ACCUMESH ROUND 20CM 278 C1781 HCPCS 5272099 local both 3408.44 2385.91 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REPLIFORM 278 C1762 HCPCS 5270523 local both 3412.93 2389.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT OXFORD UNI KNEE BRG 278 C1776 HCPCS 5271673 local both 3425.26 2397.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 16 278 C1713 HCPCS 5271537 local both 3426.52 2398.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE POST-LAT DIST HUM PLATE 278 C1713 HCPCS 5271642 local both 3444.2 2410.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC M2A CARBON MODULAR HEAD (32MM) 278 C1776 HCPCS 5270297 local both 3447.35 2413.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH HERNIA PATCH 5.4"" X 7""" 278 C1781 HCPCS 5271887 local both 3450.45 2415.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT MODULAR HEAD 278 C1776 HCPCS 5271677 local both 3469 2428.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MODULAR HEAD 36MM 278 C1776 HCPCS 5270202 local both 3486 2440.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 95 DEG DCS PLATE 278 C1713 HCPCS 5271559 local both 3489.03 2442.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CALCANEOUS PLATE 278 C1713 HCPCS 5270146 local both 3491.54 2444.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ROD CURVD CARBN FIBR 11 X 850M 278 C1713 HCPCS 5271578 local both 3494.44 2446.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 12 278 C1713 HCPCS 5271535 local both 3510.18 2457.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PRECISION PROGRAMMER KIT-NEUROSTIMRLATOR 278 C1787 HCPCS 5270312 local both 3510.49 2457.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PRECISION PATIENT PROGRAMMER 278 C1787 HCPCS 5271732 local both 3510.49 2457.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MENISCAL BEARING SMALL 4MM 278 C1776 HCPCS 5270350 local both 3510.49 2457.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANATOMIC ARCOM MENISCAL BEARING SMALL 4MM 278 C1776 HCPCS 5270361 local both 3510.49 2457.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 20 HOLE 267 278 C1713 HCPCS 5271404 local both 3517.17 2462.02 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP 3.5MM 22 HOLE 293 278 C1713 HCPCS 5271818 local both 3520.67 2464.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT AEQ REV LAT HUM INSERT 36MM DI 278 C1776 HCPCS 5271719 local both 3526.28 2468.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQUALIS REVERSED LATERALILZED HUMERAL INSERT(36MMX6MM) 278 C1776 HCPCS 5271870 local both 3526.28 2468.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE VOLAR DIST RAD 278 C1713 HCPCS 5271330 local both 3531.16 2471.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PCOX 25CM X 20CM 278 C1781 HCPCS 5272089 local both 3531.23 2471.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM NARROW LCP PLATE 16 HOLES/296MM 278 C1713 HCPCS 360841 local both 3533.6 2473.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SMART TOE-IMPLANT (ALL SIZES) 278 C1776 HCPCS 5270372 local both 3551.54 2486.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE VOLAR DIST RAD 278 C1713 HCPCS 5271497 local both 3573.11 2501.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP DIST RAD PLATE VOLAR 5H 278 C1713 HCPCS 5271600 local both 3573.11 2501.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ARCOMXL HMRL BRG 278 C1776 HCPCS 5271711 local both 3598.89 2519.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG MESH, SYMBOTEX, COMP, 25 CM X 20 CM" 278 C1781 HCPCS 5272114 local both 3603.29 2522.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MODULAR HEAD COMPONENT 28MM 278 C1776 HCPCS 5270356 local both 3608.84 2526.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC BIOMET SERIES A THIN PATELLA, JOINT DEVICE, TOTAL KNEE" 278 C1776 HCPCS 5270193 local both 3612.08 2528.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES DBX PUTTY MIX 5CC 278 C1763 HCPCS 5270164 local both 3615.76 2531.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GENESIS II RESURFACING PATELLAR COMPONENT 278 C1776 HCPCS 5271863 local both 3630.46 2541.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 6HL 278 C1713 HCPCS 5271378 local both 3639.54 2547.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE VOLAR DIST RAD 278 C1713 HCPCS 5271331 local both 3643.03 2550.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH-KUGEL COMPOSIX MEDIUM 278 C1781 HCPCS 5270406 local both 3649.14 2554.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES DBX PUTTY 5 CC 278 C1763 HCPCS 5270162 local both 3657.8 2560.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE OLECRANON PLATE 278 C1713 HCPCS 5271636 local both 3663.23 2564.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP WRIST FUSION PLATE 278 C1713 HCPCS 5271950 local both 3675.6 2572.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AMBIODRY ALLOGRAFT 4X4CM 278 C1762 HCPCS 5270391 local both 3679.25 2575.48 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 278 C1713 HCPCS 5271637 local both 3682.66 2577.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FINGER JOINT IMPLANT W/GROMMETS (SIZE 4-6) 278 C1776 HCPCS 5270340 local both 3690.44 2583.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP CURV RECON PLATE 18 278 C1713 HCPCS 5271538 local both 3693.6 2585.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE DORSAL NAIL DNP ANTM 278 C1713 HCPCS 5271608 local both 3702.08 2591.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE VADR 2COL 2.4MM 278 C1713 HCPCS 5271946 local both 3704.8 2593.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC HUMAN AMNIOTIC MEMBRANE W/TISSEAL GLUE 278 C1762 HCPCS 5270416 local both 3705.55 2593.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 7 HL 278 C1713 HCPCS 5271379 local both 3709.46 2596.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 95 DEG DCS PLATE 16 HL/274MM 278 C1713 HCPCS 5271560 local both 3719.17 2603.42 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SUTURE PATELLAR BUTTON 278 C1713 HCPCS 5271310 local both 3729.27 2610.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE VOLAR DIST RAD 278 C1713 HCPCS 5271332 local both 3747.92 2623.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 8 HL 278 C1713 HCPCS 5271380 local both 3765.4 2635.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANTERIOR CLAVICLE PLATE 3.5MM 5 HOLE-SYNTHES 278 C1713 HCPCS 5271811 local both 3772.39 2640.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 8"" X 10"" OBLONG" 278 C1781 HCPCS 5271891 local both 3778.83 2645.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIPOLAR ACETABULAR CUP 278 C1776 HCPCS 5270151 local both 3779.88 2645.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 95 DEG DCS PLATE 278 C1713 HCPCS 5271558 local both 3800.36 2660.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIO AMNIOGRAFT SIZE B W/TISEEL 278 C1762 HCPCS 5270502 local both 3806.01 2664.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MESH-KUGEL COMPOSIX LARGE 278 C1781 HCPCS 5270407 local both 3821.01 2674.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 9 HL 278 C1713 HCPCS 5271381 local both 3828.33 2679.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 278 C1713 HCPCS 5271638 local both 3837.04 2685.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT MODULAR HEAD 36MM 278 C1776 HCPCS 5271695 local both 3849.7 2694.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX SKIRT 25CM X 20CM 278 C1781 HCPCS 5272090 local both 3849.77 2694.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE VADR 2COL 2.4MM 278 C1713 HCPCS 5271947 local both 3850.09 2695.06 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OXFORD UNICOMP KNEE SM RT 3MM 278 C1776 HCPCS 5270533 local both 3851.08 2695.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OXFORD UNICOMP KNEE MED LT 4MM 278 C1776 HCPCS 5270537 local both 3851.08 2695.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE CORONOID PLATE STD 278 C1713 HCPCS 5271643 local both 3883.01 2718.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT RNGLC BI-POLAR 28 CUP 278 C1776 HCPCS 5271691 local both 3886.17 2720.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PCOX 30CM X 20CM 278 C1781 HCPCS 5272091 local both 3923.29 2746.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT EXPLOR IMPLANT HEAD 278 C1776 HCPCS 5271693 local both 3924.05 2746.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP PROXIMAL TIBIA PLATE 4 HOLE 278 C1713 HCPCS 5270357 local both 3974.56 2782.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PERMACOL PROCINE 10CM X 10CM X 1.0MM 278 C1781 HCPCS 5272092 local both 4003.7 2802.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG COVODIEN SYMBOTEX MESH 30CM X 20CM 278 C1781 HCPCS 360829 local both 4003.92 2802.74 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC PATIENT PROGRAMMER, MEDTRONIC NEUROSTIMULATOR" 278 C1787 HCPCS 5270320 local both 4009.29 2806.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC RINGLOC ACETABULAR CUP 28MM 278 C1776 HCPCS 5270355 local both 4044 2830.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP OLECRANAN PLATE 8 HOLE 278 C1713 HCPCS 5270470 local both 4085.11 2859.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX SKIRT 30CM X 20CM 278 C1781 HCPCS 5272093 local both 4089.16 2862.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REVERSE SHOULDER HUMERAL BEARING (44-36MM)-BIOMET 278 C1776 HCPCS 5270271 local both 4097.68 2868.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SOLYX-MESH 278 C1781 HCPCS 5271885 local both 4141.25 2898.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 12 HL 278 C1713 HCPCS 5271384 local both 4148.19 2903.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MENISCAL BEARING-SMALL,MEDIUM, LARGE" 278 C1776 HCPCS 5270166 local both 4148.27 2903.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PROXIMAL HUMERUS PLATE 3 HOLE-SYNTHES LCP 278 C1713 HCPCS 5270277 local both 4154.5 2908.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 8.7"" X 10.7"" OVAL" 278 C1781 HCPCS 5271892 local both 4210.7 2947.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT BIO-MOD HMRL HEAD 278 C1776 HCPCS 5271660 local both 4230.27 2961.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PASTE 278 C1765 HCPCS 5270147 local both 4258.62 2981.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KNEE JOINT DEVICE 278 C1776 HCPCS 5270128 local both 4264.56 2985.19 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 14 HL 278 C1713 HCPCS 5271385 local both 4284.57 2999.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD CR TIB BRG 278 C1776 HCPCS 5271684 local both 4287.1 3000.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL NAIL TITANIUM LATERAL ENTRY (ALL SIZES) 278 C1713 HCPCS 5270294 local both 4321.19 3024.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD M UNI BRG 278 C1776 HCPCS 5271705 local both 4366.02 3056.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 1 HL 278 C1713 HCPCS 5271386 local both 4375.49 3062.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MEDTRONIC SPINAL STIMULATOR LEAD 1X8 COMPACT 278 C1897 HCPCS 5270381 local both 4388.12 3071.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BOIMET VANGUARD M SERIES KNEE JOINT DEVICE 278 C1776 HCPCS 5270171 local both 4411.54 3088.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET RINGLOC ACETABULAR LINER-HIP COMPONENT 278 C1776 HCPCS 5270175 local both 4411.54 3088.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REV LAT HUM INSERT 42MM DI 278 C1776 HCPCS 5271878 local both 4419.7 3093.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REV GLEN BASEPLATE 29MM 278 C1776 HCPCS 5271879 local both 4419.7 3093.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP WRIST FUSION PLATES 278 C1713 HCPCS 5270339 local both 4432.32 3102.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 6.3""X12""" 278 C1781 HCPCS 5271951 local both 4444.63 3111.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP METPHY PLATE 18 HL 278 C1713 HCPCS 5271387 local both 4457.89 3120.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL BEARING 14MM X 71/75MM VANGUARD 278 C1776 HCPCS 5270300 local both 4463.88 3124.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MEDICAL GRAFT JACKET 4X4 278 C1762 HCPCS 5270436 local both 4497.08 3147.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD PS TIB BRG 278 C1776 HCPCS 5271685 local both 4501.77 3151.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL HEAD CO-CR 28MM -3 278 C1776 HCPCS 5271874 local both 4514.4 3160.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR 10"" X 14"" OBLONG" 278 C1781 HCPCS 5271897 local both 4528.6 3170.02 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG STENT, NCOV/NCOAT W/DEL SYS" 278 C1876 HCPCS 4410434 local both 4539.38 3177.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES-TITANIUM CANNULATED TIBIAL NAIL 10MM X 360MM 278 C1713 HCPCS 5270248 local both 4542.43 3179.7 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES DBX PUTTY 10CC 278 C1763 HCPCS 5270163 local both 4560.17 3192.12 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE LCP MDT 10H 278 C1713 HCPCS 5271952 local both 4628.83 3240.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 278 C1713 HCPCS 5271315 local both 4631.31 3241.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE NAIL TI CANN NAIL 278 C1713 HCPCS 5271588 local both 4634.04 3243.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT EXPLOR IMPLANT STEM 278 C1776 HCPCS 5271694 local both 4650.14 3255.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PARIETEX PCOX 37CM X 28CM 278 C1781 HCPCS 5272094 local both 4658.92 3261.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ARCOMXL LNR 28MM 278 C1776 HCPCS 5271707 local both 4665.93 3266.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ARCOMXL LNR 36MM 278 C1776 HCPCS 5271710 local both 4665.93 3266.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VANGUARD-DCM PS TIBIAL BEARING 12X79/83MM 278 C1776 HCPCS 5270304 local both 4684.86 3279.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL BEARING 10MM X 63/67MM 278 C1776 HCPCS 5270278 local both 4684.88 3279.42 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT M2A MODULAR HEAD 278 C1776 HCPCS 5271692 local both 4694.34 3286.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE GRAFT COMPOSITE 278 C1763 HCPCS 5270148 local both 4719.52 3303.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG PLASMAX CONCENTRATOR KIT, CONNECTIVE TISSUE" 278 C1762 HCPCS 5270084 local both 4735.32 3314.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 95 DEG DCS PLATE 18 HL/306MM 278 C1713 HCPCS 5271561 local both 4744.85 3321.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP MED DIS PLATE 4-H 278 C1713 HCPCS 5271405 local both 4750.53 3325.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TI LCP MED DIS TIB 3.5 4 278 C1713 HCPCS 5271581 local both 4750.53 3325.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 2 H 278 C1713 HCPCS 5271503 local both 4781.79 3347.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD PS+ TIB BRG 278 C1776 HCPCS 5271686 local both 4789.05 3352.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP MED DIS PLATE 6-H 278 C1713 HCPCS 5271406 local both 4801.68 3361.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TI LCP MED DIS TIB 3.5 278 C1713 HCPCS 5271582 local both 4801.68 3361.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC RINGLOC ACETABULAR LINER (32MM) HI WALL 278 C1776 HCPCS 5270298 local both 4811.14 3367.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL BEARING 12X71/75MM 278 C1776 HCPCS 5270153 local both 4848.86 3394.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP MED DIS PLATE 8-H 278 C1713 HCPCS 5271407 local both 4849.98 3394.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 4-H 278 C1713 HCPCS 5271417 local both 4855.66 3398.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC VANGUARD M SERIES, PARTIAL KNEE JOINT COMPONENT" 278 C1776 HCPCS 5270387 local both 4864.18 3404.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 4-H 278 C1713 HCPCS 5271418 local both 4869.86 3408.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X106MM 4H 278 C1713 HCPCS 5271434 local both 4872.71 3410.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GLENOSPHERE BASEPLATE 278 C1713 HCPCS 5270333 local both 4873.8 3411.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 4 H 278 C1713 HCPCS 5271504 local both 4875.55 3412.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET: M2A MODULAR HEAD COMPONENT (38 MM) 278 C1776 HCPCS 5270281 local both 4886.91 3420.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ARCOMXL LNR 28MM 278 C1776 HCPCS 5271709 local both 4886.91 3420.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ARCOMXL LNR 278 C1776 HCPCS 5271708 local both 4886.91 3420.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP MED DIS PLATE 10-H 278 C1713 HCPCS 5271408 local both 4901.12 3430.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 95 DEG DCS PLATE 20 HL/338MM 278 C1713 HCPCS 5271562 local both 4901.12 3430.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TI LCP MED DIS TIB 3.5 278 C1713 HCPCS 5271583 local both 4901.12 3430.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X4H 278 C1713 HCPCS 5271435 local both 4907.12 3434.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ELBOW HINGE FIXATOR 278 C1713 HCPCS 5270240 local both 4911.28 3437.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 6-H 278 C1713 HCPCS 5271419 local both 4921.01 3444.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 6-H 278 C1713 HCPCS 5271420 local both 4929.53 3450.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X142MM 6H 278 C1713 HCPCS 5271436 local both 4932.37 3452.66 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X6H 278 C1713 HCPCS 5271437 local both 4935.21 3454.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP MED DIS PLATE 12-H 278 C1713 HCPCS 5271409 local both 4955.1 3468.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TI LCP MED DIS TIB 3.5 278 C1713 HCPCS 5271584 local both 4955.1 3468.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 6 H 278 C1713 HCPCS 5271505 local both 4969.31 3478.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 8-H 278 C1713 HCPCS 5271421 local both 4977.83 3484.48 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE MDT LOCKING 4HOLE 278 C1713 HCPCS 5271411 local both 4980.67 3486.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 8-H 278 C1713 HCPCS 5271422 local both 4986.36 3490.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL BEARING 12 MM X63/67 MM-BIOMET 278 C1776 HCPCS 5270316 local both 4987.93 3491.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL BEARING 10MM X 71/75 278 C1713 HCPCS 5270337 local both 4987.93 3491.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TI NAIL CANN TIBIAL 278 C1713 HCPCS 5271349 local both 4989.2 3492.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X178MM 8H 278 C1713 HCPCS 5271438 local both 4989.2 3492.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X8H 278 C1713 HCPCS 5271439 local both 4992.04 3494.43 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE NAIL TI CANN LAT FEM 278 C1713 HCPCS 5271353 local both 4994.25 3495.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP MED DIS PLATE 14-H 278 C1713 HCPCS 5271410 local both 5017.61 3512.33 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TI LCP MED DIS TIB 3.5 278 C1713 HCPCS 5271585 local both 5017.61 3512.33 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE MDT LOCKING 6HOLE 278 C1713 HCPCS 5271412 local both 5034.66 3524.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 10-H 278 C1713 HCPCS 5271423 local both 5034.66 3524.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X214MM 10H 278 C1713 HCPCS 5271440 local both 5043.18 3530.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES TITANIUM CANNULATED HUMERAL NAIL 11-7MM ALL LENG 278 C1713 HCPCS 5270317 local both 5046.02 3532.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X10H 278 C1713 HCPCS 5271441 local both 5046.02 3532.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE MDT LOCKING 8-HOLE 278 C1713 HCPCS 5271413 local both 5082.96 3558.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 12-H 278 C1713 HCPCS 5271425 local both 5091.48 3564.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X12H 278 C1713 HCPCS 5271442 local both 5102.85 3572 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MINIARC PRECISE, REPAIR DEVICE W/SLING" 278 C1771 HCPCS 5271860 local both 5104.74 3573.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC IMPLANT HEAD 14X24MM 278 C1713 HCPCS 5270231 local both 5104.75 3573.33 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 12-H 278 C1713 HCPCS 5271426 local both 5105.69 3573.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X250MM 12H 278 C1713 HCPCS 5271443 local both 5105.69 3573.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT SHLDR COMP RVS GLNSR 278 C1776 HCPCS 5271663 local both 5117.37 3582.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 95 DEG DCS PLATE 22 HL/370MM 278 C1713 HCPCS 5271563 local both 5119.89 3583.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE MDT LOCKING 10HOLE 278 C1713 HCPCS 5271414 local both 5136.94 3595.86 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC RING LOC ACETABULAR LINER 36MM 278 C1776 HCPCS 5270200 local both 5147.94 3603.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 14-H 278 C1713 HCPCS 5271427 local both 5151.15 3605.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X14H 278 C1713 HCPCS 5271444 local both 5159.67 3611.77 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 14-H 278 C1713 HCPCS 5271428 local both 5162.51 3613.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X286MM 14H 278 C1713 HCPCS 5271445 local both 5162.51 3613.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TITANIUM HINDFOOT ARTHRODESIS NAIL-ALL SIZES 278 C1713 HCPCS 5270364 local both 5166.87 3616.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE MDT LOCKING 12HOLE 278 C1713 HCPCS 5271415 local both 5193.77 3635.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHORT BEND FUSION PLATE 278 C1713 HCPCS 5270187 local both 5196.04 3637.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FLEXIBLE HINGE W/GROMMETS/TOE 278 C1776 HCPCS 5270418 local both 5208.97 3646.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 6-H 278 C1713 HCPCS 5271429 local both 5213.65 3649.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE TIB PROX 4.5X322MM 16H 278 C1713 HCPCS 5271446 local both 5213.65 3649.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX5H RT 278 C1713 HCPCS 5271322 local both 5216.49 3651.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX5H LF 278 C1713 HCPCS 5271360 local both 5216.49 3651.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 8 H 278 C1713 HCPCS 5271483 local both 5216.49 3651.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE PROX HUMERUS 3.5 3HOLE 278 C1713 HCPCS 5271467 local both 5225.02 3657.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACETABULAR SHELL-HIP JOINT DEVICE 278 C1776 HCPCS 5270174 local both 5239.12 3667.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP PROXIMAL HUMERUS PLATE. 5 HOLES 278 C1713 HCPCS 5270474 local both 5247.05 3672.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ECHO FX HIP/LAT FEMORAL 278 C1776 HCPCS 5271697 local both 5253.11 3677.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE MDT LOCKING 14HOLE 278 C1713 HCPCS 5271416 local both 5259.11 3681.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LCP PROXIMAL HUMERUS PLATE 2 HOLE/9 HOLE SHAFT 278 C1713 HCPCS 5270375 local both 5268.52 3687.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PLATE LCP ANT-LAT DIS TIBIA 17-19 H 278 C1713 HCPCS 5272075 local both 5268.55 3687.99 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X6H 278 C1713 HCPCS 5271371 local both 5279 3695.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PATELLA TENDON-HEMI 278 C1762 HCPCS 5270097 local both 5326.56 3728.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 16-H 278 C1713 HCPCS 5271430 local both 5330.14 3731.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX7H RT 278 C1713 HCPCS 5271359 local both 5344.35 3741.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX7H LF 278 C1713 HCPCS 5271325 local both 5344.35 3741.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHOULDER JOINT DEVICE 278 C1776 HCPCS 5270137 local both 5352.8 3746.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR TACHSHIELD 10.8""X13" 278 C1781 HCPCS 5271954 local both 5356.35 3749.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG PLATE LCP ANT-LAT DIS TIBIA 21 H 278 C1713 HCPCS 5272076 local both 5360.2 3752.14 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFT TIBIALIS TENDON ANTERIOR 278 C1762 HCPCS 5271953 local both 5366.76 3756.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X8H 278 C1713 HCPCS 5271372 local both 5378.44 3764.91 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE PROX HUMERUS 3.5 5HOLE 278 C1713 HCPCS 5271468 local both 5389.81 3772.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC NAIL LFN FEMORAL RECON 278 C1713 HCPCS 5271922 local both 5401.84 3781.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT SHLDR COMP RVS BASEPLAT 278 C1776 HCPCS 5271664 local both 5423.59 3796.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT SHLDR HYBRID GLEN BASE-ALL 4MM 278 C1776 HCPCS 5271662 local both 5429.9 3800.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PROX HUM PLATE 5H LG 278 C1713 HCPCS 5271469 local both 5440.95 3808.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX9H RT 278 C1713 HCPCS 5271323 local both 5469.36 3828.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX9H LF 278 C1713 HCPCS 5271326 local both 5469.36 3828.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ECHO FX HIP FEMORAL STEM 278 C1776 HCPCS 5270226 local both 5470.95 3829.67 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES FIXATION NAIL 11MM 278 C1713 HCPCS 5270140 local both 5515.07 3860.55 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 18-H 278 C1713 HCPCS 5271432 local both 5520.51 3864.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271484 local both 5540.39 3878.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.5 PERIART HUM PLATE 2H 278 C1713 HCPCS 5271333 local both 5568.81 3898.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CANNULATED HUMERAL NAIL 240MM 278 C1713 HCPCS 5270149 local both 5570.5 3899.35 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X10H 278 C1713 HCPCS 5271373 local both 5577.33 3904.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 10 278 C1713 HCPCS 5271485 local both 5588.7 3912.09 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX11H RT 278 C1713 HCPCS 5271324 local both 5594.38 3916.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX11H LF 278 C1713 HCPCS 5271327 local both 5594.38 3916.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACETABULAR SHELL (LIMITED HOLES/POROUS COATED) 54MM 278 C1776 HCPCS 5270241 local both 5603.53 3922.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET-EXPLOR IMPLANT HEAD 18 X 28 MM 278 C1776 HCPCS 5271861 local both 5603.53 3922.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHELL COCR UHMWPE LINER 28/46M 278 C1776 HCPCS 5271875 local both 5603.53 3922.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACETABULAR SHELL (52MM) 278 C1776 HCPCS 5270299 local both 5603.53 3922.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271486 local both 5617.11 3931.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.5 PERIART HUM PLATE 3H 278 C1713 HCPCS 5271334 local both 5650.89 3955.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PATELLA TENDON-WHOLE 278 C1762 HCPCS 5270096 local both 5654.69 3958.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PROX HUM PLATE 6H LG 278 C1713 HCPCS 5271470 local both 5656.88 3959.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNTHES DBX PUTTY MIX 10CC 278 C1763 HCPCS 5270165 local both 5674.89 3972.42 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X12H 278 C1713 HCPCS 5271374 local both 5690.98 3983.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PRX TIB PLATE 20-H 278 C1713 HCPCS 5271433 local both 5702.34 3991.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271487 local both 5702.34 3991.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.5 PERIART HUM PLATE 4H 278 C1713 HCPCS 5271335 local both 5739.28 4017.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 12 278 C1713 HCPCS 5271316 local both 5750.65 4025.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X14H 278 C1713 HCPCS 5271375 local both 5804.63 4063.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET REVERSE SHOULDER GLENOSPHERE (36MM+3) 278 C1776 HCPCS 5270269 local both 5827.68 4079.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT RINGLOC+ACET.SHELL LTD HOLE 278 C1776 HCPCS 5271716 local both 5830.83 4081.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX13H LF STRL 278 C1713 HCPCS 5271328 local both 5838.72 4087.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 14 278 C1713 HCPCS 5271317 local both 5869.97 4108.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PROX HUM PLATE 8H LG 278 C1713 HCPCS 5271471 local both 5875.66 4112.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.5 PERIART HUM PLATE 5H 278 C1713 HCPCS 5271336 local both 5878.18 4114.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VERSA-DIAL MOD HEAD JOINT COMPONENT 278 C1776 HCPCS 5271655 local both 5884.5 4119.15 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TENDON GRAFT 278 C1762 HCPCS 5270459 local both 5886.13 4120.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MINIARC PRO SLING SYSTEM 278 C1771 HCPCS 501786 local both 5887.66 4121.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271488 local both 5915.44 4140.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT SHLDR COMP RVS HMRL TRY 44MM 278 C1776 HCPCS 5271665 local both 5916.07 4141.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 12 278 C1713 HCPCS 5271489 local both 5918.28 4142.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X16H 278 C1713 HCPCS 5271376 local both 5921.12 4144.78 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT BIOMET INTLK PRI TIB TRAY 278 C1776 HCPCS 5271667 local both 5982.36 4187.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 16 278 C1713 HCPCS 5271320 local both 5983.63 4188.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACETABULAR SHELL 56 MM 278 C1776 HCPCS 5270201 local both 5995.78 4197.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PERMACOL PORCINE 10CM X 15CM X 1.0MM 278 C1781 HCPCS 5272095 local both 6005.54 4203.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT COCR OFFSET FEM HEAD 278 C1776 HCPCS 5271676 local both 6007.62 4205.33 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE DIA-META 4HX15H LF STRL 278 C1713 HCPCS 5271329 local both 6029.09 4220.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE LCP CONDYLAR 4.5X18H 278 C1713 HCPCS 5271377 local both 6040.45 4228.32 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.5 PERIART HUM PLATE 6H 278 C1713 HCPCS 5271337 local both 6045.5 4231.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC IMPLANT STEM AND SCREW 278 C1713 HCPCS 5270230 local both 6051.83 4236.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GLENOSPHERE 36MM BIOMET COMPREHENSIVE REVERSE SHOULDER 278 C1776 HCPCS 5270368 local both 6061.29 4242.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PROX HUM PLATE 10H 278 C1713 HCPCS 5271472 local both 6094.43 4266.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE NAIL TI CANN NAIL 278 C1713 HCPCS 5271589 local both 6100.12 4270.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 18 278 C1713 HCPCS 5271318 local both 6108.64 4276.05 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT BIOMET I-BEAM TIB TRAY 278 C1776 HCPCS 5271668 local both 6165.46 4315.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AMBIODRY ALLOGRAFT 6X8CM 278 C1762 HCPCS 5270392 local both 6166.34 4316.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GLENOID BASE-SHOULDER JOINT DEVICE 278 C1776 HCPCS 5270177 local both 6178.19 4324.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271490 local both 6219.45 4353.62 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFT JACKET X-PRESS 278 C1762 HCPCS 5270434 local both 6233.38 4363.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIALIS TENDON ANTERIOR 278 C1762 HCPCS 5270438 local both 6233.38 4363.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MODULAR HEAD-SHOULDER JOINT DEVICE 278 C1776 HCPCS 5270178 local both 6235.62 4364.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 20 278 C1713 HCPCS 5271358 local both 6264.91 4385.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC AEQUALIS HUMERAL HEAD, 43MM X 16MM, SHOULDER COMPONENT" 278 C1776 HCPCS 5270222 local both 6266.03 4386.22 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 3.5 PERIART HUM PLATE 8H 278 C1713 HCPCS 5271338 local both 6279.11 4395.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CRUCIATE TIBIAL PLATE 278 C1713 HCPCS 5270154 local both 6289.66 4402.76 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 3.5MM LCP PROX HUM PLATE 12H 278 C1713 HCPCS 5271473 local both 6307.53 4415.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PROXIMAL HUMERUS PLATE 13 HOLE 278 C1713 HCPCS 5271812 local both 6313.84 4419.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DEPUY-CROSSLINK ANCHOR PED GLENOID 278 C1713 HCPCS 5270138 local both 6354.8 4448.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC 4.5MM LCP CURV CNDLR PLATE 22 278 C1713 HCPCS 5271319 local both 6384.24 4468.97 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SBI RADIAL IMPLANT, STANDARD STEM, SIZE 4" 278 C1776 HCPCS 5270283 local both 6392.76 4474.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 14 278 C1713 HCPCS 5271509 local both 6392.76 4474.93 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CRUCIATE TIBIAL PLATE 63MM 278 C1713 HCPCS 5270279 local both 6421.17 4494.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC TIBIAL PLATE, FIXED CRUCIATE, 71MM" 278 C1713 HCPCS 5270338 local both 6421.18 4494.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271492 local both 6421.18 4494.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PLATE PROX HUMERUS 3.5 11-HOLE 278 C1713 HCPCS 5271829 local both 6487.47 4541.23 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271493 local both 6495.05 4546.54 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL ARTICULAR SURFACE 15MM-MG 11 TOTAL KNEE SYSTEM 278 C1776 HCPCS 5270273 local both 6536.78 4575.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR PLATE 16 278 C1713 HCPCS 5271494 local both 6585.97 4610.18 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC TIBIAL BEARING-ANTIOXIDANT INFUSED, VANGUARD" 278 C1776 HCPCS 5270328 local both 6590.68 4613.48 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET-EXPLOR IMPLANT STEM W/SCREW 7 X 28 278 C1776 HCPCS 5271862 local both 6642.16 4649.51 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE PLATE 4.5MM LCP PROX FEMUR HOOK PLAT 278 C1713 HCPCS 5271495 local both 6710.98 4697.69 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REVERSE SHOULDER HUMERAL TRAY W/LOCKING RING-BIOMET 278 C1776 HCPCS 5270270 local both 6733.71 4713.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL NAIL PHOENIX 278 C1713 HCPCS 5271837 local both 6828.42 4779.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LINEAR LEADS WITH PRELOADED ENHANCED STYLET-NEUROSTIM 278 C1778 HCPCS 5270310 local both 6844.2 4790.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFT JACKET 5X5 278 C1762 HCPCS 5270435 local both 6858.48 4800.94 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANTERIOR ELEVATE MESH 278 C1781 HCPCS 5271893 local both 6945.22 4861.65 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT E1 RNGLC LNR 278 C1776 HCPCS 5271700 local both 7052.56 4936.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MESH C-QUR 12"" X 18"" OBLONG" 278 C1781 HCPCS 5271925 local both 7073.71 4951.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SIGNATURE TIBIAL PLATE 278 C1713 HCPCS 5270229 local both 7210.4 5047.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC MEDIAL TIBIAL TRAY-SMALL, MEDIUM, LARGE" 278 C1776 HCPCS 5270168 local both 7218.58 5053.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOMET E-POLY-RINGLOC ACETABULAR LINER (38MM) 278 C1776 HCPCS 5270285 local both 7232.5 5062.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFT PATELLAR LIGAMENT SPLIT 278 C1762 HCPCS 5271924 local both 7260.92 5082.64 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT OXFORD UNI TIB TRAY 278 C1776 HCPCS 5271672 local both 7324.05 5126.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MEDIAL TIBIAL TRAY 278 C1776 HCPCS 5270133 local both 7420.87 5194.61 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT AEQ REV CEM HUM META 36MM DIA 278 C1776 HCPCS 5271718 local both 7462.96 5224.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQUALIS REVERSED CEMENTED HUMERAL METAPHYSIS (36 MM) 278 C1776 HCPCS 5271869 local both 7462.96 5224.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT AEQ REV II GLEN BASEPLATE 25MM 278 C1776 HCPCS 5271721 local both 7494.51 5246.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQUALIS REVERSED II GLENOID BASE PLATE (25MM) 278 C1713 HCPCS 5271815 local both 7494.53 5246.17 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BONE SCREW-REPOSE SUSPENSION 278 C1713 HCPCS 5271836 local both 7522.94 5266.06 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG AEQ REV FRAC CONSTRAINED INSERT 36MM 278 C1776 HCPCS 501782 local both 7576.61 5303.63 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG NEURO, PRECISE STENT 6FR" 278 C1875 HCPCS 4410252 local both 7590.83 5313.58 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TIBIAL NAIL TRIGEN 278 C1713 HCPCS 5271838 local both 7766.02 5436.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL STEM 278 C1776 HCPCS 5270160 local both 7917.81 5542.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG GORE VIATORR TIPS STENT 278 C1874 HCPCS 4410301 local both 7969.88 5578.92 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC LINER ACETABULAR R3 20D 54MMOD 278 C1776 HCPCS 5271725 local both 7971.22 5579.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT REGENEREX RNGLC + CUP 278 C1776 HCPCS 5271703 local both 8024.89 5617.42 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT AEQ REV CEM HUMERAL STEM 9X100 278 C1776 HCPCS 5271717 local both 8081.71 5657.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TENDON ALLOGRAFT 278 C1762 HCPCS 5270173 local both 8106.97 5674.88 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SBI RADIO-CAPITELLIUM, STANDARD HEAD, SIZE 2" 278 C1776 HCPCS 5270282 local both 8113.29 5679.3 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REGENEREX RINGLOC LIMITED HOLE ACETABULAR CUP (62MM) 278 C1776 HCPCS 5270280 local both 8226.93 5758.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ASCEND HUMERAL HEAD (DIAMETER 48-THICK 184-OFFSET 400) 278 C1776 HCPCS 5271882 local both 8286.92 5800.84 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC OCTAD LEAD, MEDTRONIC NEUROSTIMULATOR" 278 C1778 HCPCS 5270321 local both 8299.54 5809.68 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT E1 VANGRD CB TIB BRG 278 C1776 HCPCS 5271701 local both 8356.37 5849.46 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC SBI RADIO-CAPITELLUM, CAPITELLUM, RIGHT, LARGE" 278 C1776 HCPCS 5270284 local both 8444.76 5911.33 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT E1 VANGRD PS TIB BRG 278 C1776 HCPCS 5271702 local both 8533.15 5973.21 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT E1 VANGUARD PS+TIB BRG 278 C1776 HCPCS 5271712 local both 8561.57 5993.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT E1 VANGRD AS TIB BRG 278 C1776 HCPCS 5271713 local both 8618.39 6032.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL HEAD OXINUM 36MM +0 278 C1776 HCPCS 5271724 local both 8673.67 6071.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT ECHO PF HIP FEMORAL 278 C1776 HCPCS 5271696 local both 9082.46 6357.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC NAIL AFFIXUS HIP 278 C1713 HCPCS 5271840 local both 9205.58 6443.91 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD M UNI FEMORAL 278 C1776 HCPCS 5271704 local both 9394.99 6576.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC TROCH NAIL LONG RT 11MM X 34CM 278 C1713 HCPCS 5271828 local both 9398.15 6578.71 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQUALIS REVERSED CEMENTED HUMERAL STEM (9MMX100MM) 278 C1776 HCPCS 5271868 local both 9480.23 6636.16 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL CONQUEST FX SZ.13 278 C1776 HCPCS 5271873 local both 9707.53 6795.27 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFT PATELLAR LIGAMENT PRESHAPED 278 C1762 HCPCS 5271859 local both 9786.45 6850.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CORTILOC PEGGED GLENOID(SZ 48) 278 C1776 HCPCS 5271881 local both 9802.24 6861.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DECELLULARIZED SOFT TISSUE SCAFFOLD 278 C1762 HCPCS 5270541 local both 9844.95 6891.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC REGENEREX RINGLOCK MULTI HOLE ACETABULAR CUP-56MM 278 C1776 HCPCS 5271865 local both 9934.83 6954.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHELL R3 STIKTITE COATING 54MM 278 C1776 HCPCS 5271872 local both 10086.36 7060.45 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ACHILLES TENDON ALLOGRAFT 10MM-BIO CLEANSE 278 C1762 HCPCS 5270366 local both 10102.14 7071.5 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REV CEM HUM META 42MM DIA 278 C1776 HCPCS 5271877 local both 10354.7 7248.29 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BTB(BONE TENDON BONE)PRESHAPED PATELLAR TENDON ALLOGRAFT 278 C1762 HCPCS 5270242 local both 10417.84 7292.49 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC METACARPOPHALANGEAL IMPLANT- SM 278 C1776 HCPCS 5270274 local both 10623.04 7436.13 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PROXIMAL INTERPHALANGEAL IMPLANT SIZE 3(SBI) 278 C1776 HCPCS 5270373 local both 10626.38 7438.47 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL JOINT DEVICE 278 C1776 HCPCS 5270172 local both 10684.3 7479.01 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC FEMORAL COMPONENT-SMALL, MEDIUM, LARGE" 278 C1776 HCPCS 5270167 local both 10684.31 7479.02 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ANKLE LOCKING NAIL 278 C1713 HCPCS 5271834 local both 10862.96 7604.07 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC KNEE FEMORAL-JOINT IMPLANT 278 C1776 HCPCS 5270127 local both 10983.71 7688.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT OXFORD UNI FEMORAL 278 C1776 HCPCS 5271669 local both 10995.55 7696.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT OXFORD TWIN-PEG UNI FEMORAL 278 C1776 HCPCS 5271674 local both 10995.55 7696.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE OXFORD UNI FEMORAL XS 278 C1776 HCPCS 5271671 local both 10995.55 7696.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CEMENTED TWIN PEGGED FEMORAL-JOINT COMPONENT 278 C1776 HCPCS 5271866 local both 10995.55 7696.89 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC BIOCLEANSE PATELLAR TENDON ALLOGRAFT 278 C1762 HCPCS 5270192 local both 11147.08 7802.96 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT COMPONENT-COMPR STEM ALL SIZES 278 C1776 HCPCS 5271658 local both 11159.71 7811.8 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC WRIGHT GRAFT JACKET 2.0MM 278 C1762 HCPCS 5270471 local both 11285.92 7900.14 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG AEQ REV II 10 TILTED SPHERE 36MM DIA 278 C1776 HCPCS 501780 local both 11364.91 7955.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC GRAFT BTB 278 C1762 HCPCS 5271858 local both 11364.91 7955.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT COPELAND MB HUMERAL HEAD 278 C1776 HCPCS 5271688 local both 11481.72 8037.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC PRIMARY MINI LENGHT SHOULDER STEM (15X83MM) 278 C1776 HCPCS 5270336 local both 11605.32 8123.72 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQ REV II GLEN SPHERE 42MM 278 C1776 HCPCS 5271880 local both 11996.3 8397.41 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PERMACOL PORCINE 15CM X 20CM X 1.0MM 278 C1781 HCPCS 5272096 local both 12011.07 8407.75 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD CR FEMORAL 278 C1776 HCPCS 5271678 local both 12084.69 8459.28 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC DEPUY HUMERAL STEM W/POROCOAT, SHOULDER JOINT DEVICE" 278 C1776 HCPCS 5270136 local both 12187.75 8531.43 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OXFORD UNICOMP KNEE SM FEMORAL 278 C1776 HCPCS 5270534 local both 12202.58 8541.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC OXFORD UNICOMP KNEE MD FEMORAL 278 C1776 HCPCS 5270535 local both 12202.58 8541.81 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT COPELAND HA HUMERAL HEAD 278 C1776 HCPCS 5271689 local both 12431.95 8702.37 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VNAGUARD-CR FEMORAL 65MM 278 C1776 HCPCS 5270302 local both 12763.43 8934.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD PS OP FEMORAL 278 C1776 HCPCS 5271681 local both 13034.92 9124.44 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL BOX 278 C1713 HCPCS 5270155 local both 13113.02 9179.11 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD PS CL FEMORAL 278 C1776 HCPCS 5271682 local both 13224.34 9257.04 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT AEQ REV II GLEN SPHERE 36MM 278 C1776 HCPCS 5271722 local both 13274.85 9292.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC AEQUALIS REVERSED II CENTERED GLENOID SPHERE (36MMX25MM) 278 C1776 HCPCS 5271871 local both 13274.85 9292.4 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VANGUARD-PS FEMORAL OPEN BOX 70MM 278 C1776 HCPCS 5270303 local both 13464.26 9424.98 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC COPELAND, HUMERAL RSRF HEAD" 278 C1776 HCPCS 5270141 local both 13552.47 9486.73 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC VANGUARD CR FEMORAL, KNEE JOINT COMPONENT" 278 C1776 HCPCS 5270184 local both 13656.84 9559.79 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DENOVO NATURAL TISSUE GRAFT 278 C1762 HCPCS 5270376 local both 13732.6 9612.82 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC VANGUARD PS OPEN BOX FEMORAL 278 C1776 HCPCS 5270275 local both 13770.48 9639.34 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHOULDER COMPONENT STEM MICRO 278 C1776 HCPCS 5271657 local both 14506.05 10154.24 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD CR POR FEMORAL 278 C1776 HCPCS 5271679 local both 14954.33 10468.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SHOULDER STEM- JOINT DEVICE 278 C1776 HCPCS 5270179 local both 15021.54 10515.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL MOD TLOC PRO-JOINT COMPONENT 278 C1776 HCPCS 5271654 local both 15146.9 10602.83 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC HUMERAL STEM, HA COATED FRACTURE 6.5MM DIA X 130MM LENG" 278 C1776 HCPCS 5270221 local both 15160.04 10612.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC COMPR STEM 278 C1776 HCPCS 5271659 local both 15330 10731 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL STEM MODULAR TAPERLOC (11X142MM) 278 C1776 HCPCS 5270296 local both 15775.14 11042.6 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT HA TPRLC FEMORAL 278 C1776 HCPCS 5271699 local both 15932.97 11153.08 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL STEM (TAPERLOC) 278 C1776 HCPCS 5270150 local both 16105.86 11274.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ASCEND HUMERAL STEM (SIZE 4A-ANGLE 127.5-LENGTH 78) 278 C1776 HCPCS 5271883 local both 17404.1 12182.87 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC HAP MODULAR TAPERLOC FEMORAL, TOTAL HIP COMPONENT" 278 C1776 HCPCS 5270186 local both 17757.65 12430.36 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE-GLOBAL CAP 48X18 278 C1776 HCPCS 5270170 local both 17869.12 12508.38 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ALLODERM REGENERATIVE TISSUE MATRIX ALLOGRAFT 278 C1781 HCPCS 5270135 local both 18310.28 12817.2 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SIGNATURE FEMORAL BOX 278 C1776 HCPCS 5270228 local both 18505.5 12953.85 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC DEPUY-GLOBAL C.A.P.HEAD DUOFIX 278 C1776 HCPCS 5271864 local both 18943.6 13260.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC CAP FIXATION STUD 8.5MM 278 C1713 HCPCS 5271918 local both 19295.09 13506.56 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT TAPERLOC MP FEMORAL 278 C1776 HCPCS 5271698 local both 19490.82 13643.57 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG AEQ REV FRAC HUMERAL STEM 9X130 278 C1776 HCPCS 501781 local both 19572.9 13701.03 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC JOINT DEVICE COMPONENT VANGRD SSK FEMORAL 278 C1776 HCPCS 5271683 local both 20437.9 14306.53 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC FEMORAL SYNERGY SIZE 15 278 C1776 HCPCS 5271723 local both 21014.29 14710 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ARTHROSURFACE-OFFSET TROCHLEA 20MM 278 C1776 HCPCS 5271715 local both 21356.56 14949.59 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG MESH PERMACOL PORCINE 18CM X 28CM X 1.5MM 278 C1781 HCPCS 5272097 local both 22196.46 15537.52 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC ALLODERM REGENERATIVE TISSUE MATRIX 16X20 CM 278 C1762 HCPCS 5270145 local both 33557.59 23490.31 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC MEDTRONIC-SYNCHROMED PUMP 278 C1772 HCPCS 5270314 local both 35357.5 24750.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC SYNCHROMED II PUMP MEDTRONIC 278 C1772 HCPCS 5270383 local both 35357.5 24750.25 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC IMPLANTABLE PULSE GENERATOR W/CHARGING KIT 278 C1820 HCPCS 5270311 local both 47237 33065.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC NEUROSTIMULATOR W/PROGRAMMER MEDTRONIC PRIME ADVANCED 278 C1820 HCPCS 5270369 local both 48711.28 34097.9 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG CVMC NEUROSTIMULATOR W/CHARGE UNIT-RESTORE ADVANCED 278 C1820 HCPCS 5270365 local both 63580.37 44506.26 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
"HCHG CVMC NEUROSTIMULATOR W/RECHARGING UNIT, MEDTRONIC" 278 C1820 HCPCS 5270322 local both 66737.29 46716.1 87 percent of total billed charges 24 percent of total billed charges 47 percent of total billed charges 45 percent of total billed charges 38 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $2500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 33.5 percent of total billed charges 79 percent of total billed charges 40 percent of total billed charges 81.3 percent of total billed charges if inpatient billed charges must be over 1000 24 percent of total billed charges
HCHG O&P CYCLOSPORA *R 300 87207 cpt 357319 local both 25 17.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ROUTINE VENIPUNCTURE LAB 300 36415 cpt 360562 local both 36 25.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAPILLARY BLOOD SPECIMEN COLL LAB 300 36416 cpt 360073 local both 37.89 26.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEMOGLOBIN 300 85018 cpt 308196 local both 46 32.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG O&P CRYPTOSPORIDIUM *R 300 87207 cpt 357318 local both 79 55.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMEAR COMPLEX STAIN REF 300 87209 cpt 357320 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC LEGAL SPEC COLLECT 300 99001 cpt 360820 local both 87.8 61.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC EXAM,SYNOVIAL FLUID CRYSTALS" 300 89060 cpt 355011 local both 213.33 149.33 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SENSITIVITY, MICROBIOLOGY" 300 87186 cpt 357315 local both 281.57 197.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NFCT DS CHRNC HCV 6 ASSAYS (FIBRO TEST) REF 300 81596 cpt 362176 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH HEMOCHROMATOSIS GENOTYPE PANEL*R 300 81256 cpt 357314 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FACTOR V GENOTYPE LEIDEN*REF 300 81241 cpt 357313 local both 578 404.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FACTOR II GENOTYPE PANEL*REF 300 81240 cpt 357312 local both 737 515.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC AUTOLOGOUS BLOOD/COMPONENT-COLLECTION/STORAGE PREDEPOSIT 300 86890 cpt 351002 local both 998.67 699.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH CYSTIC FIBROSIS GENOTYPE*R 300 81220 cpt 357311 local both 1670 1169 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC PORPHOBILINOG, URINE *R" 301 84106 cpt 357106 local both 28.16 19.71 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHOSPHATASE ACID TOTAL REF 301 84060 cpt 356392 local both 33.67 23.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE BLOOD TEST LAB 301 82962 cpt 310129 local both 38 26.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEMOCULT TEST POC 301 82270 cpt 303928 local both 39 27.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UREA NITROGEN URINE LAB 301 84540 cpt 360207 local both 43 30.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SODIUM SERUM REF 301 84295 cpt 356102 local both 44 30.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SODIUM OTHER SOURCE LAB 301 84302 cpt 360216 local both 45 31.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHLORIDE OTHER SOURCE REF 301 82438 cpt 356141 local both 45 31.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN TOTAL SERUM PLASMA LAB 301 84155 cpt 360168 local both 46 32.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHLORIDE URINE REF 301 82436 cpt 356148 local both 46 32.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BILIRUBIN DIRECT LAB 301 82248 cpt 360148 local both 46 32.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPECIFIC GRAVITY NON-URINE LAB 301 84315 cpt 360381 local both 46.21 32.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC G6PD *R 301 82960 cpt 357073 local both 49.36 34.55 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FATS/LIPIDS FECES QUAL REF 301 82705 cpt 356296 local both 53 37.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROID (T3 OR T4) REF 301 84479 cpt 356227 local both 60 42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLASMA HEMOGLOBIN REF 301 83051 cpt 356136 local both 60 42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALCIUM URINE QUANT LAB 301 82340 cpt 360117 local both 60 42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URIC ACID BLOOD LAB 301 84550 cpt 360133 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UREA NITROGEN QUANT LAB 301 84520 cpt 360129 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPECTROPHOTOMETRY ANALYTE NOS REF 301 84311 cpt 356395 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN TOTAL SERUM PLASMA REF 301 84155 cpt 362203 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHOSPHORUS URINE LAB 301 84105 cpt 360116 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PH BODY FLUID NOT SPECIFIED LAB 301 83986 cpt 360134 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MAGNESIUM REF 301 83735 cpt 356111 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MAGNESIUM LAB 301 83735 cpt 360128 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE BODY FLUID NOT BLOOD LAB 301 82945 cpt 360105 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALCIUM URINE QUANT REF 301 82340 cpt 356101 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OCCULT BLOOD FECES COLORECTAL SCREENING LAB 301 82270 cpt 360400 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HGB ELECTROPHORESIS ACID REF 301 83020 cpt 360367 local both 70 49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHOLINESTERASE SERUM REF 301 82480 cpt 357178 local both 70 49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MERCURY *R 301 83825 cpt 357280 local both 71.04 49.73 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN TOTAL OTHER SOURCE LAB 301 84157 cpt 360203 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG POTASSIUM RANDOM URINE LAB 301 84133 cpt 360212 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG POTASSIUM SERUM PLASMA OR WB LAB 301 84132 cpt 360119 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHOSPHORUS LAB 301 84100 cpt 360127 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OXALATE URINE QUANT REF 301 83945 cpt 356155 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LACTATE (LD) (LDH) ENZYME LAB 301 83615 cpt 360138 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HGB ELECTROPHORESIS ALK REF 301 83020 cpt 360368 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOGLOBULIN G (IGG) REF 301 82784 cpt 356758 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CRYOGLOBULINS REF 301 82595 cpt 356764 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CREATININE BLOOD LAB 301 82565 cpt 360130 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALCIUM TOTAL REF 301 82310 cpt 356110 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALCIUM TOTAL LAB 301 82310 cpt 360126 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALBUMIN SERUM LAB 301 82040 cpt 360160 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG QUINIDINE REF 301 80194 cpt 356203 local both 74.57 52.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEMOGLOBIN ELECTROPHORESIS REF 301 83020 cpt 357074 local both 76 53.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PKU INITIAL *H 84030 301 84030 cpt 357105 local both 78.75 55.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CRYOFIBRINOGEN REF 301 82585 cpt 356600 local both 80 56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN GABAPENTIN QUANT REF 301 80171 cpt 357188 local both 80 56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSFERRIN LAB 301 84466 cpt 360502 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSFERASE (ALT) (SGPT) LAB 301 84460 cpt 360140 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSFERASE (AST) (SGOT) LAB 301 84450 cpt 360139 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN E REF 301 84446 cpt 356278 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SODIUM RANDOM URINE LAB 301 84300 cpt 360215 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROSTATIC ACID PHOSPHATASE LAB 301 84066 cpt 360338 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROSTATIC ACID PHOSPHATASE REF 301 84066 cpt 356267 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG IGG SUBCLASSES 1,2,3 OR 4 EACH REF" 301 82787 cpt 356031 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH STONE ANALYSIS, KIDNEY*R" 301 82365 cpt 370007 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALCULUS SPECTROSCOPY REF 301 82365 cpt 357273 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OCCULT BLOOD FECES OTHER THAN COLORECTAL SCREEN LAB 301 82272 cpt 360405 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BILIRUBIN TOTAL LAB 301 82247 cpt 360149 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MICROALBUMIN URINE QUANT LAB 301 82043 cpt 360202 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PROCAINAMIDE*R 301 80190 cpt 357060 local both 85.05 59.54 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GASTRIC OCCULT BLOOD 301 82271 cpt 350612 local both 85.77 60.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LEAD LEVEL*R 301 83655 cpt 357279 local both 87.49 61.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URIC ACID OTHER SOURCE LAB 301 84560 cpt 360115 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LACTIC ACID LAB 301 83605 cpt 360224 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IRON BINDING CAPACITY LAB 301 83550 cpt 360145 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IRON LAB 301 83540 cpt 360144 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE (G6PD) ENZYME LAB 301 82955 cpt 360370 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE (G6PD) ENZYME REF 301 82955 cpt 356285 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE TOLERANCE (GTT) EA ADDL LAB 301 82952 cpt 360108 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE BLOOD QUANT LAB 301 82947 cpt 360103 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESTROGEN TOTAL SERUM REF 301 82672 cpt 356261 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CREATINE KINASE (CK) (CPK) TOTAL LAB 301 82550 cpt 360136 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COPPER SERUM REF 301 82525 cpt 356210 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASCORBIC ACID VITAMIN C BLOOD REF 301 82180 cpt 356064 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOZAPINE REF 301 80159 cpt 357248 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEMOGLOBIN CHROMOTOGRAPHY REF 301 83021 cpt 356377 local both 96 67.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN BENZO 1-12 CLONOPIN REF 301 80346 cpt 303098 local both 100 70 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MEPHOBARBITAL LAB 301 80299 cpt 360256 local both 100 70 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRAZODONE REF 301 80299 cpt 356059 local both 100 70 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN OXCARBAZEPINE QUANT REF 301 80183 cpt 357192 local both 100 70 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VALPROIC ACID (DEPAKANE) FREE REF 301 80165 cpt 361059 local both 101 70.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC SUGARS, SINGLE, QUAL" 301 84376 cpt 360803 local both 104.48 73.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRIGLYCERIDES REF 301 84478 cpt 356130 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRIGLYCERIDES LAB 301 84478 cpt 360157 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CARDIO IQ PANEL, TRIGLYCERIDES*R" 301 84478 cpt 352105 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SEX HORMONE BINDING GLOBULIN REF 301 84270 cpt 356087 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ZINC PROTOPORPHYRINS LAB 301 84202 cpt 360210 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ZINC PROTOPORPHYRINS REF 301 84202 cpt 356165 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN E-PHORESIS SERUM REF 301 84165 cpt 356131 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN E-PHORESIS SERUM LAB 301 84165 cpt 360159 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN TOTAL URINE REF 301 84156 cpt 356160 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN TOTAL URINE LAB 301 84156 cpt 360204 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GAMMA (GGT) LAB 301 82977 cpt 360141 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DIHYDROTESTOSTERONE (DHT) REF 301 82642 cpt 357410 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CREATININE OTHER SOURCE REF 301 82570 cpt 356169 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CREATININE OTHER SOURCE LAB 301 82570 cpt 360219 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHOLESTEROL SERUM WB TOTAL LAB 301 82465 cpt 360155 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OXYCARBAZEPINE METABOLITE REF 301 80299 cpt 356636 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN LAMOTRIGINE QUANT REF 301 80175 cpt 357189 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOPIRAMATE REF 301 80201 cpt 356221 local both 107.25 75.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC VLDL *R 301 83719 cpt 357085 local both 107.73 75.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CARDIO IQ PANEL, CHOLESTEROL*R" 301 82465 cpt 352101 local both 110 77 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG QUANTITATION NOT SPECIFED REF 301 80299 cpt 356840 local both 112 78.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTRIN REF 301 82941 cpt 356260 local both 115 80.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN MYCOPHENOLATE QUANT REF 301 80180 cpt 357190 local both 115 80.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROXINE TOTAL LAB 301 84436 cpt 360293 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SELENIUM REF 301 84255 cpt 356394 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALKALINE PHOSPHATASE LAB 301 84075 cpt 360142 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALKALINE PHOSPHATASE REF 301 84075 cpt 356122 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSMOLALITY URINE REF 301 83935 cpt 356107 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC OSMOLALITY 301 83930 cpt 370021 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEAD BLOOD REF 301 83655 cpt 356205 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSULIN TOTAL REF 301 83525 cpt 356256 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CERULOPLASMIN REF 301 82390 cpt 356827 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OCCULT BLOOD FECES IMMUNOASSAY LAB 301 82274 cpt 360026 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BILE ACIDS TOTAL REF 301 82239 cpt 356299 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMYLASE LAB 301 82150 cpt 360151 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALDOLASE REF 301 82085 cpt 356222 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ZONISAMIDE QUANT REF 301 80203 cpt 350153 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN LEVETIRACETAM QUANT REF 301 80177 cpt 357191 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATIC FUNCTION PANEL LAB 301 80076 cpt 360094 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE 1HR GESTATIONAL LOAD LAB 301 82950 cpt 360104 local both 116.31 81.42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ARSENIC LEVEL *R 301 82175 cpt 357272 local both 117.86 82.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARBOXYHEMOGLOBIN QUANT LAB 301 82375 cpt 360262 local both 123 86.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN K REF 301 84597 cpt 356601 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRIIODOTHYRONINE (T3) REVERSE REF 301 84482 cpt 356399 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN B1 THIAMINE REF 301 84425 cpt 356061 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLYCOHEMOGLOBIN A1C POC 301 83036 cpt 303849 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLYCOHEMOGLOBIN A1C LAB 301 83036 cpt 360220 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASSAY SIROLIMUS REF 301 80195 cpt 362154 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASSAY SALICYLATE LAB 301 G0480 HCPCS 360580 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ZINC SERUM LAB 301 84630 cpt 360272 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROXINE BINDING GLOBULIN REF 301 84442 cpt 356058 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PORPHYRINS URINE QUANT REF 301 84120 cpt 356156 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHOSPHATES ALK-ISOENZYMES LAB 301 84080 cpt 360143 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYOGLOBIN LAB 301 83874 cpt 360046 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG B-12 BINDING CAPACITY REF 301 82608 cpt 356063 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC GLUCOSE QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)" 301 82947 cpt 360802 local both 132.81 92.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MAGNESIUM URINE 301 83735 cpt 370001 local both 134.92 94.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ZINC SERUM REF 301 84630 cpt 356208 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VMA ACID URINE REF 301 84585 cpt 356149 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHOSPHATES ALK-ISOENZYMES REF 301 84080 cpt 356123 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ORGANIC ACID SINGLE QUANT REF 301 83921 cpt 356389 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IMMUNOASSAY NONANTIBODY *R 301 83516 cpt 330906 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TRANSGLUTAMINASE IGA *R 301 83516 cpt 357277 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HAPTOGLOBIN QUANT REF 301 83010 cpt 356767 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FRUCTOSAMINE REF 301 82985 cpt 356138 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOGLOBULIN IGE REF 301 82785 cpt 356266 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALCIUM IONIZED LAB 301 82330 cpt 360150 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALPHA 1 ANTITRYPSIN TOTAL REF 301 82103 cpt 356766 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALPHA 1 ANTITRYPSIN TOTAL LAB 301 82103 cpt 360490 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TACROLIMUS REF 301 80197 cpt 356839 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LITHIUM LAB 301 80178 cpt 360124 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BILIRUBIN TOTAL REF 301 82247 cpt 357041 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACETONE/KETONES QUANT REF 301 82010 cpt 356295 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC PORPHYRINS, URINE *R" 301 84119 cpt 357107 local both 142.9 100.03 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY QUANTITATIVE NOS LAB 301 83520 cpt 360824 local both 146 102.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SOMATOMEDIN-C IGF-1 (245) REF 301 84305 cpt 356056 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MERCURY LEVEL QUANT REF 301 83825 cpt 356209 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIPOPROTEINS (A) REF 301 83695 cpt 357084 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOGLOBULIN A REF 301 82784 cpt 356759 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOGLOBULIN M (IGM) - LAB 301 82784 cpt 360481 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC GAMMAGLOBULIN (IMMUNOGLOBULIN) IGA,IGD,IGG,IGM,EACH *R" 301 82784 cpt 357275 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OCCULT BLOOD FECES IMMUNOASSAY REF 301 82274 cpt 357344 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APOLIPOPROTEIN A1 EA REF 301 82172 cpt 356729 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APOLIPOPROTEIN B EA REF 301 82172 cpt 356730 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CARDIO IQ PANEL, APOLIOPOPROTEIN*R" 301 82172 cpt 352100 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANGIOTENSIN I CONV ENZYME REF 301 82164 cpt 356014 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACETONE/KETONES QUANT LAB 301 82010 cpt 360399 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ELECTROLYTE PANEL LAB 301 80051 cpt 360099 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOGLOBULIN M (IGM) REF 301 82784 cpt 356760 local both 150 105 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GAMMAGLOBULIN IGA IGD IGG IGM REF 301 82784 cpt 357274 local both 150 105 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG ASSAY LACOSAMIDE REF 301 80235 cpt 362257 local both 150 105 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG SCREEN QUANT PRIMIDONE REF 301 80188 cpt 356200 local both 150 105 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BASIC METABOLIC PANEL TOTAL CA LAB 301 80048 cpt 360096 local both 150 105 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIPASE LAB 301 83690 cpt 360152 local both 152 106.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRIIODOTHYRONINE (T3) TOTAL LAB 301 84480 cpt 360294 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROXINE FREE LAB 301 84439 cpt 360031 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PREALBUMIN LAB 301 84134 cpt 360468 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEPHELOMETRY EA NOT SPEC REF 301 83883 cpt 356380 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY QUANTITATIVE NOS (KAPPA LAMBDA) REF 301 83883 cpt 360781 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GROWTH HORMONE (HGH) REF 301 83003 cpt 356249 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FOLIC ACID RBC REF 301 82747 cpt 356245 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORTISOL TOTAL LAB 301 82533 cpt 360309 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CATECHOLAMINES FRACTIONATED REF 301 82384 cpt 356153 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BETA 2 MICROGLOBULIN REF 301 82232 cpt 356011 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARSENIC REF 301 82175 cpt 356070 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RENAL FUNCTION PANEL LAB 301 80069 cpt 360093 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CARBON MONOXIDE EVAL 301 82375 cpt 310110 local both 159 111.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SOMATOSTATIN REF 301 84307 cpt 356551 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENZYME CELL ACTIVITY REF 301 82657 cpt 356549 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHENOBARBITAL REF 301 80184 cpt 356201 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RECEPTOR NON-ENDOCRINE REF 301 84238 cpt 356393 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROINSULIN REF 301 84206 cpt 356257 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHOLESTEROL DIRECT LDL REF 301 83721 cpt 356126 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CREATININE CLEARANCE LAB 301 82575 cpt 360131 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COENZYME Q10 REF 301 82542 cpt 356373 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AFP SERUM REF 301 82105 cpt 356248 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHENOBARBITAL LAB 301 80184 cpt 360257 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DIGOXIN LAB 301 80162 cpt 360292 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROGLOBULIN LAB 301 84432 cpt 360060 local both 170 119 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROGLOBULIN REF 301 84432 cpt 356060 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROSTATE SPECIFIC AG FREE REF 301 84154 cpt 356078 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PSA SCREENING TOTAL LAB 301 84153 cpt 360341 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PSA DIAGNOSTIC TOTAL LAB 301 84153 cpt 360342 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PSA DIAGNOSTIC TOTAL REF 301 84153 cpt 356268 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LACTOFERRIN FECAL QUAL REF 301 83630 cpt 357042 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLLAGEN CROSSLINKS ANY METH REF 301 82523 cpt 356082 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHENYTOIN TOTAL LAB 301 80185 cpt 360254 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LACTOFERRIN FECAL QUAL LAB 301 83630 cpt 302739 local both 184 128.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GLIADIN IGG *R 301 83520 cpt 330924 local both 186 130.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RIBOFLAVIN ASSAY VITAMIN B-2 REF 301 84252 cpt 357205 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CREATINE KINASE (CK) (CPK) MB FRACTION LAB 301 82553 cpt 360173 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VANCOMYCIN LAB 301 80202 cpt 360344 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMP METABOLIC PANEL LAB 301 80053 cpt 360092 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TESTOSTERONE BIOAVAILABLE REF 301 84410 cpt 362117 local both 191 133.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROCALCITONIN (PCT) REF 301 84145 cpt 357103 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH HYDROXYPROGESTERONE 17-D*R 301 83498 cpt 357276 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GONADOTROPIN (LH) LAB 301 83002 cpt 360323 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GONADOTROPIN (FSH) LAB 301 83001 cpt 360322 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARCINOEMBRYONIC ANTIGEN LAB 301 82378 cpt 360303 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FELBAMATE REF 301 80167 cpt 357361 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VALPROIC ACID (DEPAKANE) TOTAL LAB 301 80164 cpt 360209 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIPID PANEL LAB 301 80061 cpt 360098 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC METHEMOGLOBIN *R 301 83050 cpt 357076 local both 206.24 144.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG C-PEPTIDE LEVEL REF 301 84681 cpt 356023 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TROPONIN QUANT LAB 301 84484 cpt 360176 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TSH REF 301 84443 cpt 356226 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROGESTERONE LAB 301 84144 cpt 360321 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYDROXYINDOLACETIC ACID 5-HIAA REF 301 83497 cpt 356150 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FOLIC ACID SERUM LAB 301 82746 cpt 360314 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FERRITIN LAB 301 82728 cpt 360332 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMMONIA LAB 301 82140 cpt 360162 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYCLOSPORINE REF 301 80158 cpt 356239 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARBAMAZEPINE TOTAL REF 301 80156 cpt 356197 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRIIODOTHYRONINE (T3) FREE REF 301 84481 cpt 356398 local both 220 154 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESTRONE REF 301 82679 cpt 356302 local both 220 154 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN B-12 LAB 301 82607 cpt 360315 local both 220 154 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN A REF 301 84590 cpt 356147 local both 221 154.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG METANEPHRINES TOTAL REF 301 83835 cpt 356154 local both 221 154.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEHYDROEPIANDROSTERONE (DHEA-S) REF 301 82627 cpt 356255 local both 221 154.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARBAMAZEPINE TOTAL LAB 301 80156 cpt 360253 local both 221 154.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GONADOTROPIN CHORIONIC QUANT LAB 301 84702 cpt 360318 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRIIODOTHYRONINE (T3) FREE LAB 301 84481 cpt 360743 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TESTOSTERONE TOTAL LAB 301 84403 cpt 360324 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TESTOSTERONE TOTAL REF 301 84403 cpt 356253 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TESTOSTERONE FREE REF 301 84402 cpt 356396 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROLACTIN LAB 301 84146 cpt 360331 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY NONANTIBODY LAB 301 83516 cpt 360172 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ENDOMYSIAL AB *R 301 83516 cpt 330935 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC B12 VITAMIN 301 82607 cpt 357067 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN D 25 HYDROXY REF 301 82306 cpt 356065 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TSH LAB 301 84443 cpt 360295 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTEIN E-PHORESIS URINE CSF REF 301 84166 cpt 356132 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIPOPROTEIN FRACTIONS REF 301 83701 cpt 356499 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROCALCITONIN (PCT) LAB 301 84145 cpt 302740 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYDROXYPROGESTERONE 17-D REF 301 83498 cpt 356151 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLUCOSE TOLERANCE TEST (GTT) LAB 301 82951 cpt 360107 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ERYTHROPOIETIN REF 301 82668 cpt 356026 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THEOPHYLLINE (AMINOPHYLLINE) LAB 301 80198 cpt 360238 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN B6 REF 301 84207 cpt 356062 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY NONANTIBODY REF 301 83516 cpt 356142 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HOMOCYSTEINE LAB 301 83090 cpt 360035 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESTRADIOL TOTAL LAB 301 82670 cpt 360325 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESTRADIOL TOTAL REF 301 82670 cpt 356254 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG TEST PRSMV DIR OPT OBS LAB 301 80305 cpt 362124 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH IMMUNOASSAY, NONANTIBODY TRANSGLUT*R" 301 83516 cpt 357077 local both 270 189 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CARDIO IQ PANEL, HDL CHOL*R" 301 83718 cpt 352102 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HISTAMINE REF 301 83088 cpt 356500 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORTISOL FREE REF 301 82530 cpt 356372 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASSAY ETHANOL LAB 301 G0480 HCPCS 360583 local both 278.15 194.71 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HIGH DENSITY LIPOPROTEIN (HDL) LAB 301 83718 cpt 360156 local both 279 195.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CARDIO IQ PANEL, LIPOPROTEIN SUBCLASSES*R" 301 83704 cpt 352104 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC NMR LIPO-PROFILE*R 301 83704 cpt 357316 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RENIN REF 301 84244 cpt 356055 local both 294 205.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESTROGENS FRACTIONATED REF 301 82671 cpt 356607 local both 294 205.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHLORIDE BLOOD LAB 301 82435 cpt 360120 local both 299 209.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG TEST PRSMV INSTRMNT DIR OPT OBS LAB 301 80306 cpt 357502 local both 305 213.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENZYME CELL ACTIVITY REF 301 82657 cpt 356529 local both 310 217 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARATHORMONE LAB 301 83970 cpt 360079 local both 315 220.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CATECHOLAMIN*R 301 82382 cpt 357065 local both 316.94 221.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASSAY OF DIHYDROTESTOSTERONE REF 301 G0480 HCPCS 360587 local both 319 223.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GENTAMICIN LAB 301 80170 cpt 360330 local both 320 224 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASOACTIVE INTESTINAL PEPTIDE REF 301 84586 cpt 356649 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IG LIGHT CHAINS FREE EA REF 301 83521 cpt 357441 local both 336 235.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ONCOPROTEIN (DCP) REF 301 83951 cpt 356717 local both 347 242.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PANCREATIC ELASTASE FECAL QUAL REF 301 82656 cpt 356558 local both 347 242.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AFP L3 FRACTION & TOTAL AFP REF 301 82107 cpt 357040 local both 347 242.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAMIN D 1 25-DIHYDROXY REF 301 82652 cpt 356066 local both 378 264.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACTH REF 301 82024 cpt 356000 local both 378 264.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACETAMINOPHEN LAB 301 80143 cpt 357367 local both 378 264.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOBRAMYCIN LAB 301 80200 cpt 360221 local both 379 265.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD GASES ANY COMBO LAB 301 82803 cpt 360407 local both 389 272.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY ANAL QUANT NOS REF 301 83520 cpt 356143 local both 410 287 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRICHOMONAS VAG DNA AMP PROBE REF 301 87661 cpt 362103 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SEROTONIN BLOOD REF 301 84260 cpt 356057 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASSAY ACETAMINOPHEN LAB 301 G0480 HCPCS 360581 local both 438 306.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NATRIURETIC PEPTIDE (BNP) LAB 301 83880 cpt 360413 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACUTE HEPATITIS PANEL LAB 301 80074 cpt 360313 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACUTE HEPATITIS PANEL REF 301 80074 cpt 356242 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG TEST PRSMV CHEM ANLYZR LAB 301 80307 cpt 362126 local both 483 338.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GANGLIOSIDE GM-1 AB'S 1 *R 301 83520 cpt 330966 local both 524 366.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TSI REF 301 84445 cpt 356397 local both 525 367.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALDOSTERONE REF 301 82088 cpt 356265 local both 546 382.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FETAL FIBRONECTIN LAB 301 82731 cpt 360395 local both 560.84 392.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALPROTECTIN FECAL REF 301 83993 cpt 357045 local both 567 396.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG H PYLORI (C-13) BREATH REF 301 83013 cpt 356809 local both 620 434 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PRENATAL PAN H 301 80055 cpt 370000 local both 630.17 441.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PTH RELATED PEPTIDE REF 301 83519 cpt 356633 local both 672 470.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG L/S RATIO FETAL LUNG REF 301 83661 cpt 356145 local both 727.21 509.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROCOLLAGEN 1 P1NP REF 301 83519 cpt 360598 local both 830 581 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRUG ASSAY INFLIXIMAB REF 301 80230 cpt 362256 local both 893 625.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PROG&EST RC*R 301 84233 cpt 357108 local both 907.72 635.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMILUMINESCENT (IGFBP-3) REF 301 82397 cpt 356563 local both 960 672 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY ANAL QUANT NOS REF 301 83520 cpt 356844 local both 1008 705.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IA ANAL QUANT MITOCHONDRIAL AB REF 301 83520 cpt 357081 local both 1008 705.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PANCREATIC ELASTASE FECAL QUANT REF 301 82653 cpt 357440 local both 1040 728 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SYPHILIS TEST NON-TREP QUANT LAB 302 86593 cpt 360455 local both 40 28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTICLE AGGLUTINATION ANTIBODY SCREEN REF 302 86403 cpt 357126 local both 44.53 31.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SYPHILIS TEST NON-TREP QUAL REF 302 86592 cpt 356736 local both 48 33.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALLERGEN SPECIFIC IGG REF 302 86001 cpt 356478 local both 48 33.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTINUCLEAR ANTIBODIES (ANA) TITER REF 302 86039 cpt 351308 local both 53 37.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACTIN ASMA EACH REF 302 86015 cpt 357443 local both 53 37.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EPSTEIN-BARR ANTIBODY (EA) REF 302 86663 cpt 356755 local both 57.34 40.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERPES SIMPLEX NES ANTIBODY REF 302 86694 cpt 356782 local both 60 42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EPSTEIN-BARR ANTIBODY (EA) LAB 302 86663 cpt 360476 local both 60 42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SYPHILIS TEST NON-TREP QUANT REF 302 86593 cpt 356737 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PPD TBC SKIN TEST POC 302 86580 cpt 304835 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RHEUMATOID FACTOR QUANTITATIVE REF 302 86431 cpt 356739 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC EXTRACTABLE NUC ANT,SS-B AB*R" 302 86235 cpt 357296 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMPLEMENT FUNCTION ACTIVITY EA REF 302 86161 cpt 356416 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG C-REACTIVE PROTEIN STANDARD LAB 302 86140 cpt 370004 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SYPHILIS TEST NON-TREP QUAL LAB 302 86592 cpt 360454 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CANDIDA ANTIBODY REF 302 86628 cpt 356426 local both 81.83 57.28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOXOPLASMA ANTIBODY IGM REF 302 86778 cpt 356446 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOXOPLASMA ANTIBODY REF 302 86777 cpt 356751 local both 86 60.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DNA ANTIBODY SINGLE STRAND REF 302 86226 cpt 356542 local both 87.52 61.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WEST NILE VIRUS ANTIBODY IGM REF 302 86788 cpt 356639 local both 89 62.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WEST NILE VIRUS ANTIBODY REF 302 86789 cpt 356640 local both 90 63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RHEUMATOID FACTOR QUALITATIVE LAB 302 86430 cpt 360456 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RUBEOLA ANTIBODY REF 302 86765 cpt 356750 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MUMPS ANTIBODY REF 302 86735 cpt 356045 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNODIFFUSION OUCHTERLONY REF 302 86331 cpt 356418 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HETEROPHILE ANTIBODY SCREEN LAB 302 86308 cpt 360465 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MICROSOMAL ANTIBODY EACH LAB 302 86376 cpt 360484 local both 106 74.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTINUCLEAR ANTIBODIES (ANA) LAB 302 86038 cpt 360474 local both 109 76.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NUCLEAR ANTIGEN ANTIBODY LAB 302 86235 cpt 360453 local both 114 79.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RUBELLA TITR 302 86762 cpt 370008 local both 114.72 80.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BBP SOURCE HEPATITIS B AB 302 86706 cpt 370006 local both 115.35 80.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERPES SIMPLEX ANTIBODY TYPE 2 REF 302 86696 cpt 356440 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FUNGUS ANTIBODY NES REF 302 86671 cpt 356436 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BACTERIUM ANTIBODY REF 302 86609 cpt 356423 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MITOCHONDRIAL ANTIBODY EACH REF 302 86381 cpt 357451 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INHIBIN A REF 302 86336 cpt 356001 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMPLEMENT ANTIGEN EA COMPONENT LAB 302 86160 cpt 360489 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALLERGEN SPEC IGE RECOMB EA REF 302 86008 cpt 301136 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COCCIDIOIDES ANTIBODY REF 302 86635 cpt 356019 local both 119 83.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYCLIC CITRULLINATED PEPTIDE (CCP) AB REF 302 86200 cpt 356648 local both 120 84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIOLIPIN ANTIBODY EA IG LAB 302 86147 cpt 360495 local both 120.75 84.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARVOVIRUS ANTIBODY REF 302 86747 cpt 356442 local both 121 84.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEGIONELLA ANTIBODY REF 302 86713 cpt 356041 local both 121.21 84.85 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RAPID HIV-1/2 ANTIBODY LAB 302 86703 cpt 350643 local both 122.81 85.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC COLD AGGLOTININ 302 86157 cpt 360805 local both 123.49 86.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HIV-1 ANTIBODY REF 302 86701 cpt 370005 local both 124 86.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HTLV/HIV CONFIRM ANTIBODY REF 302 86689 cpt 357003 local both 124.94 87.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREPONEMA PALLIDUM ANTIBODY REF 302 86780 cpt 356744 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREPONEMA PALLIDUM ANTIBODY LAB 302 86780 cpt 360780 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS A ANTIBODY (HAAB) REF 302 86708 cpt 356236 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERPES SIMPLEX ANTIBODY TYPE 1 REF 302 86695 cpt 356439 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASPERGILLUS ANTIBODY REF 302 86606 cpt 356069 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLD AGGLUTININ TITER REF 302 86157 cpt 356738 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTINUCLEAR ANTIBODIES (ANA) REF 302 86038 cpt 356753 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH ANTINUCLEAR ANTIBODIES*R 302 86038 cpt 357119 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLASTOMYCES ANTIBODY REF 302 86612 cpt 356012 local both 126.56 88.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FFP/CRYO THAW 302 86927 cpt 351003 local both 127.05 88.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RUSSELL VIPER VENOM DILUTED REF 302 85613 cpt 357284 local both 129.75 90.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTISTREPTOLYSIN O TITER LAB 302 86060 cpt 360460 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ANTISTREPTOLYSIN O, TITER" 302 86060 cpt 370003 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS C ANTIBODY LAB 302 86803 cpt 360312 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RUBELLA ANTIBODY LAB 302 86762 cpt 360469 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EPSTEIN-BARR VIRAL CAPSID (VCA) REF 302 86665 cpt 356757 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EPSTEIN-BARR NUCLEAR ANTIGEN (EBNA) REF 302 86664 cpt 356756 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOMEGALOVIRUS (CMV) ANTIBODY REF 302 86644 cpt 356781 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INTRINSIC FACTOR ANTIBODY REF 302 86340 cpt 357025 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY INFECTIOUS AGENT REF 302 86317 cpt 356080 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUORESCENT ANTIBODY SCREEN LAB 302 86255 cpt 360452 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DNA ANTIBODY NATIVE REF 302 86225 cpt 356752 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTISTREPTOLYSIN O TITER REF 302 86060 cpt 356742 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HELMINTH ANTIBODY NES REF 302 86682 cpt 356437 local both 139 97.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BBP SOURCE HEPATITIS C AB 302 86803 cpt 370009 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYCOPLASMA ANTIBODY REF 302 86738 cpt 356046 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS BE ANTIBODY (HBEAB) REF 302 86707 cpt 356231 local both 143.17 100.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS C ANTIBODY REF 302 86803 cpt 356241 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS B CORE ANTIBODY (HBCAB) TOTAL LAB 302 86704 cpt 360304 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LYME DISEASE ANTIBODY CONFIRMATORY REF 302 86617 cpt 356424 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TISSUE TRANSGLUTAMINASE EACH IG CLASS REF 302 86364 cpt 357450 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOFIX E-PHORESIS SERUM REF 302 86334 cpt 356419 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ALLERGEN SPEC IGE QUAN SEMIQUAN REF 302 86003 cpt 356411 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC GIARDIA ANTIBODIES *R 302 86674 cpt 357129 local both 157.11 109.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HIV-1/HIV-2 SINGLE RESULT ANTIBODY LAB 302 86703 cpt 360443 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOMEGALOVIRUS (CMV) ANTIBODY (IGM) REF 302 86645 cpt 356430 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MICROSOMAL ANTIBODY EACH REF 302 86376 cpt 356762 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH ANALYZER PANEL MICROSOMAL AB* 302 86376 cpt 357298 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IFE PARAPROTEIN URINE REF 302 86335 cpt 357181 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NUCLEAR ANTIGEN ANTIBODY REF 302 86235 cpt 356735 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH ANTI SM/RNP *R 302 86235 cpt 357295 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMPLEMENT ANTIGEN EA COMPONENT REF 302 86160 cpt 356765 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HELICOBACTER PYLORI ANTIBODY LAB 302 86677 cpt 360462 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG T CELLS ABSOLUTE COUNT CD4 REF 302 86361 cpt 356579 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSULIN ANTIBODIES REF 302 86337 cpt 356040 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTI-PHOSPHOLIPID ANTIBODY REF 302 86148 cpt 356530 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG C-REACTIVE PROTEIN HS (HSCRP) LAB 302 86141 cpt 360437 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RICKETTSIA ANTIBODY REF 302 86757 cpt 356445 local both 170 119 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROGLOBULIN ANTIBODY REF 302 86800 cpt 356761 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY TUMOR OTHER REF 302 86316 cpt 356635 local both 180 126 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LYME DISEASE ANTIBODY REF 302 86618 cpt 356754 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHROMOGRANIN A *R 302 86316 cpt 357317 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GLIADIN DGP ANTIBODY EACH IG CLASS REF 302 86258 cpt 357448 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ISLET CELL ANTIBODY REF 302 86341 cpt 356420 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSULIN ANTIBODIES LAB 302 86337 cpt 360039 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMPLEMENT TOTAL (CH50) REF 302 86162 cpt 356726 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HISTOPLASMA ANTIBODY REF 302 86698 cpt 356034 local both 207 144.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VARICELLA-ZOSTER ANTIBODY LAB 302 86787 cpt 360499 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS A ANTIBODY (HAAB) IGM LAB 302 86709 cpt 360299 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY TUMOR CA 19-9 REF 302 86301 cpt 356010 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY TUMOR CA 27.29 REF 302 86300 cpt 356053 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC RH TITRE/COOMBS TEST, INDIRECT, TITER" 302 86886 cpt 360807 local both 215.46 150.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HAEMOPHILUS INFLUENZA ANTIBODY REF 302 86684 cpt 356527 local both 220 154 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUORESCENT ANTIBODY TITER REF 302 86256 cpt 356076 local both 221 154.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EMA EACH IG CLASS REF 302 86231 cpt 357447 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ANTI-CENTROMERE AB *R 302 86255 cpt 357297 local both 238.21 166.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS B SURFACE ANTIBODY (HBSAB) LAB 302 86706 cpt 360302 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CELIAC PANEL FLUORESCENT AB REF 302 86255 cpt 357180 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUORESCENT ANTIBODY SCREEN REF 302 86255 cpt 356843 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VIRUS ANTIBODY NES REF 302 86790 cpt 356772 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOASSAY TUMOR CA 125 LAB 302 86304 cpt 360007 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS C CONFIRM ANTIBODY REF 302 86804 cpt 356448 local both 255.72 179 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTIBODY ID PLATELET IG ASSAY REF 302 86023 cpt 356413 local both 270 189 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG T CELLS ABSOLUTE CD4/CD8 COUNT REF 302 86360 cpt 356030 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG T CELLS TOTAL COUNT REF 302 86359 cpt 356656 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIOLIPIN ANTIBODY EA IG REF 302 86147 cpt 356771 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC LEUKOCYTE ANTIBODY ID *R 302 86021 cpt 357116 local both 294 205.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ANTI-CARDIOLIPIN AB *R 302 86147 cpt 357286 local both 315 220.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARANEOPLASTIC AB FLUORESCENT REF 302 86255 cpt 302319 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AGGLUTININS FEBRILE EA ANTIGEN REF 302 86000 cpt 356410 local both 339.22 237.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTIBODY ID PLATELET ANTIBODIES REF 302 86022 cpt 356003 local both 349.19 244.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANCA SCREEN TITER WBC AB ID REF 302 86021 cpt 357115 local both 357 249.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC PROTEINASE-9 AB (PAN-ANCA) *R 302 86021 cpt 357114 local both 361 252.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANCA SCREEN EACH ANTIBODY REF 302 86036 cpt 357444 local both 389 272.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NK CELL TOTAL COUNT REF 302 86357 cpt 357122 local both 400 280 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG B CELLS TOTAL COUNT REF 302 86355 cpt 356657 local both 400 280 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IMMUNOELEC*R 302 86320 cpt 357121 local both 405.91 284.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HLA TYPING A/B/C SINGLE ANTIGEN REF 302 86812 cpt 356638 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TB TEST CELL IMM MEASURE AG (QUANTIFERON) REF 302 86480 cpt 356671 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ANTIBODY ID 302 86870 cpt 330958 local both 515 360.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HLA TYPING DR/DQ MULTI ANTIGENS REF 302 86817 cpt 356770 local both 618.44 432.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARANEOPLASTIC AB EIA RIA QUANT REF 302 83519 cpt 302318 local both 641 448.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHLAMYDIA ANTIBODY REF 302 86631 cpt 356072 local both 769.32 538.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT (RBC) AUTOMATED LAB 305 85041 cpt 360563 local both 26 18.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THROMBIN TIME (TT) REF 305 85670 cpt 356349 local both 35.93 25.15 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT HEMATOCRIT (HCT) REF 305 85014 cpt 356279 local both 39 27.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT HEMATOCRIT (HCT) LAB 305 85014 cpt 360349 local both 41 28.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROTHROMBIN TIME (PT) LAB 305 85610 cpt 360371 local both 42 29.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT HEMOGLOBIN (HGB) LAB 305 85018 cpt 360350 local both 46 32.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WBC ALKALINE PHOSPHATASE REF 305 85540 cpt 356358 local both 52.39 36.67 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RETICULOCYTE COUNT 305 85045 cpt 357110 local both 53 37.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VISCOSITY REF 305 85810 cpt 356748 local both 58 40.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RBC SED RATE NONAUTOMATED LAB 305 85651 cpt 360352 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AUTOMATED DIFF WBC COUNT LAB 305 85004 cpt 360412 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RBC SED RATE AUTOMATED LAB 305 85652 cpt 360353 local both 78 54.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THROMBOPLASTIN TIME PARTIAL (PTT) PLASMA LAB 305 85730 cpt 360372 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RUSSELL VIPER VENOM TIME DILUTED REF 305 85613 cpt 356288 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT PLATELET AUTOMATED LAB 305 85049 cpt 360357 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMPLETE CBC AUTOMATED LAB 305 85027 cpt 360356 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG D-DIMER QUANTITATIVE LAB 305 85379 cpt 360426 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTITHROMBIN III ANTIGEN REF 305 85301 cpt 356352 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMPLETE CBC W/AUTO DIFF WBC LAB 305 85025 cpt 360354 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPARIN ASSAY REF 305 85520 cpt 356015 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYCLIC CITRULLINATED PEPTIDE (CCP) AB LAB 305 86200 cpt 360744 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOT FACTOR VIII VW MULTIMERIC REF 305 85247 cpt 356298 local both 133 93.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT (WBC) AUTOMATED REF 305 85048 cpt 356401 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD COUNT (WBC) AUTOMATED LAB 305 85048 cpt 360564 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RBC SICKLE REDUCTION REF 305 85660 cpt 356284 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SICKLE CELL PREP 305 85660 cpt 370002 local both 164.83 115.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MURAMIDASE REF 305 85549 cpt 356408 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PROTEIN S ACTIVITY *R 305 85306 cpt 330939 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PROTEIN C ACTIVITY *R 305 85303 cpt 330938 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOT FACTOR VIII AHG 1-STAGE REF 305 85240 cpt 356347 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLEEDING TIME LAB 305 85002 cpt 360374 local both 168.73 118.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC LUPUS ANTICOAG*R 305 85705 cpt 357112 local both 177.53 124.27 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FIBRINOGEN ACTIVITY LAB 305 85384 cpt 360421 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD PLATELET AGGREGATION LAB 305 85576 cpt 360379 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANTITHROMBIN III ACTIVITY REF 305 85300 cpt 356353 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOT FACTOR VIII VW ANTIGEN REF 305 85246 cpt 356403 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACTIVATED PROTEIN C (APC) REF 305 85307 cpt 356405 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BETA 2 GLYCOPROTEIN I AB EA REF 305 86146 cpt 356415 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CLOTTING INHIBITORS OR ANTICOAGULANTS PROTEIN S, FREE*R" 305 85306 cpt 330943 local both 270 189 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOT INHIBITORS PROTEIN S FREE REF 305 85306 cpt 356052 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOT INHIBITORS PROTEIN S TOTAL REF 305 85305 cpt 356051 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PROTEIN C *R 305 85303 cpt 330946 local both 295.66 206.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMEAR WET MOUNT SALINE/INK LAB 306 87210 cpt 360810 local both 42 29.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INDIA INK PREP *R 306 87210 cpt 357137 local both 46.87 32.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TRICHOMONAS MT 87211 306 87210 cpt 360769 local both 46.87 32.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WET MOUNTS W/PREPARATIONS MIC 306 Q0111 HCPCS 352069 local both 48 33.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS BE ANTIGEN (HBEAG) IA REF 306 87350 cpt 356230 local both 49 34.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMEAR FLUORESCENT/ACID STAIN REF 306 87206 cpt 356830 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMEAR GRAM STAIN MIC 306 87205 cpt 352019 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMEAR GRAM STAIN REF 306 87205 cpt 357135 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH CULTURE ANAEROBIC 306 87075 cpt 360754 local both 63 44.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SKIN FUNGI CULTURE MIC 306 87101 cpt 352013 local both 70 49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONCENTRATION INF AGENTS REF 306 87015 cpt 356450 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC PIN WORM 306 87172 cpt 360809 local both 78.67 55.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OVA & PARASITES SMEARS REF 306 87177 cpt 357134 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CHLAMYDIA / GC DNA PROBE *R 306 87800 cpt 357142 local both 85.55 59.89 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FUNGI IDENTIFICATION YEAST MIC 306 87106 cpt 352063 local both 90 63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FUNGUS ISOLATION CULTURE MIC 306 87102 cpt 352033 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC FUNGUS ISOLATION CULTURE*R 306 87102 cpt 357131 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CULTURE ID, ANAEROBIC *R" 306 87076 cpt 370015 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENTAMOEB HIST GROUP ANTIGEN IA LAB 306 87337 cpt 360815 local both 97 67.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STREPTCOCCUS TYPING 306 87147 cpt 370018 local both 99.73 69.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CRYPTOSPORIDIUM ANTIGEN IA MIC 306 87328 cpt 352029 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CRYPTOSPORIDIUM ANTIGEN IA LAB 306 87328 cpt 360770 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC KOH PREP 306 87220 cpt 360811 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC MICRO, CULTURE SETUP" 306 87081 cpt 370017 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MICRO, ISOLATE ID" 306 87077 cpt 360757 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASPERGILLUS ANTIGEN IA REF 306 87305 cpt 362133 local both 110 77 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INF AG DETECT NOS IA MULT REF 306 87449 cpt 356454 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEGIONELLA PNEUMONPHILA ANTIGEN REF 306 87449 cpt 503387 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IAAD IA SHIGA-LIKE TOXIN REF 306 87427 cpt 301159 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AFB MYCOBACTERIA CULTURE REF 306 87116 cpt 357133 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CEFINASE-BETA LACTAMASE SENSIT 306 87185 cpt 360765 local both 117.72 82.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 COVID-19 IAADIA DIRECT OPTICAL OBS REF 306 87811 cpt 357343 local both 124 86.8 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 COVID-19 IAADIA DIRECT OPTICAL OBS LAB 306 87811 cpt 357341 local both 124 86.8 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG STREPTOCCUS GROUP A LAB 306 87430 cpt 360814 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HELICOBACTER PYLORI STOOL ANTIGEN IA REF 306 87338 cpt 356452 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MICRO, CULTURE COMAPYLOBACTER" 306 87046 cpt 370012 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CULTURE SCREEN ONLY REF 306 87081 cpt 356508 local both 130.16 91.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CULTURE SALM & SHIGELLA 306 87045 cpt 370011 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CULTURE SETUP YERSINIA/VIBRIO 306 87046 cpt 360751 local both 137.51 96.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMEAR SPECIAL STAIN REF 306 87207 cpt 356849 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC MALARIA 306 87207 cpt 360768 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STREP A ASSAY W/ VISUAL 306 87880 cpt 310130 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VIRUS ISOLATION HSV REF 306 87255 cpt 361061 local both 147 102.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ROTAVIRUS ANTIGEN IA LAB 306 87425 cpt 360774 local both 156 109.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG POC INFLUENZA ASSAY W/ VISUAL 306 87804 cpt 310131 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 RT PCR DIAGNOS PANEL REF 306 87635 cpt 357226 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS B SURFACE ANTIGEN IA REF 306 87340 cpt 356228 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS B SURFACE ANTIGEN IA LAB 306 87340 cpt 360298 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH CULTURE SETUP 306 87070 cpt 360752 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GC CULTURE 306 87070 cpt 370013 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CAMPYLOBACTER ANTIGEN DETECT 306 87899 cpt 360819 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSTRIDIUM DIFF AMP PROBE MIC 306 87493 cpt 352034 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HELICOBACTER PYLORI STOOL ANTIGEN IA MIC 306 87338 cpt 362107 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GIARDIA ANTIGEN IA REF 306 87329 cpt 356833 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GIARDIA ANTIGEN IA LAB 306 87329 cpt 360771 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VIRUS INOCULATION SHELL VIA MIC 306 87254 cpt 352072 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URINE CULTURE/COLONY COUNT MIC 306 87086 cpt 352018 local both 179 125.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRICHOMONAS VAG DNA DIR PROBE REF 306 87660 cpt 331118 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GARDNERELLA VAG DNA DIR PROBE REF 306 87510 cpt 331117 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CANDIDA DNA DIR PROBE REF 306 87480 cpt 331116 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CULTURE, ANAEROBIC" 306 87075 cpt 370014 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BORDETELLA PERTUSSIS NDA QUAL REF 306 87798 cpt 352099 local both 195 136.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 RT PCR DIAGNOS PANEL MIC 306 87635 cpt 362354 local both 208 145.6 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 RT PCR DIAGNOS PANEL LAB 306 87635 cpt 362355 local both 208 145.6 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 RT PCR DIAGNOS PANEL POC 306 87635 cpt 362356 local both 208 145.6 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS COV-2 COVID-19 ANTIGEN EIA LAB 306 87426 cpt 357259 local both 210 147 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH BLOOD CULTURE (BLOOD CULTURE FOR BACTERIA) 306 87040 cpt 360749 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD CULTURE 306 87040 cpt 370010 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CULTURE MYCOPLASMA REF 306 87109 cpt 356835 local both 221.7 155.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INFLUENZA A/B EACH ANTIGEN IA LAB 306 87400 cpt 360772 local both 234 163.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CULTURE AEROBIC IDENTIFICATION REF 306 87077 cpt 370016 local both 239 167.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC SENSITIVITY MICROSCAN 306 87186 cpt 343045 local both 252 176.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSTRIDIUM ANTIGEN IA LAB 306 87324 cpt 360813 local both 273 191.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RSV 306 87807 cpt 360818 local both 278 194.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC MR-STAPH, DNA, AMP PROBE" 306 87641 cpt 360775 local both 294 205.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HIV-1 AG W/HIV-1&-2 AB AG IA LAB 306 87389 cpt 360742 local both 294 205.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CULTURE & SENSITIVITY 306 87184 cpt 370019 local both 294 205.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS COV-2 COVID-19 ANTIBODY MULTI STEP REF 306 86769 cpt 357242 local both 305 213.5 100 fee schedule 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS COV-2 COVID-19 ANTIBODY MULTI STEP LAB 306 86769 cpt 357245 local both 305 213.5 100 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MTB RIFAMPIN RESISTANCE TESTING LAB 306 87798 cpt 360826 local both 310 217 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYCOBACTERIA TB DNA AMP PROBE LAB 306 87556 cpt 360825 local both 310 217 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOMEGALOVIRUS (CMV) DNA AMP PROBE REF 306 87496 cpt 356466 local both 310 217 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH HERPES CULTURE*R 306 87255 cpt 357139 local both 315 220.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG STAPH AUREUS DNA AMP PROBE MIC 306 87640 cpt 352095 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N GONORRHOEAE DNA AMP PROBE REF 306 87591 cpt 356481 local both 347 242.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHLAMYDIA TRACHOMATIS DNA AMP PROBE REF 306 87491 cpt 356482 local both 347 242.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DETECT AGENT NOS DNA QUANT REF 306 87799 cpt 356617 local both 399 279.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOMEGALOVIRUS (CMV) DNA QUANT REF 306 87497 cpt 356626 local both 399 279.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HIV-1 DNA QUANT REF 306 87536 cpt 356678 local both 431 301.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS B DNA QUANT REF 306 87517 cpt 356456 local both 441 308.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATITIS C DNA QUANT REF 306 87522 cpt 356841 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 COVID-19 NFCT DS RESP RNA 4 TRGT LAB 306 0241U cpt 357348 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC VIRAL CULTURE*R 306 87252 cpt 357138 local both 480.58 336.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HEP.C RNA PCR QUALITIVE 306 87522 cpt 357305 local both 657 459.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HIV-1 DNA AMP PROBE REF 306 87535 cpt 356491 local both 837.13 585.99 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RESP VIRUS 12-25 TARGETS REF 306 87633 cpt 350154 local both 925.47 647.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GENOTYPE DNA/RNA HEP C REF 306 87902 cpt 356462 local both 945 661.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RESP VIRUS 12-25 TARGETS MIC 306 87633 cpt 301142 local both 980 686 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GENOTYPE DNA HIV REVERSE T REF 306 87901 cpt 356461 local both 1145 801.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SARS-COV-2 COVID-19 NFCT DS 22 TARGET MIC 306 0202U cpt 503522 local both 1250 875 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URINE VOLUME MEASURE LAB 307 81050 cpt 360565 local both 19 13.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MICROALBUMIN SEMIQUANT LAB 307 82044 cpt 302527 local both 33 23.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URINALYSIS AUTO W/O SCOPE LAB 307 81003 cpt 360380 local both 42 29.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URINE PREGNANCY TEST COLOR COMP POC 307 81025 cpt 305619 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URINE PREGNANCY TEST COLOR COMP LAB 307 81025 cpt 360391 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BODY FLUID CELL COUNT W/DIFF LAB 309 89051 cpt 360355 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEUKOCYTE ASSESSMENT FECAL LAB 309 89055 cpt 360409 local both 105 73.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DIRECT COOMBS 86880 309 86880 cpt 360745 local both 116 81.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SEMEN ANALYSIS SPERM DETECTION LAB 309 89321 cpt 360392 local both 126 88.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC BLOOD TYPING RH 309 86901 cpt 360747 local both 136 95.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TYPING SEROLOGIC RH(D) BLD 309 86901 cpt 350028 local both 138 96.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BODY FLUID CELL COUNT LAB 309 89050 cpt 360351 local both 152.89 107.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXAM SYNOVIAL FLUID CRYSTALS LAB 309 89060 cpt 360348 local both 158 110.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC SPUTUM INDUCTION 309 89220 cpt 309024 local both 171.09 119.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC BLOOD TYPING ABO 309 86900 cpt 360746 local both 200 140 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TYPING SEROLOGIC ABO BLD 309 86900 cpt 350027 local both 202 141.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TYPING AG REAGENT REF 309 86902 cpt 356999 local both 245.64 171.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NASAL SMEAR EOSINOPHILS LAB 309 89190 cpt 360363 local both 284.78 199.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SEMEN ANALYSIS VOLUME/COUNT/MOTILITY LAB 309 89320 cpt 360393 local both 309.42 216.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC BLOOD TYPING ANTIGEN SCREEN 309 86902 cpt 360748 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INTRAOP CYTO PATH CONSULT 2 PAT 310 88334 cpt 354050 local both 58.3 40.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INTRAOP CYTO PATH CONSULT 1 PAT 310 88333 cpt 354049 local both 87.46 61.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CFTR GENE COMMON VAR REF 310 81220 cpt 357031 local both 123.75 86.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR IMMUNOCHEM COMPUTER ASSISTED TECH PAT 310 88361 cpt 355007 local both 127 88.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH FLOWCYTOMETRY/ TC, 1 MARKER*R" 310 88184 cpt 357143 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH CELL ENHANCE TECH PAT 310 88112 cpt 354047 local both 291 203.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HFE GENE ANALYSIS REF 310 81256 cpt 357036 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FMR1 GEN ANAL DETECT ABNORMAL ALLELES REF 310 81243 cpt 350156 local both 336.75 235.73 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HLA II TYPING 1 LOC HR BLDR 310 81382 cpt 301148 local both 370 259 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HLA II TYPING 1 LOCUS LR REF 310 81376 cpt 350619 local both 389 272.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BCR/ABL1 GENE MINOR BRK REF 310 81207 cpt 357029 local both 422 295.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IADNA-DNA/RNA PROBE TQ 6-11 LAB 310 87506 cpt 361060 local both 468 327.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BCR/ABL1 TRANSLOCATION REF 310 81206 cpt 357028 local both 470 329 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CALR GEN EXON 9 MUTATION PCR REF 310 81219 cpt 362147 local both 480 336 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MOPATH PROCEDURE LEVEL 4 REF 310 81403 cpt 357160 local both 501.75 351.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED MOLECULAR PATHOLOGY REF 310 81479 cpt 357163 local both 519 363.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HLA II TYPING 1 LOC HR REF 310 81382 cpt 357157 local both 531 371.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TPMT GENE ANAL COMMON VARIANTS REF 310 81335 cpt 301133 local both 546 382.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BCR/ABL1 GENE OTHER BRK REF 310 81208 cpt 357209 local both 672 470.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MOPATH PROCEDURE LEVEL 5 REF 310 81404 cpt 357161 local both 700.5 490.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG F2 GENE ANALYSIS A VARIANT REF 310 81240 cpt 357032 local both 725 507.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MTHFR GENE COMMON VARIANT REF 310 81291 cpt 357038 local both 767 536.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IGH VARI REGIONAL MUTATION REF 310 81263 cpt 301131 local both 884 618.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG JAK2 V617F MUTATION DETECT REF 310 81270 cpt 357194 local both 924 646.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG JAK2 V617F MUTATION DETECT PATREF 310 81270 cpt 357472 local both 924 646.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BCR/ABL1 TRANSLOCATION PATREF 310 81206 cpt 362326 local both 961 672.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG JAK2 TARGETED SEQUENCE ANAL REF 310 81279 cpt 362285 local both 1040 728 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HTT GENE DETECT ABNORMAL ALLELES REF 310 81271 cpt 357466 local both 1200 840 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOG ANAL CHROMO ABNOR SNP CGH REF 310 81229 cpt 357148 local both 2537.25 1776.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BRCA1&2 SEQ FULL DUP DEL REF 310 81162 cpt 357087 local both 9854 6897.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 130 fee schedule 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLOWCYTOMETRY TC EA ADDL MARKER REF 311 88185 cpt 356032 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLOWCYTOMETRY TC EA ADDL MARKER PATREF 311 88185 cpt 357386 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH SMEAR OTHER SOURCE >5 SLIDES PAT 311 88162 cpt 354048 local both 141.03 98.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH FLUIDS NONGYN SMEARS PAT 311 88104 cpt 354024 local both 146.9 102.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH DX EVAL FNA 1ST EA SITE PAT 311 88172 cpt 354010 local both 163 114.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH SMEAR OTHER SOURCE PREP PAT 311 88161 cpt 354009 local both 166.86 116.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOGENETICS DNA PROBE REF 311 88271 cpt 356470 local both 189 132.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOGENETICS 100-300 CELLS REF 311 88275 cpt 356472 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLOWCYTOMETRY READ 16+ MARKERS REF 311 88189 cpt 357052 local both 263 184.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLOWCYTOMETRY TC 1 MARKER REF 311 88184 cpt 356033 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLOWCYTOMETRY TC 1 MARKER PATREF 311 88184 cpt 357385 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH SMEAR OTHER SOURCE SCREEN PAT 311 88160 cpt 354008 local both 294.07 205.85 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH EVAL FNA INTERP PAT 311 88173 cpt 354011 local both 504 352.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH EVAL FNA INTERP PATREF 311 88173 cpt 357384 local both 504 352.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYTOPATH CONCENTRATE TECH PAT 311 88108 cpt 354007 local both 511.62 358.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHROMOSOME ANALYSIS 20-25 CELLS REF 311 88264 cpt 356468 local both 1145 801.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TISSUE CULTURE BONE MARROW REF 311 88237 cpt 357007 local both 1166 816.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TISSUE CULTURE BONE MARROW PATREF 311 88237 cpt 357388 local both 1166 816.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TISSUE CULTURE BONE MARROW LAB 311 88237 cpt 360514 local both 1187 830.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLOWCYTOMETRY READ 2-8 MARKERS REF 311 88187 cpt 362145 local both 1376 963.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TUMOR IMMUNOHISTOCHEMISTRY/MANUAL 312 88360 cpt 354082 local both 57 39.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC CONSULT & REPORT, REFERRED MATERIAL, REQ PREP OF SLIDES" 312 88323 cpt 355000 local both 67.08 46.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC MICROSLIDE CONSULTATION 312 88323 cpt 355001 local both 82.37 57.66 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR IMMUNOHISTOCHEMISTRY MANUAL REF 312 88360 cpt 357053 local both 88 61.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC TUMOR, IMMUNOHISTOCHEMICAL/MANUAL" 312 88360 cpt 355006 local both 88 61.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC IN SITU HYBRIDIZATION (EG, FISH), EACH PROBE" 312 88365 cpt 355008 local both 130 91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MICROSLIDE CONSULT REQUIRING SLIDE PREP PATREF 312 88323 cpt 357396 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DECALCIFICATION PROCEDURE PAT 312 88311 cpt 354012 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PATH CONSULT INTRAOP EA ADDL BLOCK PAT 312 88332 cpt 354003 local both 141.03 98.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC IN SITU HYBRIDIZATION, EACH PROBE MANUAL" 312 88368 cpt 355009 local both 180.17 126.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR IMMUNOHISTOCHEMISTRY COMPUTER PATREF 312 88361 cpt 357403 local both 219 153.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL I SURGICAL PATH PAT 312 88300 cpt 354021 local both 231 161.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPECIAL STAINS GROUP II PAT 312 88313 cpt 354026 local both 242 169.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PATH CONSULT INTRAOP PAT 312 88329 cpt 354016 local both 248.93 174.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PATH CONSULT INTRAOP 1 BLOCK PAT 312 88331 cpt 354023 local both 264.34 185.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOHISTO ANTIBODY ADDL STAIN PAT 312 88341 cpt 354058 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOHISTO ANTIBODY ADDL STAIN REF 312 88341 cpt 354059 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOHISTO ANTIBODY ADDL STAIN PATREF 312 88341 cpt 357397 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL II SURGICAL PATH PAT 312 88302 cpt 354029 local both 284 198.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IN SITU HYBRIDIZATION COMPUTER EA MULTIPLEX PROBE PATREF 312 88374 cpt 357406 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IN SITU HYBRIDIZATION FISH INITIAL PROBE PAT 312 88365 cpt 362192 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IN SITU HYBRIDIZATION FISH INITIAL PROBE PATREF 312 88365 cpt 357405 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL III SURGICAL PATH PAT 312 88304 cpt 354030 local both 357 249.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IN SITU HYBRIDIZATION MANUAL EA MULTIPLEX PROBE PATREF 312 88377 cpt 357407 local both 399 279.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL IV SURGICAL PATH PAT 312 88305 cpt 354032 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL IV SURGICAL PATH PATREF 312 88305 cpt 357391 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPECIAL STAINS GROUP I PAT 312 88312 cpt 354025 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IN SITU HYBRIDIZATION FISH EA ADDL PROBE STAIN PATREF 312 88364 cpt 357404 local both 493 345.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL V SURGICAL PATH PAT 312 88307 cpt 354033 local both 536 375.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IMMUNOHISTOCHEMISTRY*R 312 88342 cpt 355004 local both 874 611.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC IMMUNOHISTOCHEMISTRY, EACH ANTIBODY" 312 88342 cpt 355005 local both 874 611.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL VI SURGICAL PATH PAT 312 88309 cpt 354034 local both 956 669.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOHISTO ANTIBODY 1ST STAIN PAT 312 88342 cpt 354031 local both 1155 808.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOHISTO ANTIBODY 1ST STAIN LAB 312 88342 cpt 360043 local both 1155 808.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNOHISTO ANTIBODY 1ST STAIN REF 312 88342 cpt 356044 local both 1155 808.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1175 85 percent of total billed charges up to 914 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 120 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VERTEBRAL FRACTURE ASSESSMENT VIA DXA 320 77086 cpt 305040 local both 148.35 103.85 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY FEMUR 1 VW 320 73551 cpt 4401625 local both 173 121.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XR SPINE ENTIRE L/T ONE VW 320 72081 cpt 4401615 local both 173 121.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY HIP UNI W/WO PELVIS 1 VW 320 73501 cpt 4401619 local both 194 135.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY FEMUR 2+ VW 320 73552 cpt 4401626 local both 216 151.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY HIP UNI W/WO PELVIS 2-3 VW 320 73502 cpt 4401620 local both 216 151.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY ARM, INFANT" 320 73092 cpt 4400691 local both 230 161 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DXA BONE DENSITY STUDY 320 77085 cpt 305039 local both 237.45 166.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY OPER CHOLANGIO ADDNL SET 320 74301 cpt 4400748 local both 238.89 167.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY HIP UNI W/WO PELVIS 4+ VW 320 73503 cpt 4401621 local both 251.73 176.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XR SPINE ENTIRE L/T 2/3 VW 320 72082 cpt 4401616 local both 251.73 176.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY WRIST 2 VW 320 73100 cpt 4400795 local both 260 182 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY HIP BIL W/WO PELVIS 3-4 VW 320 73522 cpt 4401623 local both 270 189 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY FOOT 2 VW 320 73620 cpt 4400713 local both 281 196.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SACROILIAC JTS <3 VW 320 72200 cpt 4400763 local both 281 196.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY FACIAL BONES <3 VW 320 70140 cpt 4400709 local both 303 212.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY EXAM OF FINGER(S) 320 73140 cpt 4400706 local both 313 219.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG JOINT SURVEY, SINGLE VIEW" 320 77077 cpt 4400402 local both 324 226.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY FOOT 3+ VW 320 73630 cpt 4400714 local both 324 226.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY KNEE BILAT STANDING 320 73565 cpt 4400736 local both 324 226.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY HAND 2 VW 320 73120 cpt 4400721 local both 324 226.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY ELBOW 2 VW 320 73070 cpt 4400704 local both 324 226.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY WRIST 3+ VW 320 73110 cpt 4400796 local both 330 231 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY ANKLE 2 VW 320 73600 cpt 4400688 local both 335 234.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY LEG, INFANT" 320 73592 cpt 4400737 local both 335 234.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY HIP BIL W/WO PELVIS 2 VW 320 73521 cpt 4401622 local both 335 234.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUORO GUIDE VENOUS ACCESS DEVICE 320 77001 cpt 4400328 local both 346 242.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY KNEE 1 OR 2 VIEW 320 73560 cpt 4400733 local both 346 242.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY HAND 3+ VW 320 73130 cpt 4400722 local both 346 242.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY RIBS 2 VW UNILAT 320 71100 cpt 4400759 local both 346 242.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY NECK SOFT TISSUE 320 70360 cpt 4400746 local both 346 242.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY TOE(S) 320 73660 cpt 4400786 local both 356 249.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY FOREARM 2 VW 320 73090 cpt 4400717 local both 367 256.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY KNEE 3 VIEW 320 73562 cpt 4400734 local both 378 264.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY ELBOW 3+ VW 320 73080 cpt 4400705 local both 378 264.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY EXAM, BREAST SPECIMEN" 320 76098 cpt 4400707 local both 380 266 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY CLAVICLE 320 73000 cpt 4400698 local both 389 272.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY THORACIC SPINE+SWIM 3 VW 320 72072 cpt 4400782 local both 389 272.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY HEEL 320 73650 cpt 4400723 local both 400 280 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY PELVIS 1/2 VW 320 72170 cpt 4400752 local both 400 280 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY RIBS, CHEST 3+ VW" 320 71101 cpt 4400761 local both 400 280 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY ANKLE 3+ VW 320 73610 cpt 4400689 local both 421 294.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY HUMERUS 320 73060 cpt 4400728 local both 421 294.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SHOULDER 1 VW 320 73020 cpt 4400767 local both 432 302.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAYS, BONE LENGTH STUDIES" 320 77073 cpt 4400803 local both 454 317.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY BILE/PANCREAS ENDOSCOPY 320 74330 cpt 4400693 local both 454 317.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY KNEE 4+ VIEW 320 73564 cpt 4400735 local both 454 317.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SACRUM/COCCYX 2+ VW 320 72220 cpt 4400765 local both 454 317.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY THORACIC SPINE 2 VW 320 72070 cpt 4400780 local both 454 317.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESOPHAGRAM DOUBLE CONTRAST STUDY 320 74221 cpt 362238 local both 460 322 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY ABDOMEN 1 VIEW 320 74018 cpt 4401022 local both 464 324.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY TIB + FIB, 2VW" 320 73590 cpt 4400784 local both 475 332.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY HIP BIL W/WO PELVIS 5+ VW 320 73523 cpt 4401624 local both 479.93 335.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XR SPINE ENTIRE L/T 6/MORE VW 320 72084 cpt 4401618 local both 479.93 335.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XR SPINE ENTIRE L/T 4/5 VW 320 72083 cpt 4401617 local both 479.93 335.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY ABDOMEN 2 VIEWS 320 74019 cpt 4401023 local both 486 340.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SHOULDER 2+ VW 320 73030 cpt 4400768 local both 486 340.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY LUMBAR SPINE 2/3 VW 320 72100 cpt 4400738 local both 486 340.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONTRAST XRAY THROAT/CERV ESO* 320 74210 cpt 4400226 local both 508 355.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY THOR-LUMB SP 2 VW 320 72080 cpt 4400783 local both 540 378 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY TMJ BILAT 320 70330 cpt 4400785 local both 564.43 395.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAYS FOR BONE AGE 320 77072 cpt 4400802 local both 572 400.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SPINE ONE VIEW 320 72020 cpt 4400775 local both 574.79 402.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UGI TRACT SINGLE CONTRAST STUDY 320 74240 cpt 4400790 local both 600 420 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY NASAL BONES 320 70160 cpt 4400745 local both 607 424.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY CERV SPINE 4 VW 320 72050 cpt 4400695 local both 620 434 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SINUSES <3 VW 320 70210 cpt 4400770 local both 626 438.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY AC JTS 320 73050 cpt 4400687 local both 630 441 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SACROILIAC JTS 3+ VW 320 72202 cpt 4400764 local both 637 445.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY GUIDE ENTEROCLYSIS TUBE 320 74355 cpt 4400913 local both 651.86 456.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY PELVIS 3+ VW 320 72190 cpt 4400753 local both 652 456.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY CERV SPINE 2 VW 320 72040 cpt 4400694 local both 670 469 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY STERNO-CLAVICLUAR JT 320 71130 cpt 4400777 local both 685.79 480.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESOPHAGRAM SINGLE CONTRAST STUDY 320 74220 cpt 4400319 local both 691 483.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SCAPULA 320 73010 cpt 4400766 local both 691 483.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY STERNUM 2+ VW 320 71120 cpt 4400778 local both 691 483.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SKULL <4 VW 320 70250 cpt 4400772 local both 691 483.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY SKULL MRI SCREEN 320 70250 cpt 4400986 local both 691 483.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY FACIAL BONES 3+ VW 320 70150 cpt 4400710 local both 700 490 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UGI TRACT DOUBLE CONTRAST STUDY 320 74246 cpt 362239 local both 702 491.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY LUMBAR SPINE 4 VW 320 72110 cpt 4400739 local both 702 491.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ABDOMEN COMP ACUTE SERIES 320 74022 cpt 4400686 local both 713 499.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY OPTIC FORAMEN 320 70190 cpt 4400750 local both 777.81 544.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY LUMBAR SPINE FLEX/EXTEN 320 72120 cpt 4400741 local both 797.73 558.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SINUSES 3+ VW 320 70220 cpt 4400771 local both 810 567 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SIALOGRAM 320 70390 cpt 4400769 local both 818 572.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC X-RAY EXAM OF SALIVARY DUCT 320 70390 cpt 343232 local both 818 572.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUORO GUIDE NEEDLE PLACEMENT 320 77002 cpt 4400331 local both 821 574.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SALIVARY GLAND 320 70380 cpt 4400881 local both 821.94 575.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY JAW <4 VW 320 70100 cpt 4400731 local both 833 583.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SWALLOWING FCN,W/CINE &/OR VIDEO" 320 74230 cpt 4400612 local both 842 589.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUORO GUIDE SPINE INJECTION 320 77003 cpt 4400332 local both 886 620.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY CERV SPINE 7 VW 320 72052 cpt 4400696 local both 896 627.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY SKULL 4+ VW 320 70260 cpt 4400773 local both 939.95 657.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FLUOROSCOPE EXAMINATION 320 76000 cpt 4400330 local both 1015 710.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY RIBS, CHEST 4+ VW" 320 71111 cpt 4400762 local both 1026 718.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY LUMBAR SPINE 6+ VW 320 72114 cpt 4400740 local both 1050.96 735.67 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMALL INTESTINE FOLLOW-THROUGH 320 74248 cpt 362240 local both 1069 748.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XRAY ABDOMEN 3/MORE VIEWS 320 74021 cpt 4401024 local both 1115 780.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY THORACIC SPINE 4 VW 320 72074 cpt 4400781 local both 1123 786.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMALL INTESTINE SINGLE CONTRAST 320 74250 cpt 4400800 local both 1177 823.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, ADD LEVEL" 320 64492 cpt 4400917 local both 1343 940.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY MIDDLE EAR 320 70134 cpt 4400744 local both 1358.59 951.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAYS, BONE SURVEY, INFANT" 320 77076 cpt 4400805 local both 1426.64 998.65 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY URETHROCYSTOGRAM 320 74450 cpt 4400793 local both 1469.05 1028.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHANGE PERCUT TUBE/DRAIN CATH* 320 75984 cpt 4400111 local both 1486.02 1040.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY VIA LUMBAR INJ CERVICAL 320 62302 cpt 305029 local both 1535.1 1074.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY VIA LUMBAR IN THORACIC 320 62303 cpt 305030 local both 1540 1078 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY CYSTOGRAM, MIN 3 VIEW" 320 74430 cpt 4400703 local both 1543 1080.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAYS, BONE SURVEY COMPLETE" 320 77075 cpt 4400804 local both 1609 1126.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY ORBITS 320 70200 cpt 4400751 local both 1620 1134 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY VIA LUMBAR IN 2+ REGIONS 320 62305 cpt 305032 local both 1658 1160.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLON DOUBLE CONTRAST 320 74280 cpt 4400699 local both 1733 1213.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY JAW 4+ VW 320 70110 cpt 4400732 local both 1836 1285.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY OPER CHOLANGIOGRAM 320 74300 cpt 4400749 local both 1860 1302 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLON SINGLE CONTRAST 320 74270 cpt 4400700 local both 1880 1316 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 2ND LEVEL" 320 64494 cpt 4400919 local both 1923 1346.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, ADD LEVEL" 320 64495 cpt 4400920 local both 1934 1353.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMALL INTESTINE DOUBLE CONTRAST 320 74251 cpt 4400774 local both 2134.63 1494.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY HYSTEROSALPINGOGRAM 320 74740 cpt 4400729 local both 2142.63 1499.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENOGRAM EXTREM UNILAT 320 75820 cpt 4400672 local both 2152.59 1506.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY VIA LUMBAR IN LUMBOSACRAL 320 62304 cpt 305031 local both 2160 1512 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY RETROGRADE PYELOGRAM 320 74420 cpt 4400758 local both 2192.52 1534.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG X-RAY FISTULA,ABSCESS,SINUS T*" 320 76080 cpt 4400712 local both 2258.84 1581.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG X-RAY URETHROCYSTOGRAM+VOIDING S&I 320 74455 cpt 4400794 local both 2263 1584.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IVP 320 74410 cpt 343235 local both 2469.8 1728.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, 2ND LEVEL" 320 64491 cpt 4400916 local both 2514 1759.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENOGRAM EXTREM BILATERAL 320 75822 cpt 4400671 local both 2610.67 1827.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY CERV SPINE 320 72240 cpt 4400483 local both 2643 1850.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISCOGRAPHY LUMBAR SPINE 320 72295 cpt 4400278 local both 2915.42 2040.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC IVP W/TOMO 320 74415 cpt 343237 local both 2963.59 2074.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY OF ENTIRE SPINE 320 72270 cpt 4400485 local both 3191.98 2234.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENOUS SAMPLING BY CATHETER 320 75893 cpt 4400682 local both 3309.97 2316.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERCUT XHEPATIC PORTO+DYNAMIC 320 75885 cpt 4400530 local both 3309.97 2316.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INFERIOR VENOCAVOGRAM 320 75825 cpt 4400675 local both 3896.95 2727.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY THORAX SPINE 320 72255 cpt 4400486 local both 4167.45 2917.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYELOGRAPHY LUMBAR SPINE 320 72265 cpt 4400484 local both 4635 3244.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, CERV/THORAC, 1ST LEVEL" 320 64490 cpt 4400915 local both 4652 3256.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUPERIOR VENOCAVOGRAM 320 75827 cpt 4400681 local both 5986.69 4190.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASCULAR BIOPSY 320 75970 cpt 4400666 local both 7008.23 4905.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENOGRAM HEPATIC W HEMODYNAMI* 320 75889 cpt 4400674 local both 8367.85 5857.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSCATHETER RX EMBOLIZATN 320 75894 cpt 4400632 local both 9386.44 6570.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROGRAM OF WRIST 322 73115 cpt 4400162 local both 852.15 596.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROGRAM OF HIP 322 73525 cpt 4400159 local both 1447 1012.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROGRAM OF KNEE JOINT 322 73580 cpt 4400160 local both 1820.42 1274.29 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROGRAM OF ELBOW 322 73085 cpt 4400158 local both 1820.42 1274.29 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROGRAM OF SHOULDER 322 73040 cpt 4400161 local both 1880 1316 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FOLLOW-UP ANGIO THRU EXISTING CATH 323 75898 cpt 4400155 local both 1900.24 1330.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC SELECTIVE CATH PLACEMENT, EXTERNAL CAROTID ARTERY, UNILA" 323 36227 cpt 343221 local both 3628.12 2539.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANGIO VISCERAL SELECTIVE W/WO AORTA ABDOMINAL 323 75726 cpt 4400154 local both 4249.98 2974.99 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DESCENDING THORACIC AORTOGRAM MULTI IMAGE 323 75605 cpt 4400133 local both 4829.16 3380.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EA ADDL VESSEL AFTER BASIC SELECTIVE 323 75774 cpt 4400140 local both 5682.69 3977.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PLACE CATHETER SUBCLAVIAN OR INNOMINATE ARTERY, UNILATER" 323 36225 cpt 343217 local both 8930 6251 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC SELECTIVE CATH PLACEMENT,COMMON CAROTID/INNOMINATE ARTER" 323 36223 cpt 343213 local both 8930.91 6251.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC SELECTIVE CATH PLACE,COMMON CAROTID/INNOMINATE ARTERY" 323 36222 cpt 343210 local both 8930.91 6251.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC NON-SELECTIVE CATH PLACE,THORACIC AORTA,W/ANGIOGRAPHY" 323 36221 cpt 343208 local both 8930.91 6251.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC SELECTIVE CATHETER PLACEMENT VERTEBRAL ARTERY UNILATERAL 323 36226 cpt 343219 local both 14606 10224.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC SELECTIVE CATHETER PLACEMENT, INTERNAL CAROTID ARTERY" 323 36224 cpt 343215 local both 14606 10224.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ABDOMINAL AORTOGRAM BILAT ILIOFEMORAL 323 75630 cpt 4400131 local both 15475.77 10833.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ABDOMINAL AORTOGRAM S&I 323 75625 cpt 4400132 local both 16017.49 11212.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANGIO EXTERMITY BILAT RS&I 323 75716 cpt 4400143 local both 16548.2 11583.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANGIO PELVIS SELECTIVE RS&I 323 75736 cpt 4400146 local both 17137.47 11996.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANGIO EXTREMITY UNILAT RS&I 323 75710 cpt 4400144 local both 17242.14 12069.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEST XRAY SINGLE VIEW 324 71045 cpt 4401018 local both 389 272.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEST XRAY 2 VIEWS 324 71046 cpt 4401019 local both 486 340.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEST XRAY 3 VIEWS 324 71047 cpt 4401020 local both 572 400.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEST XRAY 4/MORE VIEWS 324 71048 cpt 4401021 local both 1154.57 808.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-SQ/IM HORMONAL 331 96402 cpt 303165 local both 255 178.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-SQ/IM NON HORMONAL 331 96401 cpt 303166 local both 388 271.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-IV-PUSH ADDL DRUG 331 96411 cpt 303163 local both 469 328.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-IV-PUSH 1ST DRUG 331 96409 cpt 303161 local both 643 450.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-IV-DIFF DRUG < 1HR 335 96417 cpt 303160 local both 316 221.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-IV INF-EA ADD HR 335 96415 cpt 303157 local both 449 314.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HIGHLY COMPLEX DRUG INF-1ST HR.-1ST SUBSTANC 335 96413 cpt 343268 local both 627.87 439.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HIGHLY COMPLEX DRUG INFUSION-ADDITION HRS. 335 96415 cpt 343269 local both 635.78 445.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-IV-W/PUMP > 8 HR 335 96416 cpt 303164 local both 998 698.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEMO ADMIN-IV-1ST DRUG < 1 HR 335 96413 cpt 303158 local both 1224 856.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIVER IMAGING W/VASCULAR FLOW 340 78202 cpt 4410691 local both 1922.25 1345.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROID IMAGING W/BLOOD FLOW 341 78013 cpt 4410502 local both 603.66 422.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTRIC EMPTY STUDY W SB TRANSIT 341 78265 cpt 360937 local both 831.63 582.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROID IMAGING W/BLOOD FLOW W/UPTAKE 341 78014 cpt 4410503 local both 876 613.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTRIC EMPTY STUDY W SB MULTI DAY 341 78266 cpt 360938 local both 1103.4 772.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THYROID UPTAKE MEASUREMENT 341 78012 cpt 4410501 local both 1166 816.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEART FIRST PASS ADD-ON 341 78496 cpt 4400906 local both 1366.55 956.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GI NUCLEAR PROCEDURE UNLISTED 341 78299 cpt 4400337 local both 1428.91 1000.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARATHYROID NUCLEAR IMAGING 341 78070 cpt 4400509 local both 1489 1042.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTRIC EMPTYING STUDY 341 78264 cpt 4400333 local both 1601 1120.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BONE/JOINT IMAGING WHOLE BODY 341 78306 cpt 4400191 local both 1816 1271.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LUNG PERFUSION IMAGING 341 78580 cpt 4400409 local both 1897 1327.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BONE/JOINT IMAGING 3 PHASE STUDY 341 78315 cpt 4400188 local both 1928 1349.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATOBILIARY IMAGING 341 78226 cpt 4400342 local both 1969 1378.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BONE/JOINT IMAGING LIMITED AREA 341 78300 cpt 4400189 local both 2175 1522.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LUNG VENT/PERF IMAGING 341 78582 cpt 4400865 local both 2178 1524.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CSF LEAKAGE DETECTION & LOCAL* 341 78650 cpt 4400228 local both 2199.5 1539.65 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR LOCALIZATION 2+AREA 1D/1 AREA 2+DAY 341 78801 cpt 4400911 local both 2330 1631 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LYMPHATICS & LYMPH GLANDS IMA* 341 78195 cpt 4400411 local both 2498.06 1748.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEPATOBILIARY WITH CCK 341 78227 cpt 4400869 local both 2550 1785 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG RENAL IMAGING, MORPH W/ FLOW" 341 78701 cpt 4400578 local both 2574.53 1802.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG 341 78803 cpt 4400638 local both 2680 1876 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG RENAL IMAGING, MORPH W/ FLOW/*" 341 78708 cpt 4400581 local both 2703 1892.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG RENAL IMAGING, MORPHOLOGY" 341 78700 cpt 4400582 local both 2805.19 1963.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG RENAL IMAGING, MORPH W/ FLOW/*" 341 78707 cpt 4400579 local both 2884.84 2019.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BOWEL IMAGING 341 78290 cpt 4400194 local both 2887.74 2021.42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LUNG VENTILATION IMAGING 341 78579 cpt 4400864 local both 2904.66 2033.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG RENAL IMAGING, MORPH W/ FLOW/*" 341 78709 cpt 4400580 local both 2942.63 2059.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIVER AND SPLEEN IMAGING 341 78215 cpt 4400405 local both 2978.54 2084.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG GATED HEART, PLANAR SINGLE" 341 78472 cpt 4400336 local both 3029.64 2120.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR LOCALIZATION 1 AREA 1 DAY 341 78800 cpt 4400639 local both 3037 2125.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG QUANT DIFF LUNG PERF/VENT 341 78598 cpt 4400867 local both 3052.34 2136.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LUNG PERFUSION DIFFERENTIAL 341 78597 cpt 4400866 local both 3052.34 2136.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG HEART FIRST PASS SINGLE,PLANAR" 341 78481 cpt 4400341 local both 3059.82 2141.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BONE/JOINT IMAGING MULTIPLE AREAS 341 78305 cpt 4400190 local both 3136.86 2195.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACUTE GI BLOOD LOSS IMAGING 341 78278 cpt 4400124 local both 3561.07 2492.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BRAIN FLOW IMAGING ONLY 341 78610 cpt 4400195 local both 3665.8 2566.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BRAIN IMAGING MIN 4 STATIC VI* 341 78605 cpt 4400104 local both 3665.8 2566.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BRAIN IMAGING < 4 STATIC VIEWS W V FLOW 341 78601 cpt 4400910 local both 3665.8 2566.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BRAIN IMAGING < 4 STATIC VIEWS 341 78600 cpt 4400907 local both 3665.8 2566.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR LOCALIZATION WHOLE BODY 1 DAY 341 78802 cpt 4400640 local both 3982 2787.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG HEART IMAGE, SPECT" 341 78494 cpt 4400905 local both 4079.79 2855.85 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYOCARDIAL SPECT MULTIPLE STUDIES 341 78452 cpt 4400488 local both 4590 3213 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CSF FLUID SCAN CISTERNOGRAPHY 341 78630 cpt 4400227 local both 4811.51 3368.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BRAIN IMAGING MIN 4 STATIC VI* 341 78606 cpt 4400105 local both 4811.51 3368.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUMOR LOCALIZATION WHOLE BODY 2+DAY 341 78804 cpt 4400641 local both 5393.94 3775.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS 341 78453 cpt 4400487 local both 8055.86 5639.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS 341 78451 cpt 4400489 local both 8298 5808.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TC 99M PERTECHNETATE PER MILLICURIE 343 A9512 HCPCS 309174 local both 11.93 8.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M TETROFOSMIN MYOVIEW DX PER DOSE 343 A9502 HCPCS 4410326 local both 80 56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M MEBROFENIN CHOLETEC DX PER DOSE 343 A9537 HCPCS 4410310 local both 143 100.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M MAA DIAGNOSTIC PER DOSE 343 A9540 HCPCS 4410557 local both 153 107.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M SULFUR COLLOID DX PER DOSE 343 A9541 HCPCS 4410558 local both 194 135.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M MEDRONATE MDP DX PER DOSE 343 A9503 HCPCS 4410320 local both 194 135.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M PENTETATE DTPA DX PER DOSE 343 A9539 HCPCS 4410346 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG I-123 SODIUM IODIDE DIAGNOSTIC PER 100 UCI 343 A9516 HCPCS 4410172 local both 335 234.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG CVMC TC99M DTPA (AEROSOL) 343 A9567 HCPCS 309177 local both 340 238 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M LABELED RBC ULTRATAG VIALS DX PER DOSE 343 A9560 HCPCS 4410484 local both 439 307.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TL201 THALLIUM CHLORIDE DX PER MCI 343 A9505 HCPCS 4410328 local both 450.05 315.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M DTPA AEROSOL PER DOSE 343 A9567 HCPCS 4410307 local both 551 385.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M SESTAMIBI CARDIOLITE DX PER DOSE 343 A9500 HCPCS 4410324 local both 551 385.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG CVMC TC99M TETROFOSMIN 343 A9500 HCPCS 4401016 local both 630 441 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M MERTIATIDE MAG3 DX PER DOSE 343 A9562 HCPCS 4410327 local both 836 585.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG I-123 IODINE IOBENGUANE MIBG DX PER DOSE 343 A9582 HCPCS 4410171 local both 930.45 651.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG GA67 GALLIUM DIAGNOSTIC PER MCI 343 A9556 HCPCS 4410131 local both 1402.48 981.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG CVMC I 111 WBC ISOTOPE 343 A9570 HCPCS 309178 local both 2920 2044 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG IN111 INDIUM PENTETATE DTPA DX PER 0.5 MCI 343 A9548 HCPCS 4410173 local both 3241.59 2269.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TC99M EXAMETAZINE CERETEC DX PER DOSE 343 A9521 HCPCS 4410317 local both 3241.59 2269.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG INDIUM IN-111 OXYQUINOLINE DIAG PER 0.5 MCI 343 A9547 HCPCS 503840 local both 3742.5 2619.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG IN111 INDIUM PENTETROTIDE OCTREOSCAN DX PER DOSE 343 A9572 HCPCS 4410175 local both 10932 7652.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM 350 75571 cpt 4400244 local both 367 256.9 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG 3D RENDER W/O IMAGE POSTPROCE* 350 76376 cpt 4400117 local both 853.93 597.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG 3D RENDERING W/ IMAGE POSTPRO* 350 76377 cpt 4400118 local both 1269.02 888.31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED CT PROCEDURE 350 76497 cpt 4400644 local both 1334.29 934 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT GUIDANCE NEEDLE PLACEMENT 350 77012 cpt 4400239 local both 1673 1171.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CT SCAN LIMITED LOCALIZED F/U STUDY 350 76380 cpt 4400266 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST 350 75574 cpt 4400231 local both 2797.41 1958.19 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH, CONGEN HEART DISEASE" 350 75573 cpt 4400243 local both 2797.41 1958.19 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH 350 75572 cpt 4400242 local both 2797.41 1958.19 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,SOFT TISSUE NECK,W/O *" 351 70490 cpt 4400272 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,MAXILLOFACIAL AREA,W/*" 351 70486 cpt 4400269 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,ORBIT/SELLA/POST FOSS*" 351 70480 cpt 4400270 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,HEAD/BRAIN,W/O CONTRA*" 351 70450 cpt 4400265 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT NECK TISSUE CONTRAST 351 70491 cpt 4400246 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN, FACE/JAW CONTRAST" 351 70487 cpt 4400262 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN SKULL CONTRAST 351 70481 cpt 4400261 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN HEAD CONTRAST 351 70460 cpt 4400250 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN SKULL COMBO 351 70482 cpt 4400260 local both 2660 1862 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO,NECK COMBO,INCL IMAG*" 351 70498 cpt 4400237 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO,HEAD COMBO,INCL IMAG*" 351 70496 cpt 4400235 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT NECK TISSUE COMBO 351 70492 cpt 4400245 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN HEAD COMBO 351 70470 cpt 4400249 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCANS FACE/JAW COMBO 351 70488 cpt 4400276 local both 2800 1960 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,LUMBAR SPINE,W/O CONTRAST" 352 72131 cpt 4400268 local both 1550 1085 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT THORAX DIAG WO CONTRAST 352 71250 cpt 4400274 local both 1652 1156.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT CHEST W/O LOW DOSE SCREEN 352 71250 cpt 4401009 local both 1700 1190 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,CERVICAL SPINE,W/O CONTRAST" 352 72125 cpt 4400264 local both 1897 1327.9 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,ABDOMEN,W/O CONTRAST" 352 74150 cpt 4400263 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,LOWER EXTREMITY,W/O C*" 352 73700 cpt 4400267 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,PELVIS,W/O CONTRAST" 352 72192 cpt 4400271 local both 2132 1492.4 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,ABD & PELVIS,W/O CONTRAST" 352 74176 cpt 4400845 local both 2326 1628.2 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,THORACIC SPINE,W/O CONTRAST" 352 72128 cpt 4400273 local both 2407 1684.9 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF ABDOMEN CONTRAST 352 74160 cpt 4400253 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF PELVIS CONTRAST 352 72193 cpt 4400259 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN LUMBAR SP CONTRAST 352 72132 cpt 4400251 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN DORSAL SP CONTRAST 352 72129 cpt 4400248 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CAT SCAN OF CHEST CONTRAST 352 71260 cpt 4400205 local both 2428 1699.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO,UPPER EXTREM,COMBO" 352 73206 cpt 4400238 local both 2560 1792 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,ABD & PELVIS,W CONTRAST" 352 74177 cpt 4400846 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CTA ABD/PEL W & W/O 352 74174 cpt 4400862 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF ABDOMEN COMBO 352 74170 cpt 4400252 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC" 352 71275 cpt 4400233 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CAT SCAN OF CHEST COMBO 352 71270 cpt 4400204 local both 2713 1899.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF PELVIS COMBO 352 72194 cpt 4400258 local both 2856 1999.2 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,UPPER EXTREMITY,W/O C*" 352 73200 cpt 4400275 local both 2866 2006.2 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO,LOWER EXTREM,COMBO,I*" 352 73706 cpt 4400236 local both 2999 2099.3 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT SCAN,ABD & PELVIS,COMBO" 352 74178 cpt 4400847 local both 3101 2170.7 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO, ABD, COMBO,INCL IMA*" 352 74175 cpt 4400232 local both 3101 2170.7 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF LEG CONTRAST 352 73701 cpt 4400257 local both 3203 2242.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF ARM CONTRAST 352 73201 cpt 4400255 local both 3203 2242.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN CERV SPINE CONTRAST 352 72126 cpt 4400247 local both 3376 2363.2 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF LEG COMBO 352 73702 cpt 4400256 local both 3488 2441.6 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO, PELVIS, COMBO, INCL IMAGE PROC" 352 72191 cpt 4400234 local both 3553 2487.1 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
"HCHG CT ANGIO AORTOBIFEMORAL, COMBO" 352 75635 cpt 4400230 local both 3590 2513 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN OF ARM COMBO 352 73202 cpt 4400254 local both 3600 2520 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG CT SCAN CERV SP COMBO 352 72127 cpt 4400912 local both 3658.87 2561.21 87 percent of total billed charges 24 percent of total billed charges 815 case rate 693 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 83 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 693 815
HCHG DENTOALVEOLAR STRUCTURES ADDL 15 MIN 360 41899 cpt 309172 local both 100 70 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-ANOSCOPY DIAGNOSTIC 360 46600 cpt 330911 local both 141.01 98.71 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ SCLEROSANT MLT INCOMPETENT VEINS 360 36471 cpt 4400887 local both 145.78 102.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ SCLEROSANT SGL INCOMPETENT VEIN 360 36470 cpt 4400886 local both 145.78 102.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-CHEMICAL CAUTERIZATION OF GRANULATION TISSUE 360 17250 cpt 330913 local both 152 106.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES FEMORAL NERVE (INCLUDES IG) 360 64447 cpt 503496 local both 209 146.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NEG PRESS WND TX <50 CM DME 360 97605 cpt 343270 local both 331.94 232.36 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DENTOALVEOLAR STRUCTURES 1ST HR 360 41899 cpt 309171 local both 400 280 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NEG PRESS WND TX >50 CM DME 360 97606 cpt 343271 local both 408.89 286.22 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE 360 20702 cpt 503798 local both 445.98 312.19 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC INJ,PLATELET RICH PLASMA,ANY TISSUE,INC IMAGE GUIDANCE" 360 0232T cpt 343281 local both 473.52 331.46 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX PATELLAR FRACTURE W/O MANIP 360 27520 cpt 503880 local both 566.25 396.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-BIOPSY OF LIVER,NEEDLE PERCUTANEOUS" 360 47000 cpt 5400184 local both 572.63 400.84 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-ANOSCOPY WITH CONTROL OF BLEEDING 360 46614 cpt 5401004 local both 600.48 420.34 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-SIGMOIDOSCOPY,FLEXIBLE WITH BIOPSY,SINGLE OR MULTIPLE" 360 45331 cpt 5400130 local both 600.48 420.34 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-SIGMOIDOSCOPY,FLEXIBLE DIAGNOSTIC" 360 45330 cpt 5400128 local both 606 424.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NASAL/OROGASTRIC TUBE PLACEMENT W/STENT 360 43752 cpt 5400163 local both 608 425.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SCREENING COLONOSCOPY, PT NOT HIGH RISK" 360 G0121 HCPCS 330971 local both 621.24 434.87 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BIOPSY OF LIVER,NEEDLE PERCUTANEOUS" 360 47000 cpt 5400183 local both 686.35 480.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LARYNGOSCOPY FLEXIBLE FIBEROPTIC DX 360 31575 cpt 308837 local both 770 539 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPY/LUNG BX ADD'L, W/WO FLUOROSCOPIC GUIDANCE" 360 31632 cpt 308847 local both 775.7 542.99 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BRONCHOSCOPY/LUNG BX ADD'L, W/WO FLUOROSCOPIC GUIDANCE" 360 31632 cpt 5200194 local both 775.7 542.99 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) GREATER OCCIPITAL 360 64405 cpt 503484 local both 794.25 555.98 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC NEWBORN RESUSCITATION 360 99465 cpt 309150 local both 810.75 567.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPR GASTROINTESTINAL ENDOSCOPY WITH INSERT GUIDE WIRE 360 43248 cpt 5400155 local both 900.73 630.51 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY W/DILATION OF GASTRIC 360 43245 cpt 5400152 local both 971.45 680.02 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-SIGMOISOSCOPY,FLEXIBLE WITH DIRECTED SUBMUCOSAL INJ" 360 45335 cpt 5400134 local both 974.39 682.07 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA WITHOUT IMAGING GUIDANCE 360 10021 cpt 310036 local both 990 693 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ESPHAGOSCOPY FLEXIBLE TRANSORAL-2ND ROCEDURE 360 43200 cpt 110562 local both 1047.5 733.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SCREENING COLONOSCOPY. HIGH RISK PT 360 G0105 HCPCS 5401008 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY,FLEXIBLE WITH CONTROL OF BLEEDING" 360 45382 cpt 5401001 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-SIGMOIDOSCOPY,FLEXIBLE W/REMOVAL OF TUMOR,POLYP,LESION" 360 45338 cpt 5400172 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-SIGMOIDOSCOPY,FLEXIBLE WITH CONTROL OF BLEEDING" 360 45334 cpt 5400132 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-PROCTOSIGMIODOSCOPY,RIGID WITH CONTROL OF BLEED" 360 45317 cpt 5400126 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM 2-COLONOSCOPY THROUGH STOMA W/ BIOPSY SINGLE OR MULTIPLE 360 44389 cpt 5400122 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY W/CONTROL OF BLEEDING 360 43255 cpt 5400117 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GI ENDOSCOPY W/TRANSENDOSCOPIC INTRALUMINAL TUBE 360 43241 cpt 5400106 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-ESOPHAGOSCOPY,RIGID OR FLEXIBLE,W/CONTROL OF BLEEDING" 360 43227 cpt 5400150 local both 1050.85 735.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH BAND LIGATION" 360 43205 cpt 5400098 local both 1061 742.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG 2-ILEOSCOPY STOMA W/BALLOON DILATION 360 44381 cpt 305034 local both 1065.11 745.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA WITH US GUIDE 360 20611 cpt 304693 local both 1094.34 766.04 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY,FLEXIBLE WITH DILATION BY BALLOON" 360 45386 cpt 5400180 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION" 360 43251 cpt 5400159 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION" 360 43250 cpt 5400157 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GI ENDOSCOPY W/PLACEMENT OF GASTROSTOMY TUBE 360 43246 cpt 5400153 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY W/ INJECT SCLEROSIS 360 43243 cpt 5400108 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY WITH SUBMUCOSAL INJ 360 43236 cpt 5400102 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-ESOPHAGOSCOPY,RIGID OR FLEXIBLE REMOVAL OF FOREIGN BOD" 360 43215 cpt 5400148 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH INJ OF SCLEROSIS" 360 43204 cpt 5400096 local both 1200.97 840.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA W/O US GUIDE 360 20610 cpt 310037 local both 1227 858.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE" 360 43450 cpt 5400162 local both 1281.98 897.39 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY,FLEXIBLE WITH DIRECTED SUBMUCOSAL INJ" 360 45381 cpt 5401002 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM 2-COLONOSCOPY THROUGH STOMA WITH CONTROL OF BLEEDING 360 44391 cpt 5400124 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM 2-COLONOSCOPY THROUGH STOMA DIAGNOSTIC 360 44388 cpt 5400120 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-SMALL INTESTINAL ENDOSCOPY 360 44378 cpt 5400169 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-SMALL INTESTINAL ENDOSCOPY 360 44366 cpt 5400167 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-SMALL INTESTIONAL ENDOSCOPY WITH BIOPSY 360 44361 cpt 5400165 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GI ENDOSCOPY/LIGATION 360 43244 cpt 5400110 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY,FLEXIBLE WITH FOERIGN BODY REMOVAL" 360 45379 cpt 5400174 local both 1365 955.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) ILIO-ING/HYPOGI (360) 360 64425 cpt 503493 local both 1478.25 1034.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT 360 44139 cpt 303299 local both 1512.75 1058.93 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPY CLEAR AIRWAYS,INC FLUOROSCOPIC GUIDANCE" 360 31645 cpt 308849 local both 1517.17 1062.02 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BRONCHOSCOPY CLEAR AIRWAYS, INC FLUOROSCOPIC GUIDANCE" 360 31645 cpt 5200195 local both 1517.17 1062.02 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)" 360 46221 cpt 343226 local both 1578.72 1105.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG 2-COLONOSCOPY STOMA W/BALLOON DILATION 360 44405 cpt 305038 local both 1579.1 1105.37 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG 2-COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION 360 44404 cpt 305036 local both 1579.1 1105.37 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY W/BALLOON DILATION 360 43249 cpt 5400115 local both 1600 1120 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) INTERCOST MLT (360) 360 64421 cpt 503492 local both 1605.75 1124.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TUBE THORACOSTOMY WITH/WITH OUT WATER SEAL 360 32551 cpt 308854 local both 1616 1131.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY W/REMOVAL OF TUMOR,POLYP OR LESION" 360 45385 cpt 5400178 local both 1660.94 1162.66 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPY W/BIOPSY, INCLUDING FLUOROSCOPIC GUIDANCE" 360 31625 cpt 308845 local both 1664.1 1164.87 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BRONCHOSCOPY W/BIOPSY, INCLUDING FLUOROSCOPIC GUIDANCE" 360 31625 cpt 5200193 local both 1664.1 1164.87 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM 360 11402 cpt 503707 local both 1670 1169 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPY, RECLEAR AIRWAY,INC FLUOROSCOPIC GUIDANCE" 360 31646 cpt 308850 local both 1676.34 1173.44 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BRONCHOSCOPY, RECLEAR AIRWAY,INC FLUOROSCOPIC GUIDANCE" 360 31646 cpt 5200196 local both 1676.34 1173.44 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC THORACENTESIS, NEEDLE OR CATHETER,W/IMAGING GUIDANCE" 360 32555 cpt 343212 local both 1705 1193.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY,FLEXIBLE WITH BIOPSY,SINGLE OR MULTIPLE" 360 45380 cpt 5401003 local both 1765 1235.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPE/BRUSH/DX,INCLUDING FLUOROSCOPIC GUIDANCE" 360 31623 cpt 308843 local both 1781.47 1247.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BRONCHOSCOPE/BRUSH/DX.INCLUDING FLUOROSCOPIC GUIDANCE 360 31623 cpt 5200191 local both 1781.47 1247.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CARDIOVERSION 360 92960 cpt 5060034 local both 1802.82 1261.97 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPE/WASH/DX, INCLUDING FLUOROSCOPIC GUIDANCE" 360 31622 cpt 308842 local both 1869.44 1308.61 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BRONCHOSCOPE/WASH/DX, INCLUDING FLUOROSCOPIC GUIDANCE" 360 31622 cpt 5200190 local both 1869.44 1308.61 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM SIGMOIDOSCOPY, FLEXIBLE WITH DIRECTED SUBMUCOSAL INJ" 360 45335 cpt 5400133 local both 1948.77 1364.14 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION ANES AGENT AND OR STEROID UTERINE NRV 360 64435 cpt 503680 local both 1970 1379 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLONOSCOPY STOMA W/BALLOON DILATION 360 44405 cpt 305037 local both 1973.88 1381.72 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLONOSCOPY STOMA W/SUBMUCOSAL INJECTION 360 44404 cpt 305035 local both 1973.88 1381.72 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY WITH BIOPSY 360 43239 cpt 5400104 local both 2020 1414 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) PUDENDAL (360) 360 64430 cpt 503494 local both 2025.75 1418.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS 360 62267 cpt 357710 local both 2038.5 1426.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA 360 44121 cpt 5401016 local both 2075.97 1453.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESPHAGOSCOPY FLEXIBLE TRANSORAL 360 43200 cpt 110561 local both 2095 1466.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ILEOSCOPY STOMA W/BALLOON DILATION 360 44381 cpt 305033 local both 2130.23 1491.16 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE FINGER ABSCESS COMPLICATED 360 26011 cpt 308642 local both 2174 1521.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM 360 11403 cpt 503692 local both 2182 1527.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLCT TOT ABDL W/O PRC W/ILEOST/ILEOPXTS 360 44150 cpt 503887 local inpatient 2184 1528.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPH 360 43264 cpt 5400161 local both 2251.82 1576.27 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPH 360 43262 cpt 5400160 local both 2251.82 1576.27 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) SCIATIC SNG (INCLUDES IG) (360) 360 64445 cpt 503495 local both 2283 1598.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY W/SUBMUCOSAL INJ 360 43236 cpt 5400101 local both 2287.84 1601.49 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH INJ OF SCLEROSIS" 360 43204 cpt 5400095 local both 2287.84 1601.49 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GI ENDOSCOPY W/TRANSENDOSCOPIC INTRALUMINAL TUBE 360 43241 cpt 5400105 local both 2292.34 1604.64 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH CONTROL OF BLEEDING" 360 43227 cpt 5400149 local both 2292.34 1604.64 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-UPPER GASTROINTESTINAL ENDOSCOPY INC ESOPHAGUS,STOMACH" 360 43235 cpt 5400100 local both 2316 1621.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY INC ESOPHAGUS,STOMACH" 360 43235 cpt 5400099 local both 2316 1621.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) AXILLARY (INCLUDES IG) (360) 360 64417 cpt 503489 local both 2320.5 1624.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJECT NERV BLCK,STELLATE GANGLION" 360 64510 cpt 4400903 local both 2328.44 1629.91 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE TUNNELED CV CATH 360 36578 cpt 4400893 local both 2425.06 1697.54 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR TUNNELED CV CATH W/O PORT 360 36575 cpt 4400891 local both 2425.06 1697.54 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SMALL INTESTIONAL ENDOSCOPY WITH BIPOSY 360 44361 cpt 5400164 local both 2467.99 1727.59 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM COLONOSCOPY THROUGH STOMA DIAGNOSTIC 360 44388 cpt 5400119 local both 2475.49 1732.84 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC COLONOSCOPY,FLEXIBLE WITH FOREIGN BODY REMOVAL" 360 45379 cpt 5400173 local both 2480 1736 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM SIGMOIDOSCOPY,FLEXIBLE WITH BIOPSY,SINGLE OR MULTIPLE" 360 45331 cpt 5400129 local both 2497.03 1747.92 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM SIGMOIDOSCOPY,FLEXIBLE WITH CONTROL OF BLEEDING" 360 45334 cpt 5400131 local both 2519.03 1763.32 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM COLONOSCOPY THROUGH STOMA WITH BIOPSY,SINGLE OR MULITPLE" 360 44389 cpt 5400121 local both 2528.65 1770.06 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ESOPHAGOSCOPY,RIGID OR FLEXIBLE,WITH BAND LIGATION" 360 43205 cpt 5400097 local both 2529.54 1770.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ AA&/STRD BRACHIAL PLEXUS CONT NFS CATH (INCLUDES IG) 360 64416 cpt 503828 local both 2578.5 1804.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY W/INJECTION SCLEROSIS 360 43243 cpt 5400107 local both 2585.27 1809.69 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC 360 64520 cpt 357712 local both 2594.25 1815.98 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH < 3CM REDUCIBLE RECURRENT 360 49613 cpt 503993 local both 2656.45 1859.52 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH >10 CM REDUCIBLE 360 49595 cpt 503992 local both 2656.45 1859.52 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH 3-10 CM REDUCIBLE 360 49593 cpt 503991 local both 2683 1878.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH <3CM REDUCIBLE 360 49591 cpt 503989 local both 2683 1878.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM ANOSCOPY WITH CONTROL OF BLEEDING 360 46614 cpt 5400143 local both 2701.8 1891.26 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM 2-ANOSCOPY WITH CONTROL OF BLEEDING 360 46614 cpt 5400144 local both 2701.8 1891.26 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC COLONOSCOPY,FLEXIBLE WITH DILATION BY BALLOON" 360 45386 cpt 5400179 local both 2702.18 1891.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS/SOLUTION INJ 360 62263 cpt 5200199 local both 2714.8 1900.36 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM COLONOSCOPY,FLEXIBLE WITH CONTROL OF BLEEDING" 360 45382 cpt 5400141 local both 2715.68 1900.98 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-COLONOSCOPY,FLEXIBLE WITH CONTROL OF BLEEDING" 360 45382 cpt 5400142 local both 2715.68 1900.98 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL 360 58805 cpt 357709 local both 2719.5 1903.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC 2-UPPR GASTROINTESTINAL ENDOSCOPY W FOREIGN BODY REMOVAL 360 43247 cpt 5400113 local both 2770 1939 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVM COLONOSCOPY THROUGH STOMA WITH CONTROL OF BLEEDING 360 44391 cpt 5400123 local both 2771.23 1939.86 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ AA&/STRD SCIATIC NV CONT NFS CATH (INCLUDES IG) 360 64446 cpt 503829 local both 2789.25 1952.48 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY W FOREIGN BODY REMOVAL 360 43247 cpt 5400112 local both 2798 1958.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM PROCTOSIGMOIDOSCOPY,RIGID WITH CONTROL OF BLEEDING" 360 45317 cpt 5400125 local both 2823.78 1976.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION" 360 43251 cpt 5400158 local both 2860 2002 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC COLONOSCOPY,FLEXIBLE,PROXIMAL TO SPLENIC FLEXURE,DIAGNOS" 360 45378 cpt 5400135 local both 2899 2029.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SMALL INTESTINAL ENDOSCOPY 360 44366 cpt 5400166 local both 2911.6 2038.12 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON 360 28234 cpt 503616 local both 2918 2042.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX OPEN TENDON FLEXOR TOE 1 TENDON SPX 360 28232 cpt 503615 local both 2995.21 2096.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TAP BLOCK UNIL BY INJECTION (360) 360 64486 cpt 503498 local both 3060 2142 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY WITH INSERT GUIDE WIRE 360 43248 cpt 5400154 local both 3093.26 2165.28 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SIGMOIDOSCOPY,FLEXIBLE W/REMOVAL OF TUMOR,POLYP,LESION" 360 45338 cpt 5400171 local both 3100 2170 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EGD BAND LIGATION ESOPHGEAL/GASTRIC VARICES 360 43244 cpt 5400109 local both 3136.63 2195.64 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC 2-COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE DI" 360 45378 cpt 5401009 local both 3150 2205 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC TRANSCATHETER THERAPY, VENOUS INFUSION FOR THROMBOLYSIS" 360 37212 cpt 343220 local both 3162.6 2213.82 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANS THPY ART CORO/INTRAC DAY 1 360 37211 cpt 343218 local both 3162.6 2213.82 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC COLONOSCOPY,WITH REMOVAL OF TUMOR,POLYP,OR LESION" 360 45385 cpt 5400177 local both 3182 2227.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC COLONOSCOPY,FLEXIBLE,PROXIMAL TO SPLENIC FLEXURE,DIAGNOS" 360 45378 cpt 5400136 local both 3182 2227.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTIONAL ENDOSCOPY W/BALLOON DILATION 360 43249 cpt 5400114 local both 3200 2240 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXPLORATION PENETRATING WOUND SPX EXTREMITY 360 20103 cpt 503703 local both 3220 2254 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D HEMATOMA SEROMA/FLUID COLLECTION 360 10140 cpt 503712 local both 3232 2262.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM SIGMOIDOSCOPY,FLEXIBLE DIAGNOSTIC" 360 45330 cpt 5400127 local both 3250 2275 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR 360 26125 cpt 503812 local both 3275.25 2292.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOTOMY EXCISION BLADDER TUMOR 360 51530 cpt 357673 local both 3279.75 2295.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-COLONOSCOPY,FLEXIBLE WITH BIOPSY,SINGLE OR MULTIPLE" 360 45380 cpt 5400138 local both 3310 2317 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM COLONOSCOPY,FLEXIBLE WITH BIOPSY,SINGLE OR MULTIPLE" 360 45380 cpt 5400137 local both 3343 2340.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH 360 26170 cpt 357554 local both 3354.75 2348.33 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL 360 30140 cpt 503730 local both 3360 2352 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUBMUCOUS RESECTION INFERIOR TURBINATE 360 30140 cpt 503689 local both 3360 2352 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENDON SHEATH INCISION 360 26055 cpt 503723 local both 3372 2360.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM 360 24075 cpt 503693 local both 3380 2366 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY W/DIALTION OF GASTRIC 360 43245 cpt 5400151 local both 3432.92 2403.04 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS 360 23700 cpt 503806 local both 3444 2410.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC 360 64784 cpt 357718 local both 3455.25 2418.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASCULAR SURGERY PROCEDURE UNLIST 360 37799 cpt 4400898 local both 3482.97 2438.08 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR TUNNELED CV CATH W/PORT 360 36576 cpt 4400892 local both 3490.54 2443.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ 360 27238 cpt 357568 local both 3504 2452.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SMALL INTESTINAL ENDOSCOPY 360 44378 cpt 5400168 local both 3535.49 2474.84 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA 360 27570 cpt 503603 local both 3596 2517.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH 360 26520 cpt 503779 local both 3600.75 2520.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED NERVOUS SYSTEM SURGERY (360) 360 64999 cpt 503501 local both 3612.36 2528.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM 360 26115 cpt 503694 local both 3627 2538.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY 360 31256 cpt 503820 local both 3678.75 2575.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZ 360 21320 cpt 503882 local both 3724.5 2607.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX 360 46040 cpt 503706 local both 3740 2618 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DECROMPRESSIVE FASCIOTOMY HAND 360 26037 cpt 503842 local both 3767.25 2637.08 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE OF KIDNEY 360 50040 cpt 4400923 local both 3792.05 2654.44 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM 360 25075 cpt 357538 local both 3815.25 2670.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) LUMBAR PLEXUS (360) 360 64449 cpt 503497 local both 3838.5 2686.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION AA&/STRD FEMORAL NERVE CONT NFS CATH (INCLUDES IG) 360 64448 cpt 503830 local both 3838.5 2686.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM 2-COLONOSCOPY,FLEXIBLE WITH DIRECTED SUBMUCOSAL INJ" 360 45381 cpt 5400140 local both 3841.01 2688.71 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVM COLONOSCOPY,FLEXIBLE WITH DIRECTED SUBMUCOSAL INJ" 360 45381 cpt 5400139 local both 3841.01 2688.71 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM 360 22902 cpt 503704 local both 3878 2714.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON 360 26460 cpt 357560 local both 3886.5 2720.55 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH >10 CM STRANGULATED RECURRENT 360 49618 cpt 503996 local both 3909.11 2736.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH 3-10 CM STRANGULATED RECURRENT 360 49616 cpt 503995 local both 3909.11 2736.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH < 3CM STRANGULATED RECURRENT 360 49614 cpt 503994 local both 3909.11 2736.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS 360 28171 cpt 503768 local both 3912 2738.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORRJ MALROTATION BANDS&/RDCTJ VOLV 360 44055 cpt 503865 local both 3936 2755.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN 360 26145 cpt 357553 local both 3936 2755.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HERNIA REPAIR VENTRAL ANY APPROACH <3CM STRANGULATED 360 49592 cpt 503990 local both 3948 2763.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TYMPANOSTOMY GENERAL ANESTHESIA 360 69436 cpt 503683 local both 3959 2771.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH 360 26418 cpt 503708 local both 3970 2779 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION 360 38900 cpt 357640 local both 3979.5 2785.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC LESION TDN SHTH/JT CAPSL HAND/FNGR 360 26160 cpt 303372 local both 3997.5 2798.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION LESION TENDON SHEATH FOREARM&/WRIST 360 25110 cpt 303286 local both 4009.5 2806.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC LESION TDN SHTH/JT CAPSL HAND/FNGR 360 26160 cpt 503813 local both 4037 2825.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG N BLOCK INJ(S) BRACHIAL PLEXUS (INCLUDES IG) (360) 360 64415 cpt 503488 local both 4040 2828 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY WITH BIOPSY 360 43239 cpt 5400103 local both 4040 2828 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM 360 23075 cpt 503564 local both 4041.21 2828.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH 360 26100 cpt 357549 local both 4045.5 2831.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING 360 26432 cpt 357557 local both 4047.75 2833.43 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX 360 57461 cpt 503666 local both 4095.57 2866.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENDON TRANSFER TRANSPLANT CARP MTCRPL GRAFT 360 26483 cpt 503587 local both 4156.59 2909.61 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GI ENDOSCOPY W/PLACEMENT OF GASTROSTOMY TUBE 360 43246 cpt 5400111 local both 4197.16 2938.01 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PLACE GASTROSTOMY TUBE 360 43246 cpt 5200197 local both 4197.16 2938.01 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TONSILLECTOMY & ADENOIDECTOMY AGE 12/> 360 42821 cpt 503783 local both 4212 2948.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL PROSTHETIC MATRL ABDL WALL FOR INFECTION 360 11008 cpt 503555 local both 4220 2954 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D SHOULDER INFECTED BURSA 360 23031 cpt 504008 local both 4254 2977.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE 360 28310 cpt 357615 local both 4269.75 2988.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MANIPULATION HIP JOINT GENERAL ANESTHESIA 360 27275 cpt 357569 local both 4269.75 2988.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE 360 29826 cpt 503627 local both 4293 3005.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY 360 29824 cpt 503626 local both 4293 3005.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SEPTOPLASTY/SUBMUCOUS RESEC W/WO CARTILAGE GRF 360 30520 cpt 503690 local both 4330 3031 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF 360 30520 cpt 503731 local both 4330 3031 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY 360 25111 cpt 503721 local both 4333 3033.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BRONCHOSCOPE/ALVEOLAR LAVAGE, INC FLUOROSCOPIC GUIDANCE" 360 31624 cpt 308844 local both 4383.74 3068.62 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC BRONCHOSCOPE/ALVEOLAR LAVAGE, INC FLUOROSCOPIC GUIDANCE" 360 31624 cpt 5200192 local both 4383.74 3068.62 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH 360 26485 cpt 503814 local both 4443.75 3110.63 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA 360 27603 cpt 503765 local both 4445.25 3111.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION EXTENSOR TENDON SHEATH WRIST 360 25000 cpt 503580 local both 4466 3126.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO BLADDER W/URETERAL CATHETERIZATION 360 52005 cpt 503701 local both 4484 3138.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY 360 28313 cpt 357617 local both 4500.75 3150.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC HAND TUMOR DEEP< 1.5 CM 360 26116 cpt 503585 local both 4522 3165.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA 360 26080 cpt 357548 local both 4578 3204.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR 360 63661 cpt 503776 local both 4587 3210.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX 360 45990 cpt 357653 local both 4592.25 3214.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE OF RETROPERITONEAL ABSCESS OPEN 360 49060 cpt 357662 local both 4599 3219.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NASAL/SINUS NDSC TOTAL W/SPHENOIDOTOMY 360 31257 cpt 503821 local both 4620 3234 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA 360 25290 cpt 303284 local both 4633.5 3243.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH 360 26110 cpt 357550 local both 4640.25 3248.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA 360 28092 cpt 357605 local both 4666.5 3266.55 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> 360 21931 cpt 503752 local both 4680 3276 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC/CURTG CST/B9 TUM PHALANGES FOOT 360 28108 cpt 357607 local both 4689 3282.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY 360 25105 cpt 357541 local both 4725.75 3308.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MAMMAPLASTY, AUGMENTATION WITH PROSTHETIC IMPLANT" 360 19325 cpt 343200 local both 4727.73 3309.41 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION VAGINAL CYST/TUMOR 360 57135 cpt 503734 local both 4728 3309.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE 360 28312 cpt 357616 local both 4730.25 3311.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ SKELETAL FIXATION ULNAR STYLOID FRACTURE 360 25651 cpt 503584 local both 4741.13 3318.79 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEUROPLASTY & OR TRANSPOS MEDIAN NRV CARPAL TUN 360 64721 cpt 503682 local both 4747 3322.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/> 360 21012 cpt 503799 local both 4754.25 3327.98 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS 360 52281 cpt 503871 local both 4760.25 3332.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UPPER GASTROINTESTINAL ENDOSCOPY W/CONTROL OF BLEEDING 360 43255 cpt 5400116 local both 4768.27 3337.79 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO W/INSERT URETERAL STENT 360 52332 cpt 503702 local both 4787 3350.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D BELOW FASCIA FOOT MULT 360 28003 cpt 503862 local both 4820 3374 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMPUTATION FOOT TRANSMETARSAL 360 28805 cpt 503818 local both 4827 3378.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT ELBOW W/EXPLOR DRAIN/REMOVAL FB 360 24000 cpt 503756 local both 4840 3388 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTECTOMY COMPLETE 1ST METATARSAL HEAD 360 28111 cpt 503767 local both 4858.5 3400.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH 360 26410 cpt 503586 local both 4870 3409 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALC 360 28122 cpt 503873 local both 4905 3433.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL 360 11005 cpt 503860 local both 4905.75 3434.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISS NECK/ANT THORAX SUBQ <3CM 360 21555 cpt 503563 local both 4933.67 3453.57 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARPECTOMY 1 BONE 360 25210 cpt 503789 local both 4937 3455.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOTOMY TALUS 360 28302 cpt 357611 local both 4939.5 3457.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSECTION/AVULSION OTH SPINAL NRV XDRL 360 64772 cpt 357715 local both 4955.25 3468.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ADJT TIS TRNS/REARGMT 10SQCM/< 360 14040 cpt 503861 local both 4960.5 3472.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORRECTION HAMMERTOE 360 28285 cpt 503617 local both 4967 3476.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RADICAL STYLOIDECTOMY SEPARATE PROCEDURE 360 25230 cpt 357544 local both 4985.25 3489.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER 360 52287 cpt 357682 local both 4989.75 3492.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIGATION OR TRANSECTION OF FALLOPIAN TUBES 360 58600 cpt 503688 local both 4996.5 3497.55 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI 360 58600 cpt 503713 local both 5000 3500 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC UPPER GI ENDOSCOPY W/REMOVAL OF TUMOR, POLYP OR LESION" 360 43250 cpt 5400156 local both 5012.05 3508.44 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR 360 26426 cpt 357556 local both 5014.5 3510.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH 360 28080 cpt 503614 local both 5018 3512.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE 360 23130 cpt 503754 local both 5027 3518.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE 360 64585 cpt 503778 local both 5028.75 3520.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> 360 22903 cpt 503788 local both 5042.25 3529.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ESOPHAGOSCOPY FLEX REMOVAL FB 360 43215 cpt 5400147 local both 5062 3543.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH 360 27680 cpt 357591 local both 5064 3544.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TONSILLECTOMY PRIMARY/SECONDARY AGE 12/> 360 42826 cpt 503639 local both 5067.77 3547.44 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> 360 23071 cpt 504010 local both 5072.25 3550.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION PILONIDAL CYST/SINUS SIMPLE 360 11770 cpt 503716 local both 5075 3552.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK 360 27630 cpt 503606 local both 5096.04 3567.23 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TONSILLECTOMY & ADENOIDECTOMY 360 28039 cpt 503613 local both 5195 3636.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> 360 21552 cpt 503718 local both 5204 3642.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE TENDON SHEATH DIGIT&PALM EACH 360 26020 cpt 5401020 local both 5217.75 3652.43 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED PROCEDURE ARTHROSCOPY 360 29999 cpt 503714 local both 5230 3661 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REALIGNMENT EXTENSOR TENDON HAND EACH TENDON 360 26437 cpt 357558 local both 5254.5 3678.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX 360 29879 cpt 503819 local both 5312 3718.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA 360 26449 cpt 357559 local both 5321.25 3724.88 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHLEB VEINS - EXTREM - TO 20 360 37765 cpt 4400896 local both 5330.38 3731.27 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLAVICULECTOMY PARTIAL 360 23120 cpt 503753 local both 5353 3747.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTECTOMY PRTL 5TH METAR HEAD SPX 360 28110 cpt 357608 local both 5357.25 3750.08 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SURG TX ANAL FISTULA INTERSPHINCTERIC 360 46275 cpt 503652 local both 5371.02 3759.71 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY 360 31254 cpt 357634 local both 5383.5 3768.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED PROCEDURE SHOULDER 360 23929 cpt 503719 local both 5383.5 3768.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA 360 28308 cpt 357614 local both 5394.75 3776.33 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FASCIOTOMY HIP/THIGH ANY TYPE 360 27025 cpt 503885 local both 5405.2 3783.64 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER BICEPS TENODESIS 360 29828 cpt 503629 local both 5406 3784.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TMR SFT TISS SHOULDER SUBFASC <5CM 360 23076 cpt 503874 local both 5424 3796.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY 360 29894 cpt 357632 local both 5439.75 3807.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT WRST W JT EXPL W WO BX W WO RMVL LOOSE/FB 360 25101 cpt 5401017 local both 5454 3817.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB 360 25101 cpt 357540 local both 5454 3817.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SURGICAL ARTHROSCOPY SHOULDER REMOVAL LOOSE/FB 360 29819 cpt 503728 local both 5456 3819.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENDON TRANSPLNT FOREARM W GRAFTS EA TENDON 360 25312 cpt 503792 local both 5469 3828.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMPUTATION TOE METATARSOPHALANGEAL JOINT 360 28820 cpt 357624 local both 5475 3832.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FASCIECTOMY PLANTAR FASCIA PARTIAL SPX 360 28060 cpt 357604 local both 5486.25 3840.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ SKELETAL FIXJ METACARPAL FX EACH BONE 360 26608 cpt 503759 local both 5512 3858.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE 360 54620 cpt 5401012 local both 5512.5 3858.75 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTECTOMY CALCANEUS 360 28118 cpt 503863 local both 5527.5 3869.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D FOREARM/WRIST DEEP ABSCESS/HEMA 360 25028 cpt 309153 local both 5532 3872.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ILEOSCOPY,THROUGH STOMA,DIAGNOSTIC" 360 44380 cpt 5400170 local both 5544.84 3881.39 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTIAL EXCISION BONE OLECRANON PROCESS 360 24147 cpt 503720 local both 5558.25 3890.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DCMP FASCT LG ANT&/LAT CMPRTMNTS ONLY 360 27600 cpt 503886 local both 5565 3895.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS 360 31267 cpt 357635 local both 5568.75 3898.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/> 360 26111 cpt 357551 local both 5573.25 3901.28 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS 360 29876 cpt 503698 local both 5585 3909.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN 360 24358 cpt 503883 local both 5587.5 3911.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION PREPATELLAR BURSA 360 27340 cpt 503762 local both 5595 3916.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX 360 29875 cpt 503711 local both 5599 3919.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB 360 27610 cpt 503605 local both 5599 3919.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RELEASE TARSAL TUNNEL 360 28035 cpt 503612 local both 5611.07 3927.75 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE 360 52275 cpt 357679 local both 5613 3929.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OMENTAL FLAP INTRA-ABDOMINAL 360 49905 cpt 503869 local both 5633 3943.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT 360 25135 cpt 503791 local both 5645.25 3951.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE 360 64782 cpt 357717 local both 5691 3983.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LITHOLAPAXY SMPL/SM <2.5 CM 360 52317 cpt 503733 local both 5699 3989.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOURETHROSCOPY WITH BIOPSY 360 52204 cpt 357675 local both 5709 3996.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION 360 27829 cpt 503727 local both 5716 4001.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLECTOMY PRTL W/COLOPROCTOSTOMY & COLOSTOMY 360 44146 cpt 503705 local inpatient 5731 4011.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COR HLX VLGS RSC PRX PHLX BS 360 28292 cpt 303288 local both 5734 4013.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO W/DESTRUCTION OF LESIONS 360 52214 cpt 357676 local both 5739 4017.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS 360 25116 cpt 357543 local both 5747.25 4023.08 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T 360 26727 cpt 357563 local both 5755.5 4028.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC CYST ABERRANT BREAST TISSUE OPEN 1/> LESION 360 19120 cpt 503559 local both 5779 4045.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION MAXILLARY TORUS PALATINUS 360 21032 cpt 503800 local both 5792.25 4054.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES 360 52352 cpt 357684 local both 5793 4055.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION GANGLION WRIST DORSAL VOLAR RECURRENT 360 25112 cpt 5401021 local both 5795.25 4056.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB 360 29861 cpt 503771 local both 5796.75 4057.73 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMPUTATION METATARSAL W/TOE SINGLE 360 28810 cpt 503622 local both 5799 4059.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FASCIOTOMY PALMAR OPEN PARTIAL 360 26045 cpt 357547 local both 5799.75 4059.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT 360 28052 cpt 357603 local both 5810.25 4067.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL 360 28104 cpt 357606 local both 5823 4076.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIGATION/BIOPSY TEMPORAL ARTERY 360 37609 cpt 503635 local both 5838.03 4086.62 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED PROCEDURE HUMERUS/ELBOW 360 24999 cpt 357537 local both 5844 4090.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SURGICAL ARTHROSCOPY SHOULDER LMTD DBRDMT 1/2 360 29822 cpt 503699 local both 5859 4101.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SURGICAL ARTHROSCOPY SHOULDER W/LSS&RESCJ ADS 360 29825 cpt 303291 local both 5897 4127.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BONE GRAFT ANY DONOR AREA MINOR/SMALL 360 20900 cpt 503787 local both 5907 4134.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDEMENT GENITAL PERINEUM AB WALL 360 11006 cpt 503554 local both 5961.08 4172.76 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX INTERPHALANGEAL JOINT DISLOCATION 360 26785 cpt 357565 local both 5967.75 4177.43 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTIAL EXCISION BONE HUMERUS 360 24140 cpt 503575 local both 5993.77 4195.64 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE LATERAL RELEASE 360 29873 cpt 503864 local both 5999 4199.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTIAL EXCISION BONE TIBIA 360 27640 cpt 503607 local both 6001.29 4200.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTROCNEMIUS RECESSION 360 27687 cpt 357592 local both 6002.25 4201.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL IMPLANT DEEP 360 20680 cpt 503717 local both 6015 4210.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT 360 26121 cpt 357552 local both 6032.25 4222.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY 360 27626 cpt 357588 local both 6037.5 4226.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BONE GRAFT ANY DONOR AREA MAJOR/LARGE 360 20902 cpt 503875 local both 6053.25 4237.28 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE 360 29823 cpt 503625 local both 6060 4242 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT 360 29891 cpt 5401018 local both 6090 4263 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION LESION MENISCUS/CAPSULE KNEE 360 27347 cpt 357574 local both 6111 4277.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR 360 26123 cpt 503811 local both 6130 4291 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP 360 25606 cpt 503582 local both 6172 4320.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION 360 27301 cpt 357570 local both 6186 4330.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB 360 27620 cpt 357587 local both 6218.25 4352.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE 360 38525 cpt 503636 local both 6227.46 4359.22 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT 360 28289 cpt 503769 local both 6228 4359.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ SKEL FIXJ METAR FX W/MANJ 360 28476 cpt 503877 local both 6229.5 4360.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY 360 29821 cpt 357626 local both 6235.5 4364.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM 360 21556 cpt 503801 local both 6239.25 4367.48 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEUROPLASTY & OR TRANSPOS ULNAR NERVE ELBOW 360 64718 cpt 503681 local both 6241 4368.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL 360 29883 cpt 503729 local both 6242 4369.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX FX GREAT TOE/PHALANX/PHALANGES 360 28505 cpt 503872 local both 6259.5 4381.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYSTEROSCOPY BX ENDOMETRIUM POLYPC W/WO D&C 360 58558 cpt 503668 local both 6262 4383.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOURETHROSCOPY W INTERNAL URETHROTOMY 360 52276 cpt 5401019 local both 6264 4384.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO W/REMOVAL OF LESIONS SMALL 360 52224 cpt 357677 local both 6280.5 4396.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC/FULGURATION URETHRAL CARUNCLE 360 53265 cpt 357692 local both 6282 4397.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION 360 52354 cpt 357686 local both 6285.75 4400.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SECONDARY CLOSURE SURG WOUND/DEHSN EXTENSIVE 360 13160 cpt 503556 local both 6304 4412.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA 360 25645 cpt 357546 local both 6330 4431 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION OLECRANON BURSA 360 24105 cpt 503574 local both 6334 4433.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM 360 24076 cpt 357531 local both 6354.75 4448.33 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ DX/THER AGNT PARAVERT FACET JOINT, LUMBAR/SAC, 1ST LEVEL" 360 64493 cpt 4400918 local both 6373 4461.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REV/RMV IMP SP NPG/R DTCH CN 360 63688 cpt 503777 local both 6373 4461.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM 360 52235 cpt 303315 local both 6373 4461.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOT W WO LNGTH SHRT CORRJ 1ST METAR 360 28306 cpt 5401022 local both 6421.5 4495.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR 360 28306 cpt 357613 local both 6421.5 4495.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION PILONIDAL CYST/SINUS COMPLICATED 360 11772 cpt 503796 local both 6456 4519.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO 360 46260 cpt 503651 local both 6474 4531.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE 360 28525 cpt 503621 local both 6488.96 4542.27 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH 360 27658 cpt 357590 local both 6492.75 4544.93 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO W/REMOVAL OF TUMORS SMALL 360 52234 cpt 357678 local both 6501.75 4551.23 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRURL DRAINAGE PROSTATIC ABSCESS 360 52700 cpt 357690 local both 6514.5 4560.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED PROCEDURE FEMUR/KNEE 360 27599 cpt 503604 local both 6519.31 4563.52 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PALATOPHARYNGOPLASTY 360 42145 cpt 503772 local both 6591 4613.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CIRCUMCISION AGE >28 DAYS 360 54161 cpt 357693 local both 6637.5 4646.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT KNE W/EXPL DRG/RMVL FB 360 27310 cpt 503725 local both 6640 4648 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY 360 23415 cpt 357527 local both 6648.75 4654.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM 360 27328 cpt 357571 local both 6658.5 4660.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/> 360 28041 cpt 357602 local both 6663.75 4664.63 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX 360 37780 cpt 357637 local both 6679.5 4675.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE 360 64774 cpt 357716 local both 6710.25 4697.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA 360 27360 cpt 357576 local both 6719.25 4703.48 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN 360 49020 cpt 357660 local both 6769.5 4738.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYSTEROSCOPY ENDOMETRIAL ABLATION 360 58563 cpt 503669 local both 6780 4746 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC 360 64708 cpt 357713 local both 6780.75 4746.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX 360 44955 cpt 503649 local both 6782 4747.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL 360 27695 cpt 503608 local both 6796.44 4757.51 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE 360 29898 cpt 503632 local both 6802 4761.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ 360 26850 cpt 503724 local both 6807 4764.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTH GLNHMRL JT W/JT EXPL W/WO RMVL LOOSE 360 23107 cpt 503876 local both 6807.75 4765.43 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LATERAL RETINACULAR RELEASE OPEN 360 27425 cpt 503816 local both 6808 4765.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TRANSCATHETER BIOPSY 360 37200 cpt 343216 local both 6823.53 4776.47 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY 360 29874 cpt 503715 local both 6840 4788 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REOPENING RECENT LAPAROTOMY 360 49002 cpt 503655 local both 6879.92 4815.94 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR 360 24359 cpt 357533 local both 6906.75 4834.73 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION 360 29807 cpt 503624 local both 6909 4836.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL 360 27698 cpt 357593 local both 6964.5 4875.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE 360 29838 cpt 303294 local both 6981 4886.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMPUTATION FOOT MIDTARSAL 360 28800 cpt 357623 local both 7003.5 4902.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RMVL/REVJ SLING STRESS INCONTINENCE 360 57287 cpt 303333 local both 7011.75 4908.23 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE 360 52240 cpt 503732 local both 7021 4914.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT 360 28755 cpt 357622 local both 7026 4918.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC BARTHOLINS GLAND/CYST 360 56740 cpt 357701 local both 7051.5 4936.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC TRANSCATH THERAPY,ARTERIAL/VENOUS INF FOR THROMBOLYSIS" 360 37214 cpt 343224 local both 7057.2 4940.04 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC TRANSCATH THERAPY,ARTERIAL/VENOUS INF FOR THROMBOLYSIS" 360 37213 cpt 343222 local both 7057.2 4940.04 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING 360 29880 cpt 503700 local both 7070 4949 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX 360 29884 cpt 503784 local both 7080 4956 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISS NECK THORAX SUBFASC 5 CM/> 360 21554 cpt 503562 local both 7110 4977 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/< 360 49203 cpt 503656 local both 7115 4980.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/> 360 23073 cpt 504003 local both 7119.75 4983.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D SHOULDER DEEP ABSCESS/HEMATOMA 360 23030 cpt 503780 local both 7123 4986.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG 360 29881 cpt 503630 local both 7131 4991.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/> 360 24073 cpt 357530 local both 7143 5000.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MUSC MUSCLE MYO OR FASC FLAP TRUNK 360 15734 cpt 503557 local both 7146 5002.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE 360 25107 cpt 357542 local both 7147.5 5003.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY FULGURATION OVIDUCTS 360 58670 cpt 503673 local both 7151 5005.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB 360 27331 cpt 503998 local both 7155.75 5009.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PHLEB VEINS - EXTREM 20+ 360 37766 cpt 4400897 local both 7201.1 5040.77 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PLACE GASTROSTOMY TUBE PERCUTANEOUS 360 49440 cpt 5400146 local both 7217.34 5052.14 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS 360 25320 cpt 503809 local both 7236 5065.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB 360 23044 cpt 503803 local both 7298 5108.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB 360 29834 cpt 357627 local both 7323 5126.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA 360 28465 cpt 503770 local both 7339.5 5137.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH 360 26420 cpt 357555 local both 7374 5161.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION HYDROCELE UNILATERAL 360 55040 cpt 357697 local both 7383.75 5168.63 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT 360 27654 cpt 357589 local both 7401 5180.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRD CARPOMETACRP JT THMB W WO INT FX WAGRFT 360 26842 cpt 503760 local both 7438.5 5206.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX 360 56810 cpt 357702 local both 7458 5220.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ SKELETAL FIXJ FEMORAL FX DISTAL END 360 27509 cpt 357583 local both 7471.5 5230.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX 360 29805 cpt 357625 local both 7472.25 5230.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX 360 56810 cpt 5401026 local both 7495.5 5246.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENODESIS LONG TENDON BICEPS 360 23430 cpt 503565 local both 7521 5264.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY 360 49000 cpt 503654 local both 7566.74 5296.72 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERC IMPLNT NEUROSTIM ELECTRODE ARRAY EPIDURAL 360 63650 cpt 503678 local both 7575 5302.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG 360 29877 cpt 503709 local both 7575 5302.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RMV SPINE INFUSION DEVICE PRV IMPLANTED 360 62365 cpt 503677 local both 7580 5306 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ 360 37700 cpt 357636 local both 7587 5310.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION HYDROCELE BILATERAL 360 55041 cpt 503775 local both 7617 5331.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DCMPRN FASCT LEG ANT&/LAT&PST CMPRT 360 27602 cpt 503764 local both 7627 5338.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ 360 26860 cpt 357566 local both 7630.5 5341.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAPSULAR CONTRACTURE RELEASE 360 23020 cpt 504006 local both 7656 5359.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS 360 25447 cpt 503581 local both 7689 5382.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENTEROLSS FRING INTSTINAL ADHESION SPX 360 44005 cpt 503641 local both 7708 5395.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA 360 26746 cpt 357564 local both 7721.25 5404.88 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COR HLX VLGS PRX MTAR OSTEOT 360 28295 cpt 503619 local both 7734 5413.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX 360 29870 cpt 357631 local both 7756.5 5429.55 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR PRIMARY TORN LIGM& CAPSULE KNEE COLLATERAL 360 27405 cpt 503595 local both 7758 5430.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION 360 28300 cpt 357610 local both 7759.5 5431.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SLING OPERATION STRESS INCONTINENCE 360 57288 cpt 503664 local both 7830 5481 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENODESIS BICEPS TENDON ELBOW SEPARATE PX 360 24340 cpt 503576 local both 7847 5492.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ADENOIDECTOMY PRIMARY REDUCIBLE 360 49505 cpt 503657 local both 8017 5611.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HYSTEROSCOPY REMOVAL LEIOMYOMATA 360 58561 cpt 357706 local both 8048.25 5633.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR 360 29827 cpt 503628 local both 8080 5656 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT 360 27236 cpt 503696 local Inpatient 8080 5656 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA 360 26735 cpt 503589 local both 8094 5665.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR 360 27334 cpt 503761 local both 8182 5727.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION SYNOVIAL CYST POPLITEAL SPACE 360 27345 cpt 357573 local both 8250.75 5775.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT 360 29846 cpt 357629 local both 8287.5 5801.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT 360 28291 cpt 503618 local both 8294.21 5805.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOTOMY RADIUS DISTAL THIRD 360 25350 cpt 503810 local both 8329.5 5830.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMPLANT SPINAL CANAL CATH WO LAMINECTOMY 360 62350 cpt 503674 local both 8331.61 5832.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA 360 26990 cpt 357567 local both 8375.25 5862.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PATELLECTOMY OR HEMIPATELLECTOMY 360 27350 cpt 503593 local both 8383.32 5868.32 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS 360 52630 cpt 357688 local both 8385 5869.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS 360 27792 cpt 503726 local both 8534 5973.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT 360 52356 cpt 503710 local both 8557 5989.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY 360 28299 cpt 357609 local both 8562.75 5993.93 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE 360 49520 cpt 503773 local both 8630 6041 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT METATARSAL FRACTURE EACH 360 28485 cpt 503620 local both 8690 6083 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS SURG W ASPIR CAVITY CYST SINGLE MULTIPLE 360 49322 cpt 5401010 local both 8709 6096.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY 360 27416 cpt 357577 local both 8715 6100.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY HIP W/FEMOROPLASTY 360 29914 cpt 503633 local both 8725 6107.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY INTERPHALANGEAL JOINT EACH 360 26535 cpt 357561 local both 8743.5 6120.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX METACARPAL FRACTURE SINGLE EA BONE 360 26615 cpt 503588 local both 8759 6131.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY 360 29863 cpt 357630 local both 8760.75 6132.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH 360 54530 cpt 357695 local both 8821.5 6175.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX 360 20660 cpt 504004 local both 8922.75 6245.93 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE 360 25628 cpt 5401014 local both 8923.5 6246.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC TRANSCATH RETRIEVAL,PERCUT,INTRAVASCULAR FOREIGN BODY" 360 37197 cpt 343214 local both 8963.82 6274.67 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC 360 24341 cpt 357532 local both 9061.5 6343.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR 360 63663 cpt 503827 local both 9070.5 6349.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY SURG CHOLECYSTECTOMY 360 47562 cpt 503653 local both 9090 6363 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPIC APPENDECTOMY 360 44970 cpt 503650 local both 9144 6400.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA 360 26536 cpt 357562 local both 9155.25 6408.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA 360 26075 cpt 503888 local both 9161 6412.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT 360 28750 cpt 357621 local both 9168 6417.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE 360 27766 cpt 357596 local both 9172.5 6420.75 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CYSTO W/URETEROSCOPY W/LITHOTRIPSY 360 52353 cpt 357685 local both 9181.5 6427.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG 360 25608 cpt 503722 local both 9182 6427.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED LAP PX ABD PERTONEUM & OMENTUM 360 49329 cpt 503870 local both 9189.75 6432.83 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RESECTION SCROTUM 360 55150 cpt 357699 local both 9190.5 6433.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS ABD PRTM&OMENTUM DX W/WO SPEC BR/WA SPX 360 49320 cpt 357664 local both 9222.75 6455.93 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION 360 27726 cpt 357595 local both 9238.5 6466.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX 360 29840 cpt 357628 local both 9268.5 6487.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION/CURETTAGE CYST/TUMOR FEMUR 360 27355 cpt 357575 local both 9297 6507.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED 360 49507 cpt 503658 local both 9310 6517 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT GREATER TROCHANTERIC FRACTURE 360 27248 cpt 503697 local Inpatient 9315.75 6521.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV 360 64712 cpt 357714 local both 9328.5 6529.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUTURE INFRAPATELLAR TENDON PRIMARY 360 27380 cpt 503594 local both 9336.34 6535.44 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CMBND ANTERPOST COLPORRAPHY W/CYSTO 360 57260 cpt 357703 local both 9340.5 6538.35 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE 360 58662 cpt 503672 local both 9344 6540.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RCNSTJ DISLOCATING PATELLA 360 27420 cpt 357578 local both 9471.75 6630.23 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ SKEL FIXJ FEMORAL FX PROX END NECK 360 27235 cpt 503878 local both 9497 6647.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX 360 24538 cpt 503579 local both 9505 6653.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY 360 29806 cpt 503623 local both 9562 6693.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE 360 27769 cpt 357597 local both 9592.5 6714.75 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RESECTION/TRANSPLANTATION LONG TENDON BICEPS 360 23440 cpt 357528 local both 9657 6759.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS 360 28730 cpt 303289 local both 9662.25 6763.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH 360 57283 cpt 357704 local both 9748.5 6823.95 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB 360 23040 cpt 503802 local both 9752.25 6826.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE 360 27784 cpt 503609 local both 9754.07 6827.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR RECRT INGUN HERNIA ANY AGE INCARCERATED 360 49521 cpt 503825 local both 9849 6894.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE 360 49321 cpt 357666 local both 9860.25 6902.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLOSTOMY/SKIN LEVEL CECOSTOMY 360 44320 cpt 357645 local both 9963.75 6974.63 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY HIP W/ACETABULOPLASTY 360 29915 cpt 357633 local both 10033.5 7023.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR OF RUP TENDON W OR WO GRAFT 360 24342 cpt 503577 local both 10051 7035.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX THIGH FRACTURE W OR WO SCREWS CERCLAGE 360 27245 cpt 503592 local Inpatient 10100 7070 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DISKECTOMY,PERCUTANEOUS LUMBAR" 360 62287 cpt 4400279 local both 10151.25 7105.88 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT 360 27134 cpt 503782 local inpatient 10166.25 7116.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLECTOMY PARTIAL W/ANASTOMOSIS 360 44140 cpt 503643 local inpatient 10201 7140.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROSCOPY HIP W/LABRAL REPAIR 360 29916 cpt 503634 local both 10201 7140.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP 360 25607 cpt 503583 local both 10201 7140.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RPR NONUNION/MALUNIRDS/ULNA W/O ATGRFT 360 25400 cpt 503884 local both 10222.5 7155.75 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MAST RAD W PEC MUSCLES AXILLARY LYMPH NODES 360 19305 cpt 503561 local both 10266.41 7186.49 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS WRIST LIMITED W AUTOGRAFT 360 25825 cpt 5401027 local both 10279.5 7195.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MASTECTOMY PARTIAL W AXILLARY LYMPHADENECTOMY 360 19302 cpt 503560 local both 10300 7210 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR 360 27427 cpt 503596 local both 10403 7282.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY ENTEROLYSIS SEPARATE PX 360 44180 cpt 503867 local both 10483 7338.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS FULG/EXC OVARY VISCERA/PERITONEAL SURFACE 360 58662 cpt 357708 local both 10537.5 7376.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE TUNNELED CV CATH 360 36583 cpt 4400894 local both 10546.25 7382.38 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY W/MENISCUS REPAIR KNEE 360 27403 cpt 503763 local both 10580.25 7406.18 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT 360 47610 cpt 503824 local both 10582 7407.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX CLAVICAL DISLOC W FASCIAL GRAFT 360 23552 cpt 503571 local both 10604 7422.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY 360 27566 cpt 357586 local both 10617.75 7432.43 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS COLECTOMY PRTL W/RMVL TERMINAL ILEUM 360 44205 cpt 503646 local both 10630.87 7441.61 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REV COLOSTOMY W/RPR PARACLST HERNIA SPX 360 44346 cpt 503647 local both 10697.61 7488.33 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENTERORRHAPHY SINGLE PERFORATION 360 44605 cpt 357648 local both 10713 7499.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENTERORRHAPHY SINGLE PERFORATION 360 44602 cpt 357646 local both 10713 7499.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE 360 52601 cpt 503774 local both 10807 7564.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR 360 27524 cpt 503881 local both 10850 7595 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN 360 27513 cpt 357585 local inpatient 10855.5 7598.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA 360 27335 cpt 357572 local both 10867.5 7607.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS SUBTALAR 360 28725 cpt 357620 local both 10872 7610.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES 360 58661 cpt 503671 local both 10908 7635.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA 360 25575 cpt 503758 local both 10923 7646.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS CHOLECYSTECTOMY W/CHOLANGIOGRAPHY 360 47563 cpt 503868 local both 11075 7752.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY 360 27033 cpt 503815 local both 11075.25 7752.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP 360 27822 cpt 503817 local both 11138 7796.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROTOMY HIP W DRAINAGE 360 27030 cpt 5401011 local both 11183.25 7828.28 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS 360 23466 cpt 503566 local both 11200 7840 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE 360 27814 cpt 503610 local both 11207 7844.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG 360 25609 cpt 357545 local both 11227.5 7859.25 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX FEMORAL FRACTURE DISTAL MED LAT CONDYLE 360 27514 cpt 503601 local inpatient 11300 7910 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENTERECTOMY RESC SMALL INTESTINE 1 RESC & ANAST 360 44120 cpt 503642 local both 11312 7918.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX ULNAR FX PROXIMAL END 360 24685 cpt 503757 local both 11312 7918.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSURE ENTEROSTOMY LG/SMALL INTESTINE 360 44620 cpt 503790 local both 11507.25 8055.08 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INS/RPLC SPI NPG/RCVR POCKET 360 63685 cpt 503679 local both 11514 8059.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMPLANT SPINE INFUSION PUMP NON PROGRAM PUMP 360 62361 cpt 503675 local both 11686.28 8180.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA 360 27759 cpt 503766 local both 11716 8201.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL 360 27422 cpt 357579 local both 11808.75 8266.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVISE TOATL KNEE ARTHROPLASTY W OR WO GRAFT 360 27486 cpt 503599 local both 11818 8272.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA 360 49650 cpt 503662 local both 12019 8413.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX OF THIGH FX W IMPLANT 360 27506 cpt 503600 local both 12221 8554.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX 360 23670 cpt 503805 local both 12394.5 8676.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT 360 27138 cpt 503695 local inpatient 12399 8679.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT 360 44143 cpt 503645 local inpatient 12423 8696.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOTAL HIP ARTHROPLASTY W OR WO GRAFT 360 27130 cpt 503591 local both 12423 8696.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR 360 27428 cpt 357581 local both 12432 8702.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT 360 44625 cpt 503648 local both 12572 8800.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS TRIPLE 360 28715 cpt 357619 local both 12600.75 8820.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ 360 43840 cpt 503823 local both 12612 8828.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOTAL KNEE ARTHROPLASTY MEDIAL AND LATERAL 360 27447 cpt 503598 local both 12625 8837.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX CLAVICULAR FX INTERNAL FIXATION 360 23515 cpt 503570 local both 12625 8837.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR 360 23462 cpt 203287 local both 12667 8866.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER 360 43501 cpt 503822 local both 12672 8870.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY 360 27827 cpt 357599 local both 12878.25 9014.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY PATELLA W/PROSTHESIS 360 27438 cpt 357582 local both 12963 9074.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMPLANT SPINE INFUSION PUMP PROGRAM PUMP 360 62362 cpt 503676 local both 13000 9100 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX SCAPULAR FX W INTERNAL FIXATION IF 360 23585 cpt 503572 local both 13033 9123.1 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS ANKLE OPEN 360 27870 cpt 357600 local both 13103.25 9172.28 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP 360 27823 cpt 357598 local both 13238.25 9266.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMPUTATION LEG THROUGH TIBIA&FIBULA 360 27880 cpt 357601 local both 13422 9395.4 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW 360 24635 cpt 357536 local both 13488 9441.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG LAP,ABLAT 1+ LIVER TUMOR(S),RADIOFREQ" 360 47370 cpt 4400922 local both 13605.32 9523.72 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY 360 49323 cpt 357668 local both 13628.25 9539.78 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY 360 43860 cpt 357643 local both 13673.25 9571.28 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN 360 27511 cpt 357584 local inpatient 13952.25 9766.58 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS MYOMECTOMY EXC 1-4 MYOMAS 250 GM< 360 58545 cpt 5401015 local both 14061 9842.7 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG UNLISTED LAPS PX HRNAP HERNIORRHAPHY HERNIOTOMY 360 49659 cpt 357671 local both 14089.5 9862.65 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ 360 27536 cpt 503602 local both 14126 9888.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TXT PROXIMAL HUMERAL FRACTURE 360 23615 cpt 503573 local both 14140 9898 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RCNSTJ DISLC PATELLA W/PATELLECTOMY 360 27424 cpt 503879 local both 14328 10029.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS 360 44626 cpt 357651 local both 14495.25 10146.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY 360 44141 cpt 503644 local inpatient 14499 10149.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN 360 24545 cpt 503808 local both 14682.75 10277.93 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHOLECYSTECTOMY 360 47600 cpt 357657 local both 15001.5 10501.05 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHOLECYSTECTOMY W/CHOLANGIOGRAPHY 360 47605 cpt 357658 local both 15051.75 10536.23 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA 360 27828 cpt 503611 local both 15100.04 10570.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ 360 29888 cpt 503631 local both 15150 10605 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRODESIS PANTALAR 360 28705 cpt 357618 local both 15228.75 10660.13 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY 360 23470 cpt 503567 local both 15655 10958.5 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY ANKLE W/IMPLANT 360 27702 cpt 357594 local both 15705.75 10994.03 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RCNSTJ DISLC PATELLA W/PATELLECTOMY 360 27424 cpt 357580 local both 15810.75 11067.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR 360 58542 cpt 503667 local both 15894 11125.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY KNEE MEDIAL OR LATERAL COMP 360 27446 cpt 503597 local both 16160 11312 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER 360 23472 cpt 503568 local both 16160 11312 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR 360 42420 cpt 503637 local both 16479 11535.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS W VAG HYSTERECT 250 GM &RMVL TUBE&OVARIES 360 58552 cpt 5401025 local both 16495.5 11546.85 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVIS SHOULDR ARTHRPLSTY HUMERAL GLENOID 360 23473 cpt 503569 local both 16669 11668.3 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE 360 24515 cpt 357535 local both 17007 11904.9 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX SHOULDER DISLOC W/NECK FX 360 23680 cpt 503755 local both 17400 12180 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY 360 58571 cpt 357707 local both 17614.5 12330.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTHRP ELBOW W DISTAL HUM&PROX UR PROS RPLCM 360 24363 cpt 503578 local both 17634 12343.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY COLPOPEXY SUSPENSION VAGINAL APEX 360 57425 cpt 503665 local both 18106 12674.2 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPIC SURGICAL SPLENECTOMY 360 38120 cpt 357638 local both 18305.25 12813.68 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR 360 58573 cpt 503670 local both 19738 13816.6 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT 360 24435 cpt 357534 local both 19753.5 13827.45 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT 360 23474 cpt 357529 local both 19984.5 13989.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC 360 23550 cpt 503804 local both 23550 16485 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLECTOMY PRTL W/COLOST/ILEOST & MUCOFIST 360 44144 cpt 503866 local inpatient 24364.5 17055.15 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXC LOCAL MALIGNANT TUMOR STOMACH 360 43611 cpt 357641 local both 32670.75 22869.53 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 72 percent of total billed charges 83 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC URINARY REFLEX STUDY 361 51792 cpt 5200198 local both 708.52 495.96 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC INJ SACROILIAC JOINT,ARTHROGRAPHY OR ANESTHETIC/STEROID" 361 27096 cpt 308677 local both 1364 954.8 87 percent of total billed charges 24 percent of total billed charges 84 percent of total billed charges not to exceed 7000 84 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANESTH UPPR ARM PROCEDURE 370 1730 HCPCS 302794 local both 73 51.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CON SEDATION< 5 YR 1ST 15 MIN (370) 370 99151 cpt 303599 local both 210 147 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NON GENERAL ANESTHISIA CARE 1/4 HR 370 370 RC 5200169 local both 406 284.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CON SEDATION EA ADDL 15 MIN (370) 370 99153 cpt 303601 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CON SEDATION/>5 YR 1ST 15 MIN (370) 370 99152 cpt 303600 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GEN ANESTH CARE 1/4 HR 370 370 RC 5260003 local both 685 479.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CON SEDATION< 5 YR 1ST 15 MIN 371 99151 cpt 303602 local both 191 133.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CON SEDATION EA ADDL 15 MIN 371 99153 cpt 305750 local both 290 203 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CON SEDATION/>5 YR 1ST 15 MIN 371 99152 cpt 303603 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PLATELETS, EACH UNIT" 390 P9019 HCPCS 351008 local both 226.47 158.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CROSS MATCH 86922 390 86922 cpt 362100 local both 265 185.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC ABBREV X-MATCH 86920 390 86920 cpt 360808 local both 285.11 199.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC ANTIBODY SCREEN 390 86850 cpt 360806 local both 357 249.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FRESH FROZEN PLASMA < 8HRS EA UNIT BLD 390 P9017 HCPCS 350601 local both 367 256.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC WHOLE BLOOD/RED BLOOD CELLS/LEUKOCYTES REG 390 P9051 HCPCS 350602 local both 643.59 450.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LEUKOCYTE POOR PRBC'S 390 P9016 HCPCS 350609 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PRBC,LEUKOREDUCED,CMV,IRRADIAT" 390 P9058 HCPCS 350603 local both 918 642.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CRYOPRECIPITATE EACH UNIT 390 P9012 HCPCS 350600 local both 1050 735 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RBC LEUKOCYTES REDUCED BLD 390 P9016 HCPCS 350032 local both 1101 770.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC PLATELETPHERESIS LR 390 P9035 HCPCS 350608 local both 1530 1071 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PLT PHERESIS,LEUKOREDUCED,CMV" 390 P9055 HCPCS 350605 local both 1571 1099.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PRBC,LEUKOREDUCED,IRRADIATED" 390 P9040 HCPCS 350604 local both 1571 1099.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PLT,PHER,L/R CMV-NEG,IRRADIATE" 390 P9053 HCPCS 350606 local both 1999 1399.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC PLT PHERESIS,LEUKOREDUCED,IRRA" 390 P9037 HCPCS 350607 local both 2760 1932 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION HOUR 391 36430 cpt 343223 local both 800 560 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD 1ST HR UP TO 60 MIN. 391 36430 cpt 310086 local both 903 632.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC BLOOD TRANSFUSION 1ST HOUR 391 36430 cpt 310010 local both 998 698.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION 1ST HOUR 391 36430 cpt 310023 local both 998 698.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION >1HR TO 4HRS 391 36430 cpt 310087 local both 1278 894.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TRANSFUSION >1HR TO 4 HRS. 391 36430 cpt 310011 local both 1406 984.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC-TRANSFUSION BLOOD/BLOOD COMPONENTS 391 36430 cpt 310024 local both 1406 984.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION 4-6 HRS. 391 36430 cpt 310088 local both 1577 1103.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TRANSFUSION 4 TO 6 HRS 391 36430 cpt 310012 local both 1693 1185.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION 4 TO 6 HOURS 391 36430 cpt 310025 local both 1868 1307.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION 6 TO 8 HOURS 391 36430 cpt 310026 local both 2103 1472.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION 6 TO 8 HOURS 391 36430 cpt 310089 local both 2103 1472.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TRANSFUSION 6 TO 8 391 36430 cpt 310013 local both 2362 1653.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TRANSFUSION 8 TO 10 HR 391 36430 cpt 310014 local both 2500 1750 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLOOD TRANSFUSION 8 TO 10 HR 391 36430 cpt 310027 local both 2500 1750 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BLOOD TRANSFUSION >8 HOURS 391 36430 cpt 310090 local both 2500 1750 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DIAG BREAST TOMOSYNTHESIS UNI-BIL 401 G0279 HCPCS 4400949 local both 168 117.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DX MAMMO UNILATERAL W/WO CAD 401 77065 cpt 305840 local both 373 261.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DX MAMMO BILAT W/WO CAD 401 77066 cpt 305841 local both 471 329.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BX BREAST ADD LESION STRTCTC 401 19082 cpt 4410526 local both 2503.79 1752.65 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BX BREAST 1ST LESION STRTCTC 401 19081 cpt 4410525 local both 3560.25 2492.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG US GUIDANCE FOR VASCULAR ACCESS 402 76937 cpt 4400653 local both 315 220.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges up to 1082 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG US ABDOMINAL AORTA SCREEN AAA 402 76706 cpt 305843 local both 368 257.6 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG ULTRASOUND BREAST LIMITED 402 76642 cpt 4410554 local both 368 257.6 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG US LTD JOINT OR OTHER NON VAS RT W/IMAGE DOC 402 76882 cpt 4400841 local both 441 308.7 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG ULTRASOUND BREAST COMPLETE 402 76641 cpt 4410553 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG US,PREGNANT UTERUS,F/U,TRANSA*" 402 76816 cpt 4400661 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG RETROPERITNL ABD, LTD" 402 76775 cpt 4400594 local both 525 367.5 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG US,PELVIC (NONOBSTETRIC),REAL*" 402 76857 cpt 4400658 local both 599 419.3 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG ABDOMEN LIMITED 402 76705 cpt 4400120 local both 630 441 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG US GUIDANCE FOR NEEDLE PLACEMENT 402 76942 cpt 4400603 local both 683 478.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER" 402 76776 cpt 4400665 local both 709.5 496.65 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG FETAL BIOPHYSICAL PROFILE WO NST 402 76819 cpt 4400325 local both 732.59 512.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG US COMPL JOINT RT W/IMAGE DOC 402 76881 cpt 4400840 local both 756 529.2 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG ECHO,SCROTUM & CONTENTS" 402 76870 cpt 4400310 local both 788 551.6 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG US,PELVIC (NONOBSTETRIC),REAL*" 402 76856 cpt 4400657 local both 788 551.6 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG US GUIDANCE FOR AMNIOCENTESIS 402 76946 cpt 4400600 local both 788.01 551.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG US,RETROPERIT,REAL TIME,COMPL*" 402 76770 cpt 4400664 local both 809 566.3 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG ABDOM,B-SCAN &/OR REAL TIME,C*" 402 76700 cpt 4400119 local both 840 588 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG HEAD/NECK TISSUES,REAL TIME" 402 76536 cpt 4400340 local both 840 588 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG OB < 14 WKS, ADD'L FETUS" 402 76802 cpt 4400503 local both 930 651 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ECHOGRAPHY,TRANSVAGINAL" 402 76830 cpt 4400313 local both 945 661.5 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG ULTRASOUND NERVES 1 EXTR INCL IMAG 402 76883 cpt 302989 local both 1000 700 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG US,PREGNANT UTERUS,TRANSVAGIN*" 402 76817 cpt 4400663 local both 1008 705.6 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG US,PREGNANT UTERUS,LIMITED, 1*" 402 76815 cpt 4400662 local both 1008 705.6 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG CHEST,REAL TIME" 402 76604 cpt 4400220 local both 1061 742.7 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG HEAD, REAL TIME" 402 76506 cpt 4400339 local both 1084.02 758.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DEV BREAST ADD STRTCTC 402 19284 cpt 4410534 local both 1087.63 761.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DEVICE BREAST EA IMAG 402 19282 cpt 4410532 local both 1087.63 761.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DEV BREAST ADD US IMAG 402 19286 cpt 4410536 local both 1090 763 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG US GUID,COMP REPAIR,PSEUDO-AN*" 402 76936 cpt 4400651 local both 1134 793.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG OB < 14 WKS, SINGLE FETUS" 402 76801 cpt 4400504 local both 1166 816.2 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG OB >/= 14 WKS, SNGL FETUS" 402 76805 cpt 4400506 local both 1271 889.7 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG BX BREAST ADD LESION US IMAG 402 19084 cpt 4410528 local both 1418 992.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPINAL CANAL & CONTENTS 402 76800 cpt 4400607 local both 1436.39 1005.47 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
"HCHG US,PREG UTER,FET & MAT,+ DETL*" 402 76812 cpt 4400660 local both 1479 1035.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ECHO,TRANSRECTAL" 402 76872 cpt 4400311 local both 1531.91 1072.34 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG US GUIDANCE INTRAOPERATIVE 402 76998 cpt 4400642 local both 1772.55 1240.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DEV BREAST 1ST US IMAG 402 19285 cpt 4410535 local both 1780 1246 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG RAD GUIDED,PERCUT DRAINAGE,W/*" 402 75989 cpt 4400568 local both 1798 1258.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG OB >/= 14 WKS, ADDL FETUS" 402 76810 cpt 4400505 local both 2183.79 1528.65 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG US,PREG UTER,FET & MAT,+ DETL*" 402 76811 cpt 4400659 local both 2260 1582 87 percent of total billed charges 24 percent of total billed charges 420 case rate 357 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 357 420
HCHG PERQ DEV BREAST 1ST STRTCTC 402 19283 cpt 4410533 local both 2375.25 1662.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DEVICE BREAST 1ST IMAG 402 19281 cpt 4410531 local both 2375.25 1662.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BX BREAST 1ST LESION US IMAG 402 19083 cpt 4410527 local both 4547 3182.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SCRN BREAST TOMOSYNTHESIS BILAT 403 77063 cpt 4400948 local both 115 80.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SCR BREAST TOMOSYNTHESIS UNI(52MOD) 403 77063 cpt 305848 local both 157 109.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SCRN MAMMO UNI W/WO CAD (52MOD) 403 77067 cpt 305844 local both 382 267.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SCREENING MAMMO BILAT W/WO CAD 403 77067 cpt 305842 local both 382 267.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 1395 85 percent of total billed charges not to exceed $1082.00 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC AIRWAY INHALATION TREATMENT 410 94640 cpt 330950 local both 27 18.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEST PHYSIOTHERAPY-SUBSQ 410 94668 cpt 303174 local both 162 113.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC AIRWAY INHALATION TREATMENT 410 94640 cpt 330928 local both 162 113.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CHEST PHYSIOTHERAPY-PEP-INIT 410 94667 cpt 303172 local both 171 119.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC AERO TX INLINE 410 94640 cpt 330923 local both 180 126 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC HND HELD NEB INITIAL 410 94640 cpt 330670 local both 203.14 142.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTERIAL PUNCTURE-BLOOD DX 410 36600 cpt 302827 local both 207 144.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IPPB TX INIT 410 94640 cpt 330671 local both 225.98 158.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CATH ASPIRATION, NASAL TRACHEAL" 410 31720 cpt 304011 local both 228.6 160.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC IPPB RX 410 94640 cpt 330936 local both 264.6 185.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INHALER INITIAL 410 94664 cpt 330937 local both 279 195.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONT INHALATION TREATMENT W/MED EA ADD HR 410 94645 cpt 309071 local both 314.1 219.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MECH CHEST WALL OSCIL PER/SESSION 410 94669 cpt 310137 local both 334.8 234.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC BREATH ACTIVATED NEBULIZER INITIAL 410 94640 cpt 330964 local both 360 252 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC OXYGEN HOOD SET UP 410 410 RC 310107 local both 443.18 310.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC USN INITIAL 410 94664 cpt 330965 local both 486.57 340.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONT INHALATION TREATMENT W/MEDS 1ST HR 410 94644 cpt 309070 local both 495 346.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CONTINUOUS NEB < 1 HOUR 410 94640 cpt 330980 local both 540 378 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MDI DOSE TITRATION 410 94640 cpt 330970 local both 615.03 430.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MASK CPAP/BIPAP SUBQ DAY 410 94660 cpt 303381 local both 720 504 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CPAP INITIATION/MANAGEMENT 410 94660 cpt 303283 local both 954 667.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENTILATION(BIPAP)-SUBSQ DAY 410 94003 cpt 305670 local both 1827 1278.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENTILATION(BIPAP)-FIRST DAY 410 94002 cpt 305669 local both 2700 1890 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ULTRASOUND PER 15 MIN 420 97035 cpt 305599 local both 64 44.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG E STIM-UNATTENDED-NON WND CAR* 420 97014 cpt 305773 local both 64 44.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IONTOPHORESIS EA 15 MIN 420 97033 cpt 304204 local both 75 52.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONTRAST BATHS EA 15 MIN 420 97034 cpt 303268 local both 78.57 55 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SENSORY INT TCHNQS 15 MIN 420 97533 cpt 305189 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MECHANICAL TRACTION - PT 420 97012 cpt 304365 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUBSQ PROS/ORTHO TRAINING EA 15 MIN 420 97763 cpt 305846 local both 106 74.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CANALITH REPOSITIONING 420 95992 cpt 343267 local both 106 74.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASOPNEUMATIC PUMP THERAPY 420 97016 cpt 305651 local both 117.44 82.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MASSAGE 420 97124 cpt 304362 local both 120 84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PHYSICAL PERFORMANCE TEST-PER 15 MIN 420 97750 cpt 343272 local both 140 98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MANUAL THERAPY TECHNIQUE 15MIN 420 97140 cpt 305919 local both 148 103.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GAIT TRAINING-M59 420 97116 cpt 305789 local both 148 103.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INIT PROSTHETIC TRAINING EA 15 MIN 420 97761 cpt 305772 local both 154.05 107.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THERAPEUTIC ACTIVITIES 15 MIN 420 97530 cpt 305782 local both 159 111.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WHEELCHAIR MAIN/PROP TRNG 15 MIN 420 97542 cpt 305783 local both 170 119 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THERAPEUTIC EXERCISE EA 15 MIN 420 97110 cpt 305777 local both 170 119 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INITIAL ORTHOTIC TRAINING EA 15 MIN 420 97760 cpt 305778 local both 183 128.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG STERILE WHIRLPOOL-M59 420 97022 cpt 305775 local both 265.25 185.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PT RE-EVAL EST PLAN CARE 424 97164 cpt 307206 local both 148 103.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PT EVAL LOW COMPLEX 20 MIN 424 97161 cpt 307203 local both 201 140.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PT EVAL MOD COMPLEX 30 MIN 424 97162 cpt 307204 local both 307 214.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PT EVAL HIGH COMPLEX 45 MIN 424 97163 cpt 307205 local both 392 274.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARAFFIN TREATMENT-M59 430 97018 cpt 305799 local both 70 49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COGNITIVE INTERVENTION ADDL 15 MIN 430 97130 cpt 362242 local both 70.86 49.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COGNITIVE INTERVENTION FIRST 15 MIN 430 97129 cpt 362241 local both 73.05 51.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SELF CARE MANAGEMENT TRAINING 430 97535 cpt 343082 local both 95 66.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COMMUNITY WORK REINTEGRATE15MIN 430 97537 cpt 305776 local both 97.86 68.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SELF CARE ADL TRAINING 15 MIN 430 97535 cpt 305787 local both 148 103.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEUROMUSCULAR RE-EDUCATION-M59 430 97112 cpt 305798 local both 148 103.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AQUATIC THERAPY-M59 430 97113 cpt 305797 local both 159 111.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OT RE-EVAL EST PLAN CARE 434 97168 cpt 307210 local both 212 148.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OT EVAL LOW COMPLEX 30 MIN 434 97165 cpt 307207 local both 329 230.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OT EVAL HIGH COMPLEX 60 MIN 434 97167 cpt 307209 local both 370 259 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OT EVAL MOD COMPLEX 45 MIN 434 97166 cpt 307208 local both 371 259.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPEECH GEN DEVICE TREATMENT 440 92609 cpt 305266 local both 209.54 146.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPEECH LANG TX-INDIVIDUAL 440 92507 cpt 305267 local both 286 200.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NONSPEECH GEN DEVICE TREATMENT 440 92606 cpt 304553 local both 289.57 202.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SWALLOWING DYSFUNCTION TREATMT 440 92526 cpt 305393 local both 339 237.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASSESSMENT OF APHASIA PER HR 440 96105 cpt 302833 local both 509 356.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPEECH LANGUAGE TX-GROUP 443 92508 cpt 305268 local both 143.53 100.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EVAL SPEECH-GEN DEVICE 1ST HR 444 92607 cpt 303678 local both 260 182 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VIDEO FLEX FIBERENDO EVAL 444 92612 cpt 305685 local both 324 226.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ORAL PHARYNGEAL EVALUATION 444 92610 cpt 304702 local both 339 237.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPEECH SOUND LANG COMPREHEN 444 92523 cpt 310136 local both 350 245 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC EVALUATION OF VOICE PROSTHETIC 444 92607 cpt 330957 local both 364.78 255.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BEHAVRAL QUALIT ANALYS VOICE 444 92524 cpt 310133 local both 392 274.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EVALUATION OF SPEECH FLUENCY 444 92521 cpt 310134 local both 392 274.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EVALUATE SPEECH PRODUCTION 444 92522 cpt 310135 local both 413 289.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VIDEOFLUOROSCOPIC EVALUATION 444 92611 cpt 305690 local both 636 445.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANASCOPY DIAGNOSTIC 450 46600 cpt 302775 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WITHDRAWAL OF ARTERIAL BLOOD 450 36600 cpt 308881 local both 176.46 123.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OFFICE-OP CONSULTATION NEW/ESTAB PATIENT 40 MIN 450 99243 cpt 503834 local both 177 123.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASPIRATION OF BLADDER BY TROCAR OR INTRACATHETER 450 51101 cpt 308930 local both 199.19 139.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC APPLICATION OF CAST FIGURE OF EIGHT 450 29049 cpt 308779 local both 235.31 164.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SIMPLE REPAIR SUPERFICIAL WND > 30CM 450 12018 cpt 308431 local both 247.29 173.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC STRAPPING OF ANKLE AND/OR FOOT 450 29540 cpt 308801 local both 248.95 174.27 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC STRAPPING OF KNEE 450 29530 cpt 308799 local both 248.95 174.27 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC STRAPPING OF SHOULDER 450 29240 cpt 308791 local both 248.95 174.27 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NON ROTUINE BL DRAW >3 YEARS 450 36410 cpt 308871 local both 249.2 174.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH NON-ROUTINE BLOOD DRAW >3YRS 450 36410 cpt 343118 local both 249.2 174.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC STRAPPING OF CHEST 450 29200 cpt 308789 local both 266.01 186.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH APPLICATION OF PASTE BOOT 450 29580 cpt 308804 local both 283.94 198.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC STRAPPING OF ELBOW OR WRIST 450 29260 cpt 308793 local both 285.24 199.67 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPLINT APPLICATION FINGER 450 29130 cpt 305285 local both 297 207.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL I BRIEF 450 99281 cpt 304307 local both 300 210 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STRAPPING OF TOES 450 29550 cpt 308803 local both 300 210 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAST REMOVAL FULL ARM/LEG 450 29705 cpt 303059 local both 303 212.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CASTING/STRAPPING PROCEDURE 450 29799 cpt 308811 local both 306.31 214.42 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STRAPPING OF HAND OR FINGER 450 29280 cpt 308795 local both 310 217 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TREATMENT OF TALUS FRACTURE W/O MANIPULATION 450 28430 cpt 308751 local both 317 221.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLEAR OUTER EAR CANAL 450 69200 cpt 309007 local both 319 223.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAIN BLOOD FROM UNDER NAIL 450 11740 cpt 308403 local both 319 223.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT FOOT DISLOCATION W/O ANESTHESIA 450 28600 cpt 308772 local both 331 231.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC APPLICATION OF FINGER SPLINT DYNAMIC 450 29131 cpt 308787 local both 336.27 235.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE NASAL FOREIGN BODY 450 30300 cpt 308817 local both 348 243.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASPIRATION OF BLADDER BY NEEDLE 450 51100 cpt 308928 local both 352.3 246.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC APPLY FOREARM SPLINT(FOREARM TO HAND)DYNAMIC 450 29126 cpt 308784 local both 387.31 271.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH REPAIR FINGER TENDON W/O GRAFT 450 26418 cpt 308645 local both 395 276.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPLINT APPLICATION LONG ARM 450 29105 cpt 305286 local both 396 277.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPLINT APPLICATION SHORT ARM 450 29125 cpt 305287 local both 407 284.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX FINGER FX EACH W/O MANIPULATION 450 26740 cpt 308665 local both 423.34 296.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TREAT FOOT DISLOCATION W/O ANESTHESIA 450 28540 cpt 308768 local both 426.34 298.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX WRIST BONE FX WO MANIPULATION 450 25630 cpt 308629 local both 430.1 301.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE MOUTH ROOF LESION 450 42000 cpt 308911 local both 433.84 303.69 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT BIG TOE FRACTURE W/O MANIPULATION 450 28490 cpt 308760 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC ACROMIOCLAVICULAR CLSD W/O MANIP 450 23540 cpt 303449 local both 437.83 306.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREATMENT OF TOE FX-W/O MANIPULATION 450 28510 cpt 308764 local both 446.62 312.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT NEEDLE BONE CAVITY FOR INTRASSEOS INFUSION 450 36680 cpt 308887 local both 450 315 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC NASOPHARYNGOSCOPY W ENDOSCOPE 450 92511 cpt 309034 local both 452 316.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX HAND DISLOCATION W/MANIPULATION W/O ANES 450 26670 cpt 308657 local both 454.12 317.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPLINT APPLICATION LONG LEG 450 29505 cpt 305290 local both 462 323.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT METACARPAL FX W/O MANIPULATION 450 26600 cpt 308647 local both 462.37 323.66 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVAL OF DEVITALIZED TISSUE 20 CM/< 450 97597 cpt 330951 local both 463 324.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT MIDFOOT FX EACH W/O MANIPULATION 450 28450 cpt 308755 local both 471.38 329.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVE INTRAUTERINE DEVICE 450 58301 cpt 343230 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT TOE DISLOCATION W/O ANESTHESIA 450 28630 cpt 308774 local both 480.08 336.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX FX OF ULNA W/O MANIPULATION 450 25530 cpt 308614 local both 480.39 336.27 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR TONGUE LACERATION 2.5CM OR < 450 41250 cpt 308903 local both 498 348.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX FINGER FX W/O MAN 450 26750 cpt 308669 local both 499.91 349.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DIAGNOSTIC LARYNGOSCOPY-INDIRECT 450 31505 cpt 308831 local both 510 357 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE FB EYE EXTERNAL CONJ EMB 450 65210 cpt 308985 local both 510.41 357.29 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVE PHARYNX FOREIGN BODY 450 42809 cpt 308919 local both 511.17 357.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT SHOULDER BLADE FX W/O MANI 450 23570 cpt 308563 local both 513.41 359.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR MOUTH LACERATION 2.5 OR < 450 40830 cpt 308897 local both 514.91 360.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE FOREIGN BODY FROM EYE CORNEAL W SLIT LAMP 450 65222 cpt 308989 local both 517 361.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF FINGER ABSCESS 450 26010 cpt 308640 local both 520.92 364.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT TOE DISLOCATION WO ANES 450 28660 cpt 308777 local both 523 366.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX RADIUS FX W/O MANIPULATION 450 24650 cpt 308600 local both 523.92 366.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT BIG TOE FRACTURE WITH MANIPULATION 450 28495 cpt 308762 local both 530 371 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SIMPLE REPAIR SUPERFICIAL WOUND 20.1 CM-30.0 CM 450 12017 cpt 308428 local both 537.51 376.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC INSERT BLADDER CATHETER COMPLEX 450 51703 cpt 308934 local both 540 378 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPEAT CONTROL OF NOSEBLEED ANY METHOD SUBSEQUENT 450 30906 cpt 308825 local both 540 378 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF PROXIMAL FIBULA OR SHAFT FX W/O MAN 450 27780 cpt 308714 local both 544.94 381.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT HUMERUS FRACTURE W/O MAN 450 23620 cpt 308570 local both 546.44 382.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS 20.1 CM-30.0 CM" 450 12056 cpt 308467 local both 547.28 383.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX FRACTURE OF RADIUS W/O MANIPULATION 450 25500 cpt 308609 local both 547.94 383.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX ULNAR FX WO MANIPULATION 450 24670 cpt 308604 local both 551.28 385.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX OF TOE FX W MANIPULATION 450 28515 cpt 308766 local both 557 389.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREATMENT OF HEEL FX W/O MANIPULATION 450 28400 cpt 308750 local both 557 389.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLADDER IRRIGATION 450 51700 cpt 302931 local both 561 392.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX FX OF LOWER LEG W/WO ANES W/O MANIPULATION 450 27824 cpt 308730 local both 561.46 393.02 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAIN EXTERNAL EAR LESION 450 69000 cpt 309005 local both 563.62 394.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX WRIST BONE FX WO MANIPULATION 450 25622 cpt 308625 local both 575.72 403 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR COMPLEX WOUND EA ADDL 5CM < 450 13153 cpt 308495 local both 580 406 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPLINT APPLICATION SHORT LEG 450 29515 cpt 305288 local both 583 408.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT FINGER FX EACH W/O MANIPULATION 450 26720 cpt 308661 local both 590 413 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF ANKLE FX W/O MANIPULATION 450 27760 cpt 308710 local both 595.98 417.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR SUPERFICIAL WOUND >30.0CM SCALP NECK AXILLAE 450 12007 cpt 308419 local both 596.91 417.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CONTROL NOSEBLEED-INITIAL 450 30905 cpt 308823 local both 600 420 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT WRIST BONE FRACTURE CLOSED/ULNAR STYLOID 450 25650 cpt 308633 local both 600.48 420.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS 12.6 CM-20.0 CM" 450 12045 cpt 308451 local both 604.78 423.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CONTROL OF NOSEBLEED SIMPLE 450 30901 cpt 308819 local both 605 423.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT METATARSAL FRACTURE W/O MANIPULATION 450 28470 cpt 308757 local both 610 427 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX KNUCKLE DISLOCATION W/MANIPULATION W/O ANES 450 26700 cpt 308659 local both 610 427 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT HUMERUS FX W/O MANIPULATION 450 23600 cpt 308567 local both 613 429.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND/LESION ADD-ON 5 CM OR LESS 450 13102 cpt 308475 local both 616 431.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE W/O MAN 450 27786 cpt 308718 local both 620 434 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX OF ANKLE FX-W/O MANIPULATION 450 27808 cpt 308722 local both 623 436.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DRAINAGE OF ABSCESS SUBMAXILLARY, EXTERNAL" 450 42320 cpt 308913 local both 623.09 436.16 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT FX W/O MANIPULATION 450 25600 cpt 308622 local both 626 438.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL II LIMITED 450 99282 cpt 304312 local both 630 441 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT FINGER FX EACH W/MANIPULATION 450 26755 cpt 308671 local both 637 445.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT CLAVICLE FX W/O MANIPULATION 450 23500 cpt 308553 local both 638 446.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR SUPERFICIAL WOUND 12.6-20.0CM FACE EAR EYELID LIP 450 12016 cpt 308427 local both 640 448 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF MOUTH LESION 450 40800 cpt 308895 local both 642 449.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TEAT THUMB DISLOCATION W/MANIPULATION 450 26641 cpt 308653 local both 644.47 451.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER CLOSE WOUND 12.6-20.0CM FACE EARS EJYELID NOSE LIP 450 12055 cpt 308465 local both 645.08 451.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLSD TREATMNT GREATER TROCHANTERIC FRACTURE 450 27246 cpt 302768 local both 646 452.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL SKIN TAGS UP TO 15 LESIONS 450 11200 cpt 308312 local both 647.92 453.54 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT FRACTURE OF ULNA WITH MANIPULATION 450 25535 cpt 308616 local both 648.03 453.62 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS OVER 30.0 CM" 450 12057 cpt 308469 local both 648.45 453.92 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC TX KNEE W/O ANES CLSD 450 27550 cpt 303455 local both 650 455 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GASTRIC INTUBATION TREATMENT 450 43753 cpt 303817 local both 650.25 455.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX HUMERUS FX-W MANIPULATION 450 24565 cpt 308590 local both 653.92 457.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT FINGER FRACTURE EACH CLOSED W/MANIPULATION 450 26742 cpt 308667 local both 659.03 461.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE FB EYE EXTERNAL CONJ SUP 450 65205 cpt 304973 local both 660 462 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NASO GASTRIC TUBE PLACEMENT 450 43752 cpt 307082 local both 660 462 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CONTROL OF NOSEBLEED COMPLEX 450 30903 cpt 308821 local both 660 462 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION DRAINAGE OF PILONIDAL CYST SIMPLE 450 10080 cpt 308281 local both 660 462 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF BREAST LESION 450 19000 cpt 309584 local both 662.49 463.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX KNEE FX W/O MANIPULATION 450 27530 cpt 308699 local both 668.04 467.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF THIGH FX W/O MANIPULATION MEDIAL OR LATERAL 450 27508 cpt 308696 local both 668.04 467.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX HUMERUS FX W/O MANIPULATION 450 24530 cpt 308586 local both 668.04 467.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT FX RADIUS/ULNA W/O MANIPULATION 450 25560 cpt 308618 local both 670 469 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR SUPERFICIAL WOUND 7.6-12.5CM 450 12015 cpt 308425 local both 682 477.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT KNEECAP DISLOCATION WO ANES 450 27560 cpt 308702 local both 690 483 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC CLOSED TX THIGH FX W/O MAN PROXIMAL END,NECK" 450 27230 cpt 308680 local both 690 483 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RESET DISLOCATED JAW CLOSED TX INITIAL OR SUBSEQUENT 450 21480 cpt 308545 local both 690 483 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX OF HUMERAL SHAFT FRACTURE W/O MANIPULATION 450 24500 cpt 308582 local both 710 497 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE FOREIGN BODY FROM EYE CORNEAL WO SLIT LAMP 450 65220 cpt 308987 local both 715 500.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AVULSION NAIL PLATE SINGLE 450 11730 cpt 302850 local both 715 500.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF THIGH FX W/O MAN 450 27500 cpt 308690 local both 735.6 514.92 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX OF TIBIA FX W/O MANIPULATION 450 27750 cpt 308706 local both 736 515.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC REPAIR WOUND/LESION ADD-ON 5CM OR< COMPLEX SCALP,ARM,LEG" 450 13122 cpt 308481 local both 737 515.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE ABSCESS HEMATOMA NASAL 450 30000 cpt 308813 local both 747.45 523.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND 7.6-12.5CM SIMPLE 450 12004 cpt 308414 local both 759 531.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF THIGH FX W/O MANIPULATION 450 27501 cpt 308692 local both 761.11 532.78 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR SUPERFICIAL WOUND 20.1-30.0CM SCALP NECK AXILLAE 450 12006 cpt 308418 local both 770 539 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WEDGE EXCISION SKIN NAIL FOLD 450 11765 cpt 308409 local both 781 546.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION HEMORRHOID EXTERNAL 450 46083 cpt 304029 local both 783 548.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE GTUBE WO IMAGE ENDO OR TRACT REV 450 43762 cpt 503433 local both 790 553 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX FINGER FX-W MANIPULATION 450 26725 cpt 308663 local both 792 554.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CONTROL NOSE/THROAT BLEEDING SIMPLE 450 42970 cpt 308925 local both 798.65 559.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS 7.6 CM-12.5 CM" 450 12044 cpt 308449 local both 803 562.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF GUM LESION 450 41800 cpt 308907 local both 814 569.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF TRIMALLEOLAR ANKLE FX W/O MANIPULATION 450 27816 cpt 308726 local both 817 571.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND 12.6-20.0 SIMPLE 450 12005 cpt 308416 local both 820 574 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND/LESION 1.1-2.5CM COMPLEX SCALP ARM LEG 450 13120 cpt 308477 local both 829.48 580.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX ELBOW CHILD W/MANIP CLSD 450 24640 cpt 305587 local both 836 585.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INSERTION CATHETER ARTERY FOR SAMPLING MONITORING TRANSF 450 36620 cpt 308883 local both 836.03 585.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM 450 54220 cpt 308946 local both 844 590.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE OF TONSIL ABSCESS 450 42700 cpt 308915 local both 858 600.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC REPAIR, INTMD, WOUNDS 20.1-30.0 CM" 450 12036 cpt 308441 local both 873 611.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT CLAVICLE DISLOCATION CLOSED W/MANIPULATION 450 23545 cpt 308561 local both 875.2 612.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC TX ANKLE WO ANESTH CLSD 450 27840 cpt 303452 local both 880 616 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC TX ELBOW W/O ANES CLSD 450 24600 cpt 303454 local both 880 616 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT THUMB FRACTURE CLOSED W/MANIPULATION 450 26645 cpt 308655 local both 885.72 620 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF RADIAL SHAFT W/MANIPULATION 450 25505 cpt 308611 local both 891 623.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASPIRATION PUNCTURE 450 10160 cpt 306825 local both 891 623.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC REPAIR WOUND/LESION1.1-2.5CM COMPLEX FOREHEAD,CHEEK,CHIN" 450 13131 cpt 308483 local both 898 628.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR MOUTH LACERATION>2.5CM 450 40831 cpt 308899 local both 899.23 629.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC TX FINGER W/O ANES CLSD 450 26770 cpt 307077 local both 902 631.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT RADIUS FX W/MANIPULATION 450 24655 cpt 308602 local both 908.23 635.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INSERTION CATHETER ARTERY FOR SAMPLING MONITOR TRANSFUSE 450 36625 cpt 308885 local both 916.04 641.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAYER CLOSURE OF WOUND 2.5CM OR < 450 12051 cpt 308457 local both 924 646.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT WRIST DISLOCATION CLOSED W/MANIPULATION 450 25675 cpt 308635 local both 925.46 647.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CLOSED TREATMENT OF SHOULDER DISLOCATION,WITH MANIPULATI" 450 23675 cpt 308578 local both 925.46 647.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX OF CARPAL BONE FX W/MANIPULATION 450 25635 cpt 308631 local both 950.27 665.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR COMPLEX WOUND 2.6-7.5CM 450 13152 cpt 308493 local both 957 669.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TEMPORARY TRANSCUTANEOUS PACING 450 92953 cpt 309040 local both 968.28 677.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SPINAL PUNCTURE,THERA,DRAINAGE OF CEREBROSPINAL FLUID" 450 62272 cpt 310008 local both 973.5 681.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER CLOSSURE WOUND 7.6-12.5CM 450 12054 cpt 308463 local both 975 682.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER OF CLOSURE WOUND 7.6-12.5CM 450 12034 cpt 308437 local both 979 685.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVE EYELID FOREIGN BODY 450 67938 cpt 309003 local both 983.89 688.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC BLEPHAROTOMY, DRAINAGE OF ABSCESS EYELID" 450 67700 cpt 308996 local both 998.3 698.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC I & D OF VULVA/PERINEUM 450 56405 cpt 308953 local both 1011 707.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ 450 27767 cpt 503785 local both 1016.25 711.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LAYER OF CLOSURE WOUND 2.6-5.0CM 450 12052 cpt 308459 local both 1023 716.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER CLOSURE OF WOUND 5.1-7.5CM 450 12053 cpt 308461 local both 1029 720.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR TONGUE LACERATION>2.6CM 450 41252 cpt 308905 local both 1034.58 724.21 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPLACEMENT OF GASTROSTOMY OR CECOSTOMY TUBE 450 49450 cpt 309590 local both 1045 731.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TX OF ANKLE FX W/MANIPULATION 450 27788 cpt 308720 local both 1053 737.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) TRIGGER PT(S) 1/2 MUSCLE 450 20552 cpt 306584 local both 1056 739.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER CLOSE WOUND 12.6-20.0CM 450 12035 cpt 308439 local both 1056 739.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS OVER 30.0 CM" 450 12047 cpt 308455 local both 1057.08 739.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC SHOULDER W/MANIP CLSD 450 23650 cpt 303450 local both 1067 746.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC REPAIR WOUND/LESION1.1-2.5CM COMPLEX EYELID,NOSE,EAR,LIP" 450 13151 cpt 308491 local both 1090 763 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA WITH US GUIDE 450 20611 cpt 304690 local both 1094.34 766.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER CLOSURE WOUND 2.6-7.5CM 450 12042 cpt 308447 local both 1120 784 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT HIP DISLOCATION WO ANES 450 27265 cpt 308684 local both 1122 785.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT HIP DISLOCATION W/O ANES 450 27250 cpt 308682 local both 1122 785.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG REPOSITION,NASO/GASTRIC TUBE" 450 43761 cpt 307081 local both 1126 788.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND/LESION 2.6-7.5CM COMPLEX SCALP ARM LEG 450 13121 cpt 308479 local both 1144 800.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THROMBOLYTIC THERAPY(CORONARY) 450 92977 cpt 305510 local both 1144.68 801.28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TREAT FOOT DISLOCATION W/O ANESTHESIA 450 28570 cpt 308770 local both 1158.38 810.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF CARPAL SCAPHOID FRACTURE W/MANIPULATION 450 25624 cpt 308627 local both 1158.38 810.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT SHOULDER BLADE FX 450 23575 cpt 308565 local both 1158.38 810.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CLOSED TX OF STERNOCLAVICULAR DISLOCATION W/MANIPULATION 450 23525 cpt 308558 local both 1158.38 810.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC STERNOCLAVICULAR CLSD 450 23520 cpt 303451 local both 1158.38 810.87 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX OF ANKLE FX W MANIP 450 27810 cpt 308724 local both 1177 823.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC EXPLORATION OF PENETRATING WOUND(SEPARATE PROCEDURE)NECK 450 20100 cpt 308514 local both 1191.4 833.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LAYER CLOSURE OF WOUND 2.5CM OR < 450 12041 cpt 308445 local both 1210 847 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA W/O US GUIDE 450 20610 cpt 310005 local both 1227 858.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT HUMERUS FRACTURE CLOSED MEDIAL/LATERAL W/MAN 450 24577 cpt 308592 local both 1238.5 866.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT CLAVICLE FRACTURE CLOSED 450 23505 cpt 308555 local both 1262 883.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT HUMERUS FRACTURE W/WO SKELETAL TRACTION 450 24505 cpt 308584 local both 1276 893.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR COMPLEX FOREHEAD CHEEK CHIN MOUTH NECK ADD<5CM 450 13133 cpt 308487 local both 1300 910 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT METACARPAL FX W MANIPULATION 450 26605 cpt 308649 local both 1301 910.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CHANGE BLADDER TUBE 450 51705 cpt 308936 local both 1309 916.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE OF PILONIDAL CYST COMPLICATED 450 10081 cpt 308283 local both 1341 938.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC VEIN ACCESS CUTDOWN <1 YEAR VENIPUNCTURE 450 36420 cpt 308873 local both 1341.34 938.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL III INTERMEDIATE 450 99283 cpt 304317 local both 1350 945 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR OF NAIL BED 450 11760 cpt 308407 local both 1353 947.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS 20.1 CM-30.0 CM" 450 12046 cpt 308453 local both 1360 952 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DILATE URETHRA STRICTURE 450 53600 cpt 308944 local both 1385.62 969.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT DISLOCATION/FRACTURE W/MANIPULATION 450 23665 cpt 308576 local both 1407 984.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREATMENT OF ANKLE FRACTURE 450 28435 cpt 308753 local both 1426.16 998.31 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LIGATION OF HEMORRHOID(S) 450 46221 cpt 309607 local both 1501.21 1050.85 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS 450 69020 cpt 503831 local both 1527 1068.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, INTERMEDIATE, WOUNDS 30.0 CM" 450 12037 cpt 308443 local both 1541.59 1079.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH CLOSED TX VERT FX W/O MANI 450 22310 cpt 343201 local both 1574 1101.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND/LESION 2.6-7.5CM COMPLEX TRUNK 450 13101 cpt 308473 local both 1658 1160.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT HUMERUS FRACTURE CLOSED W/MANIPULATION 450 24535 cpt 308588 local both 1661 1162.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REPAIR COMPLEX TRUNK 1.1-2.5 CM 450 13100 cpt 308471 local both 1683 1178.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR LIP-VERMILLION ONLY 450 40650 cpt 308889 local both 1693.86 1185.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INCISION OF WINDPIPE EMERGENCY TRACHEOSTOMY 450 31603 cpt 308839 local both 1699.37 1189.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX ULNAR FX W MANIPULATION 450 24675 cpt 308606 local both 1711.38 1197.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ 450 90375 cpt 503833 local both 1726.5 1208.55 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE DRUG IMPLANT DEVICE 450 11982 cpt 302708 local both 1800 1260 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVAL OF FOOT FOREIGN BODY 450 28190 cpt 308742 local both 1820 1274 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TREATMENT OF METATARSAL FRACTURE WITH MANIPULATI 450 28475 cpt 308758 local both 1821 1274.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC EXPLORE OF PENETRATIN WOUND EXTREMITY 450 20103 cpt 308520 local both 1832.98 1283.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH TREAT TOE DISLOCATION W/ANES 450 28635 cpt 308775 local both 1848.75 1294.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGE 450 32556 cpt 308540 local both 1859 1301.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION/REM FB SUBQ SIMPLE 450 10120 cpt 304031 local both 1914 1339.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE SKIN TISSUE MUSCLE BONE FX 450 11012 cpt 308302 local both 1936 1355.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CRITICAL CARE-EA ADDL 30 MIN 450 99292 cpt 303293 local both 1980 1386 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ANOSCOPY REMOVE FOREIGN BODY 450 46608 cpt 343227 local both 2042.12 1429.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR WOUND/LESION 2.6-7.5CM 450 13132 cpt 308485 local both 2090 1463 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL IV EXTENDED 450 99284 cpt 304322 local both 2100 1470 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC ASPIRATE PLEURA W IMAGING 450 32555 cpt 343209 local both 2160 1512 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION WINDPIPE TRACH EMERGENCY 450 31605 cpt 308841 local both 2168.2 1517.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRAINAGE OF SCROTUM ABSCESS 450 55100 cpt 308950 local both 2315.77 1621.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC UPPER GI ENDOSCOPY, DIAGNOSTIC" 450 43235 cpt 309603 local both 2316 1621.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF MOUTH LESION 450 41000 cpt 308901 local both 2346.39 1642.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR LIP 450 40652 cpt 308891 local both 2360 1652 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSURE OF SPLIT WOUND SIMPLE 450 12020 cpt 308433 local both 2370 1659 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC DEBRIDE,FX,SKIN,TISSUE,MUSCLE FASCIA AND MUSCLE" 450 11011 cpt 308300 local both 2389.42 1672.59 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXPLORE PENETRATING WOUND (SEPARATE PROCEDURE) CHEST 450 20101 cpt 308516 local both 2480 1736 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR LIP COMPLEX 450 40654 cpt 308893 local both 2498.01 1748.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT SHOULDER DISLOCATION 450 23655 cpt 308574 local both 2585 1809.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GENITAL SURGERY PROCEDURE 450 58999 cpt 308968 local both 2592.15 1814.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STOMACH SURGERY PROCEDURE 450 43999 cpt 309604 local both 2604.6 1823.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REPAIR BLOOD VESSEL LESION 450 35226 cpt 308866 local both 2638.01 1846.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC EYE SURGERY PROCEDURE 450 66999 cpt 308994 local both 2681.16 1876.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TREATMENT OF ANKLE DISLOCATION W/ANESTHESIA 450 27842 cpt 308735 local both 2689.43 1882.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DISLOC TX RADIUS/ULNA CLSD 450 25605 cpt 307105 local both 2728 1909.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION 450 65435 cpt 308993 local both 2739.31 1917.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL FECAL IMPACTION/FOREIGN BODY UNDER ANESTHESIA 450 45915 cpt 309605 local both 2770 1939 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SKIN TISSUE PROCEDURE 450 17999 cpt 308508 local both 2777.48 1944.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL V COMPREHENSIVE 450 99285 cpt 304325 local both 2780 1946 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRAINAGE OF NOSE LESION 450 30020 cpt 308815 local both 2828.28 1979.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVAL OF FOREIGN BODY SIMPLE 450 20520 cpt 308522 local both 2854.6 1998.22 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION OF EYELID FOLD 450 67715 cpt 308998 local both 2895 2026.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC INCISION AND DRAINAGE OF ANAL ABSCESS SUPERFICIAL 450 46050 cpt 309588 local both 2937 2055.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREATMENT OF THIGH FRACTURE W/MANIPULATION 450 27503 cpt 308694 local both 2950.05 2065.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP" 450 19020 cpt 308511 local both 2953 2067.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG GENITAL MALE SURGERY PROCEDURE 450 55899 cpt 308951 local both 3057.97 2140.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INCISION AND DRAINAGE OF UPPER ARM/ELBOW BURSA 450 23931 cpt 308580 local both 3076.39 2153.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INCISION & DRAINAGE BELOW FACIA/FOOT/SINGE BURSAL SPACE 450 28002 cpt 308740 local both 3156.3 2209.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX OF NASAL BONE FRACTURE W/O STABIL W/ MANIPULATION 450 21315 cpt 308539 local both 3218.59 2253.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE REMOVAL FOREIGN MATERIAL FX 450 11010 cpt 308298 local both 3312 2318.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC ANUS SURGERY PROCEDURE UNLISTED 450 46999 cpt 309609 local both 3334.19 2333.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC INCISION OF RETAL ABSCESS 450 46040 cpt 309587 local both 3340 2338 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC LARYNGOSCOPY DIRECT W/WO TRACHEOSCOPY DX -NO NEWBORN 450 31525 cpt 308833 local both 3373 2361.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CONTROL THROAT BLEEDING W/2ND SURGICAL INTERVENTION 450 42962 cpt 308923 local both 3373.21 2361.25 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISE FINGER TENDON SHEATH 450 26055 cpt 308644 local both 3393 2375.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CONTROL OF NOSEBLEED 450 30915 cpt 308827 local both 3398.72 2379.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS" 450 46230 cpt 309660 local both 3437.78 2406.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC UNLISTED PROCEDURE, RECTUM" 450 45999 cpt 309606 local both 3486.23 2440.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CONTROL THROAT BLEEDING 450 42960 cpt 308921 local both 3512.83 2458.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISSUE 450 27086 cpt 308676 local both 3533.85 2473.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF HEMATOMA/FLUID 450 10140 cpt 308288 local both 3559 2491.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVE FOREIGN BODY FROM EYE 450 65235 cpt 308991 local both 3563.88 2494.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAINAGE OF THROAT ABSCESS 450 42720 cpt 308917 local both 3573 2501.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXPLORE PENETRATING WOUND ABDOMEN/FLANK/BACK 450 20102 cpt 308518 local both 3599.9 2519.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL" 450 46320 cpt 309589 local both 3605.16 2523.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ABDOMEN PARACENTESIS W/IMAGING 450 49083 cpt 310007 local both 3638 2546.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX POST HIP ARTHROPLASTY DISLOCATION W/ANES 450 27266 cpt 308686 local both 3641 2548.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC TX OF MISSED ABORTION COMPLETED SURGICALLY 2ND TRIMESTER 450 59821 cpt 308973 local both 3727.67 2609.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VAGINAL DELIVERY 450 59409 cpt 305639 local both 3741 2618.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST 450 53060 cpt 308942 local both 3742.56 2619.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT LOWER LEG FRACTURE W/WO ANES 450 27825 cpt 308732 local both 3744.36 2621.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF PROXIMAL FIBULA/SHAFT FX W/MANIPULATION 450 27781 cpt 308716 local both 3744.36 2621.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC CLOSED TREATMENT OF LUNATE DISLOCATION, W/MANIPULATION" 450 25690 cpt 308638 local both 3744.36 2621.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT METACARPAL FRACTURE W/MANIPULATION EACH BONE 450 26607 cpt 308651 local both 3745.97 2622.18 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES FEMORAL NERVE (INCLUDES IG) 450 64447 cpt 308981 local both 3751 2625.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC CLOSED TX OF MONTEGGIA TYPE OF FX DISLOCATION AT ELBOW 450 24620 cpt 308597 local both 3857 2699.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC COLPORRHAPHY,SUTURE OF INJURY OF VAGINA (NONO*" 450 57200 cpt 308140 local both 3970.47 2779.33 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SUTURE OF RECENT WOUND EYELID 450 67935 cpt 309001 local both 3977.86 2784.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC LEG/ANKLE SURGERY PROCEDURE 450 27899 cpt 308738 local both 4190.77 2933.54 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG TREATMENT,MISSED AB,ANY TRI." 450 59812 cpt 305568 local both 4203.39 2942.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REPAIR OF FOOT TENDON PRIMARY OR SECONDARY EACH TENDON 450 28208 cpt 308748 local both 4206.23 2944.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ASPIRATION OF BLADDER W/INSERTION OF SUPRAPUBIC CATHETER 450 51102 cpt 308932 local both 4229 2960.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX TIBIAL SHAFT FX W&WO FIBULAR FX WMANIP 450 27752 cpt 308708 local both 4240 2968 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MUSCULOSKELETAL SURGERY 450 20999 cpt 308535 local both 4294.96 3006.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT FX RADIUS/ULNA W/MANIPULATION 450 25565 cpt 308620 local both 4312 3018.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS" 450 46250 cpt 309608 local both 4372.37 3060.66 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D COMPLEX POSTOP WOUND INFECTION 450 10180 cpt 308291 local both 4390 3073 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CRITICAL CARE-30 TO 74 MINUTES 450 99291 cpt 303292 local both 4400 3080 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREATMENT OF ANKLE FRACTURE W MANIPULATION 450 27818 cpt 308728 local both 4433 3103.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REMOVE VAGINAL FOREIGN BODY 450 57415 cpt 308961 local both 4488.62 3142.03 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTIAL EXCISION PHAL TOE 450 28124 cpt 362122 local both 4499.86 3149.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DRAIN NECK/CHEST LESION 450 21501 cpt 308547 local both 4549 3184.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC REPAIR BLOOD VESSEL LESION/UPPER EXTREMITY 450 35206 cpt 308862 local both 4600.53 3220.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL FB DEEP COMPLICATED 450 20525 cpt 308524 local both 4607.37 3225.16 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG REPAIR BLOOD VESSEL, DIRECT HAND, FINGER" 450 35207 cpt 308864 local both 4609.76 3226.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PRO-APPLICATION OF FINGER SPLINT 450 21451 cpt 310009 local both 4611.5 3228.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC INCISION AND DRAINAGE OF SCROTUM 450 54700 cpt 308948 local both 4649 3254.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX FINGER DISLOCATION 450 26775 cpt 343114 local both 4650 3255 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SLITTING OF PREPUCE 450 54001 cpt 110357 local both 4658 3260.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CLOSED TX OF NASAL BONE FRACTURE W STABIL W/ MANIPULATION 450 21320 cpt 330963 local both 4660 3262 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC TREAT DENTAL RIDGE FRACTURE 450 21440 cpt 308542 local both 4664.49 3265.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH REMOVAL OF SUPPORT IMPLANT 450 20670 cpt 308532 local both 4761 3332.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION INTERPHAN JT TOE 450 28160 cpt 362123 local both 4827.36 3379.15 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC LARYNGOSCOPY,DIRECT,OPERATIVE,WITH FOREIGN BODY REMOVAL" 450 31530 cpt 308835 local both 5071 3549.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISION/REM FB SUBQ CPLX 450 10121 cpt 304030 local both 5104 3572.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REPAIR BLOOD VESSEL LESION DIRECT/NECK 450 35201 cpt 308860 local both 5104.66 3573.26 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AMPUTATION FINGER THUMB 450 26951 cpt 308673 local both 5269 3688.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF SUPPORT IMPLANT 450 20680 cpt 308534 local both 5342 3739.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF FOOT FOREIGN BODY DEEP 450 28192 cpt 308744 local both 5425 3797.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TOOTH EXTRACTION 450 41899 cpt 503473 local both 5544 3880.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT HUMERUS FRACTURE CLOSED 450 23605 cpt 308568 local both 5610 3927 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF FOOT FOREIGN BODY COMPLICATED 450 28193 cpt 308746 local both 5634 3943.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY" 450 52315 cpt 308940 local both 5635.55 3944.89 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE EACH 450 26765 cpt 343113 local both 6171 4319.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARTIAL REMOVAL OF FINGER BONE 450 26236 cpt 362121 local both 6490 4543 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DENTAL SURGERY PROCEDURE 450 41899 cpt 308909 local both 7332.08 5132.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REV/RMV PRPH SAC/GSTR NPG/R 450 64595 cpt 343051 local both 7578.72 5305.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TREAT ELBOW DISLOCATION W/ANE 450 24605 cpt 308595 local both 9017.43 6312.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC REPAIR, OPEN OR PERCUT RUPTURED ACHILLES TENDON" 450 27650 cpt 308704 local both 9570 6699 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MANIPULATION OF ANKLE UNDER GENERAL ANESTHESIA 450 27860 cpt 308737 local both 9920 6944 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE PRIMARY 450 27385 cpt 308688 local both 11330 7931 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EAR/PULSE OXIMETRY SINGLE DETM 460 94760 cpt 303508 local both 41 28.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EAR/PULSE OXIMETRY-MULTIPLE 460 94761 cpt 303507 local both 80 56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC LAVAGE A SUCTION 460 94799 cpt 309078 local both 145.63 101.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CO2 EXPIRED GAS DETERMINATION 460 94799 cpt 309102 local both 184 128.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VITAL CAPACITY 460 94150 cpt 305699 local both 204 142.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PULMONARY FUNCTION TEST BY OSCILLMETRY 460 94728 cpt 330948 local both 318 222.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPIROMETRY W/ GRAPHIC RCD (NO PROFEE) 460 94010 cpt 305946 local both 326 228.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC OVERNIGHT OXIMETRY (MEASURE BLOOD OXYGEN LEVEL) 460 94762 cpt 309077 local both 360 252 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PULMONARY FUNCT TEST BY PLETHYSMOGRAPHY 460 94726 cpt 330947 local both 418 292.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CO2/MEMBRANE DIFFUSE CAPACITY 460 94729 cpt 330968 local both 428 299.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EAR/PULSE OXIMETRY-NIGHT MONITOR 460 94762 cpt 304151 local both 436 305.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PULMONARY FUNCTION TEST BY GAS 460 94727 cpt 330967 local both 520 364 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PULMONARY STRESS TESTING 460 94618 cpt 503413 local both 636 445.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC SPIRO PRE & POST 460 94060 cpt 330976 local both 887 620.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PURETONE AUDIOMETRY AIR ONLY 471 92552 cpt 304948 local both 132.26 92.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXTERNAL ECG>48HR<7D RECORDING ONLY 480 93242 cpt 357505 local both 267 186.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXTERNAL PT ACTIVATED ECG RECORDING 30 DAYS 480 93270 cpt 357507 local both 326.25 228.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIOPULMONARY RESUSCITATION 480 92950 cpt 303027 local both 950 665 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIOVERSION EXTERNAL ELECTVE 480 92960 cpt 303030 local both 1770 1239 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SWAN LINE INSERTION 481 93503 cpt 305396 local both 3563.88 2494.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIOVASC STRESS TST TRACING ONLY 482 93017 cpt 305566 local both 1080 756 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIO STRESS TEST 482 93017 cpt 303026 local both 1082 757.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MYOCARDIAL STRAIN IMAGING STE 483 93356 cpt 4410594 local both 471.75 330.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLOR FLOW MAPPING 483 93325 cpt 303231 local both 579.75 405.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIAC DOPPLER EXAM(2ND) 483 93320 cpt 303011 local both 600.24 420.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO DOPPLER EXAM COMP 483 93320 cpt 306678 local both 600.24 420.17 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CARDIAC DOPPLER LIMITED 483 93321 cpt 303012 local both 710 497 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO DOPPLER EXAM LIMITED 483 93321 cpt 306679 local both 945.35 661.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHOCARDIOGRAM LTD W/O CONT 483 93308 cpt 303514 local both 1080 756 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO-CONGENITAL LTD W/O CONT 483 93304 cpt 303513 local both 1227.3 859.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO-CNGNTL LTD W/ CONT 483 93304 cpt 306513 local both 1227.3 859.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO LIMITED W/CONTRAST 483 93308 cpt 306675 local both 1267.82 887.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHOCRDGRM LTD W/ CONT 483 93308 cpt 306514 local both 1267.82 887.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO TEE TAVR TMVR LAAC W WO CONT 483 93355 cpt 305045 local both 1300 910 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO COMP W/O CONT W/O CF 483 93307 cpt 303511 local both 1426.28 998.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO 2D COMP W/CF W/CONTRAST 483 93307 cpt 306673 local both 1426.28 998.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO-CONGENITAL COMP W/O CONT 483 93303 cpt 303512 local both 1714.56 1200.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO CONGENITAL COMP W/CONT 483 93303 cpt 307053 local both 1714.56 1200.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO-CNGNTL COMP W/ CONT 483 93303 cpt 306512 local both 1714.56 1200.19 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO REST/STRESS W/O CONTRAST 483 93350 cpt 303515 local both 1791.75 1254.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO REST/STRESS W/ CONT 483 93350 cpt 306515 local both 1885 1319.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSESOPHAGEAL ECHO W/O CONTRAST 483 93312 cpt 305546 local both 2062.56 1443.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO TRANSESOPHAGEAL W/CONT 483 93312 cpt 306677 local both 2062.56 1443.79 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO COMP W/O CONTRAST 483 93306 cpt 306369 local both 2225 1557.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSESOPHAGEAL ECHO W/ CONTRAST 483 93312 cpt 306547 local both 2352 1646.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TEE CONGENITAL W/O CONTRAST 483 93315 cpt 305547 local both 2431.96 1702.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TEE CONGENITAL W/ CONTRAST 483 93315 cpt 306549 local both 2431.96 1702.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO 2D W/CF COMP W/CONTRAST 483 93306 cpt 306671 local both 2660 1862 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO COMP W/ CONTRAST 483 93306 cpt 306370 local both 2660 1862 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ECHO COMP W/BUBBLES W/O CONTRAST 483 93306 cpt 4410673 local both 2710 1897 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC IMMUNOTHERAPY, ONE INJECTION" 510 95115 cpt 309080 local both 28 19.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC IMMUNOTHERAPY, INJECTION, 2 OR MORE" 510 95117 cpt 309082 local both 35 24.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG AVULSION NAIL PLATE,SIMPLE/SGL" 510 11730 cpt 302851 local both 74 51.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ONL DGTL E/M SVC <7DYS 5-10MIN 510 99421 cpt 357220 local both 81 56.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC APPLICATION OF PASTE BOOT 510 29580 cpt 308805 local both 93 65.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MED TEAM CONF W/INTERDISCIPLINARY 510 99366 cpt 310394 local both 137 95.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC ESTABLISHED PATIENT LEVEL 1 510 99211 cpt 338905 local both 153 107.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERTION CATH-STRAIGHT (MINI) 510 51701 cpt 304148 local both 153 107.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S)-TRIGGER PT(S)-3/MORE MS 510 20553 cpt 306585 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ONL DGTL E/M SVC <7DYS 11-20MIN 510 99422 cpt 357221 local both 167 116.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERTION CATH-SIMPLE (FOLEY) 510 51702 cpt 304147 local both 173 121.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC NEW PATIENT LEVEL 2 510 99202 cpt 338901 local both 175 122.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARING BENIGN LESIONS > 4 510 11057 cpt 304731 local both 190.13 133.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROLONGED OUTPATIENT VISIT EA 15 MIN 510 99417 cpt 304328 local both 192 134.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PROLONGED OFFICE VISIT EA 15 MIN 510 G2212 HCPCS 503735 local both 196 137.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL II VISIT ESTABLISHED PT 510 99212 cpt 304315 local both 204 142.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC ESTABLISHED PATIENT LEVEL 2 510 99212 cpt 338906 local both 204 142.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL SUTURE AND STAPLES - NO ANES 510 15854 cpt 302749 local both 209.9 146.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL SUTURE OR STAPLES - NO ANES 510 15853 cpt 302748 local both 209.9 146.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARING BENIGN LESION-ONE 510 11055 cpt 304730 local both 252.54 176.78 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL III VISIT ESTABLISHED 510 99213 cpt 304320 local both 255 178.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC ESTABLISHED PATIENT LEVEL 3 510 99213 cpt 338907 local both 255 178.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OFFICE VISIT-NEW-LEVEL 2 510 99202 cpt 304650 local both 255 178.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ONL DGTL E/M SVC <7DYS 21+MIN 510 99423 cpt 357222 local both 265 185.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PARING BENIGN LESIONS-2 TO 4 510 11056 cpt 304732 local both 281 196.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EST PT FACILITY DETAILED 510 99214 cpt 303668 local both 300 210 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LEVEL IV VISIT ESTABLISHED PT 510 99214 cpt 304324 local both 306 214.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC ESTABLISHED PATIENT LEVEL 4 510 99214 cpt 338908 local both 306 214.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OFFICE VISIT-NEW-LEVEL 3 510 99203 cpt 304652 local both 306 214.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC NEW PATIENT LEVEL 3 510 99203 cpt 338902 local both 306 214.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC ESTABLISHED PATIENT LEVEL 5 510 99215 cpt 338909 local both 357 249.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC NEW PATIENT LEVEL 4 510 99204 cpt 338903 local both 357 249.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OFFICE VISIT-EST-LEVEL 5 510 99215 cpt 304596 local both 377 263.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OFFICE VISIT-NEW-LEVEL 4 510 99204 cpt 304654 local both 420 294 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WC NEW PATIENT LEVEL 5 510 99205 cpt 338904 local both 482 337.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG WOUND CARE W/ PACKING 510 12021 cpt 305733 local both 634.86 444.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-SMALL JT/BURSA WITH US GUIDE 510 20604 cpt 304663 local both 931.6 652.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-SMALL JT/BURSA W/O US GUIDE 510 20600 cpt 304103 local both 931.6 652.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA WITH US GUIDE 510 20611 cpt 304691 local both 1094.34 766.04 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DEBRIDE INFECTED SKIN 510 11000 cpt 308293 local both 2016.12 1411.28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DEBRIDEMENT SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE" 510 11043 cpt 308305 local both 2342 1639.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG EXCISION,BGN LESN SNE <.5 CM" 510 11420 cpt 303710 local both 2375 1662.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG EXCISION,BGN LESN TAL 3.1-4 CM" 510 11404 cpt 303718 local both 2852 1996.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG EXCISION,BGN LESN SNE 2.1-3 CM" 510 11423 cpt 303712 local both 2892 2024.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC DEBRIDE BONE/TISS 1ST 20 SQCM 510 11044 cpt 308307 local both 2998 2098.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG EXCISION,BENIGN LESION,>4.0 CM" 510 11426 cpt 303702 local both 4452 3116.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MR ANGIO PELVIS W/O & W/DYE 610 72198 cpt 4410671 local both 1260.75 882.53 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, PELVIS, W/O CONTRAST" 610 72195 cpt 4400478 local both 2276 1593.2 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, CHEST" 610 71550 cpt 4400457 local both 2276 1593.2 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI LOWER EXTREM JT, W/O CONT*" 610 73721 cpt 4400443 local both 2580 1806 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, JOINT UPPER EXTREM" 610 73221 cpt 4400467 local both 2580 1806 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, UPPER EXTREM" 610 73218 cpt 4400480 local both 2580 1806 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, ABDOMEN (MRI)" 610 74181 cpt 4400451 local both 2592 1814.4 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, LOWER EXTREM" 610 73718 cpt 4400471 local both 2632 1842.4 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG UNLISTED MR PROCEDURE 610 76498 cpt 4400647 local both 2867.24 2007.07 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, JOINT UPPER EXTREM W/CON*" 610 73222 cpt 4400469 local both 2888 2021.6 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, JOINT OF LEG W/CONTRAST" 610 73722 cpt 4400465 local both 2897 2027.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, CHEST, COMBO" 610 71552 cpt 4400458 local both 2981 2086.7 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, ABDOMEN, COMBO" 610 74183 cpt 4400452 local both 3041 2128.7 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, PELVIS, COMBO" 610 72197 cpt 4400477 local both 3041 2128.7 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, JOINT OF LEG. COMBO" 610 73723 cpt 4400466 local both 3447 2412.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, JOINT UPPER EXTREM COMBO" 610 73223 cpt 4400468 local both 3447 2412.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI UPPER EXTR, W/CONTRAST" 610 73220 cpt 4400445 local both 3447 2412.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG MR ANGIO LOWER EXTREM (MRA)W/O CONT 610 C8912 HCPCS 4400883 local both 3495 2446.5 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, UPPER EXTREM W/CONTRAST" 610 73219 cpt 4400481 local both 3495 2446.5 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG MRI CHEST WITH CONTRAST 610 71551 cpt 4400900 local both 3495 2446.5 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG MR ANGIO UPPER EXTREMITY W/CONT 610 73225 cpt 4400422 local both 3496.91 2447.84 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, LOWER EXTREM W/CONTRAST" 610 73719 cpt 4400472 local both 3576.26 2503.38 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, PELVIS W/CONTRAST" 610 72196 cpt 4400476 local both 3750 2625 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, LOWER EXTR, W/O CONTRAST*" 610 73720 cpt 4400470 local both 3814 2669.8 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRA W/O CONT, ABD" 610 C8901 HCPCS 4400430 local both 3975 2782.5 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 1085 1085
"HCHG MRA W/O FOL W/CONT, LWR EXT" 610 C8914 HCPCS 4400436 local both 3980 2786 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 1085 1085
"HCHG MRI W/CONT, BREAST, BI" 610 C8906 HCPCS 4400446 local both 4744.08 3320.86 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 1085 1085
"HCHG MRI, BONE MARROW" 610 77084 cpt 4400453 local both 5048.34 3533.84 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG CARDIAC MRI W/W/O CONTRAST & * 610 75561 cpt 4400108 local both 5048.34 3533.84 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG CARDIAC MRI MORPHOLOGY & FUNC* 610 75557 cpt 4400107 local both 5048.34 3533.84 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG MRI BRAIN 611 70551 cpt 4400438 local both 2244 1570.8 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG MRI BRAIN CONTRAST 611 70552 cpt 4400440 local both 2500 1750 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MR ANGIO, HEAD" 611 70544 cpt 4400423 local both 2591 1813.7 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCHG MRI BRAIN COMBO 611 70553 cpt 4400439 local both 3041 2128.7 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, FACE, NECK" 611 70540 cpt 4400462 local both 3468 2427.6 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, FACE, NECK, COMBO" 611 70543 cpt 4400464 local both 3713 2599.1 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MR ANGIO, HEAD W/CONTRAST" 611 70545 cpt 4400424 local both 3750 2625 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MR ANGIO, HEAD, COMBO" 611 70546 cpt 4400425 local both 3975 2782.5 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, TMJ" 611 70336 cpt 4400479 local both 4394.95 3076.47 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, LUMBAR SPINE" 612 72148 cpt 4400473 local both 2233 1563.1 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, CERV SPINE" 612 72141 cpt 4400454 local both 2233 1563.1 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, LUMBAR SPINE CONTRAST" 612 72149 cpt 4400475 local both 3000 2100 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, DORSAL SPINE" 612 72146 cpt 4400459 local both 3070 2149 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, LUMBAR SPINE COMBO" 612 72158 cpt 4400474 local both 3447 2412.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, DORSAL SPINE COMBO" 612 72157 cpt 4400460 local both 3447 2412.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, CERV SPINE COMBO" 612 72156 cpt 4400455 local both 3447 2412.9 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, DORSAL SPINE CONTRAST" 612 72147 cpt 4400461 local both 3750 2625 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MRI, CERV SPINE CONTRAST" 612 72142 cpt 4400456 local both 3750 2625 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MR ANGIO, NECK" 615 70547 cpt 4400426 local both 2754 1927.8 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MR ANGIO, NECK W/CONTRAST" 615 70548 cpt 4400921 local both 3264 2284.8 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
"HCHG MR ANGIO, NECK, COMBO" 615 70549 cpt 4400428 local both 3774 2641.8 87 percent of total billed charges 24 percent of total billed charges 1085 case rate 922 case rate 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 86 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 922 1085
HCR DRSG TELFA NON-ADH 3X4 623 A6219 HCPCS 6650189 local both 7 4.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCR DRSG INTRASITE GEL 623 A6248 HCPCS 6650225 local both 10 7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCB PURICOL PLUS 2X2 10/BX -222240X 623 A6021 HCPCS 6650159 local both 24 16.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCR DSRG MEDIHONEY 2X2 623 A6234 HCPCS 6650214 local both 33.41 23.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCR DRSG HYDROFERA BLUE TUNNELING FOAM 623 A6209 HCPCS 6651012 local both 56 39.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCR DRSG MEDIHONEY HCS 4.3 X 4.3 623 A6235 HCPCS 6650216 local both 84 58.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCR DRSG UNNABOOT - VISCOPASTE 623 A6456 HCPCS 6650281 local both 115 80.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NON-IONIC CONTRAST 350-399MG/ML PER ML 636 Q9967 HCPCS 4410256 local both 2.56 1.79 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NON-IONIC CONTRAST 300-349MG/ML PER ML 636 Q9967 HCPCS 4410255 local both 2.56 1.79 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NON-IONIC CONTRAST 150-199MG/ML PER ML 636 Q9965 HCPCS 4410254 local both 5.27 3.69 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NON-IONIC CONTRAST 200-299MG/ML PER ML 636 Q9963 HCPCS 4410133 local both 30.68 21.48 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1460 636 Q4160 HCPCS 303223 local both 70.86 49.6 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG FLU VACCINE QUAD (SPLIT VIRUS PF) 636 90686 cpt 305514 local both 144.75 101.33 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG COVID-19 MRNA-LNP SPIKE PROT 10 MCG/0.2ML DOSE 636 91319 cpt 361070 local both 175.56 122.89 100 fee schedule 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG APLIGRAF-COM 636 Q4101 HCPCS 303215 local both 210.45 147.32 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG DERMAGRAF 636 Q4106 HCPCS 303216 local both 224.56 157.19 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG TDAP VACCINE(AGE>=7) 636 90715 cpt 307090 local both 280 196 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG FLUZONE HD VACCINE (SPLIT VIRUS PF) 636 90662 cpt 305513 local both 326.5 228.55 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1660 636 Q4160 HCPCS 303224 local both 502.32 351.62 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PNEUMOCOCCAL VACCINE VALENT 23 636 90732 cpt 304806 local both 640.75 448.53 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1440 636 Q4160 HCPCS 303222 local both 646.81 452.77 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1330 636 Q4160 HCPCS 303220 local both 766.59 536.61 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1230 636 Q4160 HCPCS 303218 local both 766.87 536.81 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PCV20 VACCINE INTRAMUSCULAR USE 636 90677 cpt 357503 local both 810.92 567.64 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1340 636 Q4160 HCPCS 303221 local both 832.16 582.51 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1240 636 Q4160 HCPCS 303219 local both 862.42 603.69 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLY XT 5X5 (25 UNITS) 636 Q4197 HCPCS 303232 local both 868.16 607.71 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PNEUMOCOCCAL CONJUGATE VALENT 13 636 90670 cpt 304802 local both 1106.25 774.38 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG NUSHIELD NO-1160C 636 Q4160 HCPCS 303217 local both 1143.08 800.16 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 1.6 DISC 636 Q4196 HCPCS 303225 local both 1748.1 1223.67 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 8X16 636 Q4196 HCPCS 303230 local both 2821.23 1974.86 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 2X2 (4 UNITS) 636 Q4196 HCPCS 303226 local both 2913.5 2039.45 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 3X4 (12 UNITS) 636 Q4196 HCPCS 303252 local both 3496.15 2447.31 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 2X4 (8 UNITS) 636 Q4196 HCPCS 303227 local both 3496.19 2447.33 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIFIX 2X2 636 Q4186 HCPCS 503442 local both 3529.44 2470.61 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPICORD 1X2 (EC-5120) 2 UNITS 636 Q4187 HCPCS 503855 local both 3671 2569.7 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG APLIGRAF-COM (44 UNITS) 636 Q4101 HCPCS 504002 local both 4025.07 2817.55 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG AFFINITY 1.5 X1.5 (3 UNITS) 636 Q4159 HCPCS 303255 local both 4261.84 2983.29 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPICORD 2X3 CM 636 Q4187 HCPCS 503439 local both 4293.41 3005.39 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIFIX 2X4 CM 8 UNITS 636 Q4186 HCPCS 503852 local both 4476.51 3133.56 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIFIX MESH 4X4.5CM 11 UNITS 636 Q4186 HCPCS 503851 local both 4623.31 3236.32 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 4X4 636 Q4196 HCPCS 303253 local both 5455.16 3818.61 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG AFFINITY 2.5 X 2.5 (7 UNITS) 636 Q4159 HCPCS 303235 local both 6629.53 4640.67 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIEFFECT 2X3 (LE-5230) 636 Q4278 HCPCS 504029 local both 7103.07 4972.15 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 5X5 (25 UNITS) 636 Q4196 HCPCS 303228 local both 7260.92 5082.64 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPICORD 3X5 (EC-5350) 15 UNITS 636 Q4187 HCPCS 503856 local both 10640.4 7448.28 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLY XT 4.91 X 4.91 (25 UNITS) 636 Q4197 HCPCS 303254 local both 10733.53 7513.47 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLY XT 6X9 (54 UNITS) 636 Q4197 HCPCS 303233 local both 17558.79 12291.15 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PURAPLYAM-COM 6X9 636 Q4196 HCPCS 303229 local both 17558.79 12291.15 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIEFFECT 3X5 (LE-5350) 636 Q4278 HCPCS 504030 local both 17757.68 12430.38 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIEFFECT 7X7 (LE-5770) 636 Q4278 HCPCS 504031 local both 58008.41 40605.89 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG EPIEFFECT 7X14 (LE-5714) 636 Q4278 HCPCS 357719 local both 116016.81 81211.77 87 percent of total billed charges 24 percent of total billed charges 48 percent of total billed charges if billed charges are more than $3245 45 percent of total billed charges if billed charges are more than $3245 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 67 percent of total billed charges 81 percent of total billed charges 68 percent of total billed charges 24 percent of total billed charges 80 percent of total billed charges when medical centers charges exceed $1500 in aggregate for a single revenue code (paid in addition to all other negotiated rates) 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges for inpatient charge must be greater than 1000 24 percent of total billed charges
HCHG PACU - EA ADDL 15 MINS PHASE II 710 710 RC 160049 local both 86 60.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC RECOVERY 1/4HR FRACT 710 710 RC 5260005 local both 108 75.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC GI POST OP CARE <6HR 710 710 RC 5400191 local both 567.12 396.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC POST OP CARE 3 TO 4 HOURS 710 710 RC 5260006 local both 598.5 418.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC POST OP CARE 1 TO 2 HOURS 710 710 RC 5260009 local both 700 490 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PACU - 1ST 60 MINS PHASE II 710 710 RC 160046 local both 713 499.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG POST OP CARE 1ST HOUR 710 710 RC 5260008 local both 713 499.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PHASE II (EXTENDED) RECOVERY 710 710 RC 310091 local both 950 665 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION 730 93248 cpt 504015 local both 96.75 67.73 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XTRNL PT ACTIVTD ECG DWNLD W/R&I 30 DAYS 730 93272 cpt 504013 local both 111.75 78.23 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG HOLTER MONITOR UP TO 48 HRS 730 93227 cpt 504014 local both 116.25 81.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS 730 93228 cpt 504012 local both 131.25 91.88 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC RHYTHM ECG 93041 730 93041 cpt 330915 local both 160 112 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ER EKG 730 93005 cpt 303630 local both 340 238 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ELECTROCARDIOGRAM 730 93005 cpt 303560 local both 347 242.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC UNLISTED CARDIO SERVICES 730 93799 cpt 307911 local both 966.83 676.78 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXTERNAL ECG>7D<15D RECORDING ONLY 731 93246 cpt 357524 local both 297.75 208.43 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH ECG MONIT/REPRT UP TO 48 HRS 731 93225 cpt 343141 local both 428 299.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ECG MONITOR/REPORT UP TO 48 HRS 731 93225 cpt 330959 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EEG AWAKE 740 95816 cpt 303523 local both 479 335.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SLP STDY UNATTENDED W/HRT RATE/O2 SAT/RESP/SLP TIME 740 95800 cpt 305070 local both 679.5 475.65 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EEG AWAKE AND ASLEEP 740 95819 cpt 303522 local both 757 529.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EEG SLEEP OR COMA 740 95822 cpt 303528 local both 809 566.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EEG EXTENDED MONITORING 41-60 MIN 740 95812 cpt 303525 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EEG CEREBRAL DEATH EVAL 740 95824 cpt 303524 local both 819 573.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ELECTRODE STIM, BRAIN ADD-ON" 740 95962 cpt 5200179 local both 847.92 593.54 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EEG EXTENDED MONITORING 61-119 MIN 740 95813 cpt 303526 local both 1054 737.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ELECTRODE STIMULATION,BRAIN" 740 95961 cpt 5200178 local both 1128.01 789.61 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC EEG DURING SURGERY 740 95955 cpt 5200177 local both 1190.73 833.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SLEEP STUDY UNATT & RESP EFFT 740 95806 cpt 309168 local both 1224 856.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC POLYSOMNOGRAPHY, 4 OR MORE" 740 95810 cpt 309085 local both 4080 2856 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC MSLT 740 95805 cpt 309084 local both 4080 2856 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG POLYSOMNOGRAPHY <6 YRS SLEEP STAGING 4> 740 95782 cpt 309169 local both 5200 3640 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG POLYSOM <6 YRS SLEEP STAGING 4> W/CPAP/BILVL 740 95783 cpt 309170 local both 5400 3780 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC POLYSOMNOGRAPHY/CPAP 740 95811 cpt 309086 local both 5610 3927 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLONOSCOPY W/ABLATION 750 45388 cpt 342757 local both 1351.09 945.76 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLORECTAL CANCER SCN-FLEX SIG 750 G0104 HCPCS 111560 local both 2046 1432.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLORECTAL CANCER SCN-COLON HR 750 G0105 HCPCS 111570 local both 2430 1701 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SIGMOIDOSCOPY W/BALLOON DILATION 750 45340 cpt 111330 local both 2698.57 1889 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CANCER SCN-COLONOSCOPY-NON HR 750 G0121 HCPCS 111580 local both 2948 2063.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMALL BOWEL ENDOSCOPY BRUSH/WASH 750 44360 cpt 111010 local both 2955.8 2069.06 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLONOSCOPY W/ABLATION 2 OR 3 750 45388 cpt 342758 local both 3299.37 2309.56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COLONOSCOPY FLX W/RMVL TUMOR W/FRCP 750 45384 cpt 302313 local both 3315 2320.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMALL BOWEL ENDOSCOPY J TUBE PLACE 750 44372 cpt 110356 local both 3559.95 2491.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SIGMOIDOSCOPY W/FB REMOVAL 750 45332 cpt 111260 local both 3809.25 2666.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG TRIM DYSTROPHIC NAILS,ANY NUM" 761 G0127 HCPCS 362277 local both 78.91 55.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG TRIM NONDYSTROPHIC NAILS,ANY NUM" 761 11719 cpt 306644 local both 99.14 69.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REM IMPACTED CERUMEN IRR/LVG UNILAT 761 69209 cpt 302260 local both 102 71.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC FLUSH (CATH CARE) 761 99211 cpt 330931 local both 153 107.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF PICC-SIMPLE 761 99211 cpt 330930 local both 153 107.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APPLICATION ON-BODY INJECTOR 761 96377 cpt 304128 local both 153 107.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IV START 761 36000 cpt 304227 local both 167.36 117.15 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BLADDER SCAN PROCEDURE 761 51798 cpt 302932 local both 173 121.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WOUND CARE W/O SHARP DEBRIDE 761 99211 cpt 330932 local both 209.9 146.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL OF CENTRAL LINE 761 99211 cpt 343277 local both 209.9 146.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC STAPLE/SUTURE REMOVAL 761 99211 cpt 330933 local both 214 149.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXTREMITY VENOGRAPHY INJECTION 761 36005 cpt 4400378 local both 214.84 150.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH IN VEIN 2ND & HIGHER BRANCH 761 36012 cpt 4400545 local both 214.92 150.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH IN VEIN 1ST ORDER BRANCH 761 36011 cpt 4400544 local both 214.92 150.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJECT DISCOGRAM,LUMBAR,EA LEVEL" 761 62290 cpt 4400359 local both 236.91 165.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CATH/INJECT HYSTEROSALPINGOGRAM 761 58340 cpt 4400206 local both 236.91 165.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECT FOR RETROGRADE URETHOCYSTO 761 51610 cpt 4400360 local both 236.91 165.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION FOR BLADDER X-RAY 761 51600 cpt 4400370 local both 236.91 165.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECT SINUS TRACT FOR DX W XRAY 761 20501 cpt 4400364 local both 236.91 165.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DEBRIDE NAIL,ANY METHOD 6/MORE" 761 11721 cpt 306646 local both 238.69 167.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DEBRIDE NAIL,ANY METHOD 1 TO 5" 761 11720 cpt 306645 local both 242.07 169.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FUNDAL PHOTOGRAPHY 761 92250 cpt 302268 local both 255 178.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WOUND/ S CARE NON-SELECTIVE 761 97602 cpt 338917 local both 275 192.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL DEVITALOZED TISSUE ADD'L 20 CM /< 761 97598 cpt 338916 local both 282 197.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DEBRIDE INFECTED SKIN ADD-ON 761 11001 cpt 338919 local both 293.6 205.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL IMPACTED CERUMEN INSTR UNILAT 761 69210 cpt 304214 local both 296 207.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDEMENT NON-SELECTIVE RN 761 97602 cpt 303339 local both 299.27 209.49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE 761 49465 cpt 4400114 local both 306.24 214.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CAUTERIZATION CHEM TISSUE GRAN 761 17250 cpt 303124 local both 324.26 226.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION FOR ELBOW ARTHROGRAM 761 24220 cpt 4400371 local both 342.12 239.48 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC WOUND CARE W/O DEBRIDEMENT 761 99211 cpt 330961 local both 391.53 274.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NEG PRESS WND TX <50 CM DME 761 97605 cpt 338913 local both 398 278.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NEG PRESS WND TX >50 CM DME 761 97606 cpt 338914 local both 430 301 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC APPLY MULTILAYER COMPRESSION SYSTEM LOWER LEG 761 29581 cpt 338923 local both 432 302.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC APPLICATION OF PASTE BOOT 761 29580 cpt 338924 local both 433 303.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESS/DEBRIDE MEDIUM 761 16025 cpt 303482 local both 433.84 303.69 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-SMP-FEENL <2.5 CM 761 12011 cpt 305001 local both 439 307.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PUNCH BIOPSY OF SKIN SINGLE LESION 761 11104 cpt 503429 local both 442 309.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TANGENTIAL SKIN BX SINGLE LESION 761 11102 cpt 503427 local both 442 309.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-SMP-SNAGTE 2.6-7.5 CM 761 12002 cpt 305005 local both 459 321.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-SMP-SNAGTE <2.5 CM 761 12001 cpt 305004 local both 459 321.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-SMP-FEENL 2.6-5.0 CM 761 12013 cpt 305002 local both 469 328.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TX BURN 1ST DEGREE INITIAL 761 16000 cpt 305586 local both 480 336 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC REMOVAL DEVITALIZED TISSUE 20 CM /< 761 97597 cpt 338915 local both 495 346.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESS/DEBRIDE-SMALL 761 16020 cpt 303483 local both 520 364 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION FOR WRIST ARTHROGRAM 761 25246 cpt 4400375 local both 540 378 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION FOR ANKLE ARTHROGRAM 761 27648 cpt 4400369 local both 544.14 380.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE-SELECTIVE FIRST 20 CM RN 761 97597 cpt 303342 local both 550 385 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VESSEL INJECTION PROCEDURE UNLISTED 761 36299 cpt 4400884 local both 559.76 391.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH EA ADDL 2ND+ ORDER BELOW DIAPHRAGM 761 36248 cpt 4400536 local both 559.76 391.83 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG I&D BARTHOLIN GLAND ABSCESS 761 56420 cpt 303980 local both 592 414.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION FOR SALIVARY X-RAY 761 42550 cpt 4400373 local both 610.73 427.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJECTION,THERAPEUTIC CARPAL T" 761 20526 cpt 304120 local both 623.85 436.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG AVULSION OF NAIL PLATE ADD-ON 761 11732 cpt 308401 local both 625.84 438.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ CONTRAST KNEE RAD CT MRI ARTHO 761 27369 cpt 503452 local both 630 441 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAIN SKIN ABSCESS SIMPLE 761 10060 cpt 4400287 local both 631 441.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG I&D ABSCESS, SIMPLE OR SINGLE" 761 10060 cpt 303978 local both 632 442.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APPLY MULTILAYER COMPRESSION SYSTEM LOWER LEG BILATERAL 761 29581 cpt 306656 local both 648 453.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CONTRAST INJ CENT VEN CATH, INC FLOURO" 761 36598 cpt 4400224 local both 683 478.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W MRI EA ADD LESION 761 10012 cpt 4410581 local both 725 507.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W CT GUIDE EA ADD LESION 761 10010 cpt 4410579 local both 725 507.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W FLUORO EA ADD LESION 761 10008 cpt 4410577 local both 725 507.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECTION HIP ARTHROGRAM 761 27093 cpt 4400376 local both 734 513.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W US GUIDE EA ADD LESION 761 10006 cpt 4410575 local both 745 521.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DX BONE MARROW ASPIRATIONS 761 38220 cpt 4400926 local both 750 525 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEG PRESS WND THERAPY >50CM RN DISP 761 97608 cpt 304442 local both 783 548.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MIDLINE NON-ROUTINE BL DRAW > AGE 3 761 36410 cpt 362178 local both 783 548.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ SOFT TISSUE DEV PLACE ADDL GUIDE 761 10036 cpt 360934 local both 800 560 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-SMP-FEENL 5.1-7.5 CM 761 12014 cpt 305003 local both 806 564.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRACHEOTOMY TUBE CHANGE 761 31502 cpt 305533 local both 808.7 566.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES GREATER OCCIPITAL NERVE 761 64405 cpt 304114 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENDOTRACHEAL INTUBATION 761 31500 cpt 303606 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-INTERMED JT/BURSA W/O US GUIDE 761 20605 cpt 304104 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) TRIGGER PT(S) 3/MORE MS 761 20553 cpt 304099 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) SNGL TENDON SHEATH/LIGAMNT 761 20550 cpt 304139 local both 816 571.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEEDLE BIOPSY PLEURA 761 32400 cpt 4400493 local both 843.37 590.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI 761 23350 cpt 4400350 local both 847 592.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APPLICATION OF PASTE BOOT BILATERAL 761 29580 cpt 306732 local both 856 599.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DX BONE MARROW BIOPSIES 761 38221 cpt 4400192 local both 857 599.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ PERQ CHOLANGIO EXIST W RAD/GDE 761 47531 cpt 360855 local both 879.28 615.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA WITH US GUIDE 761 20611 cpt 304692 local both 898 628.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-SMALL JT/BURSA WITH US GUIDE 761 20604 cpt 4400760 local both 931.6 652.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-SMALL JT/BURSA W/O US GUIDE 761 20600 cpt 4400291 local both 931.6 652.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-INTERMED JT/BURSA W/O US GUIDE 761 20605 cpt 4400289 local both 955.26 668.68 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA WO GUIDE 1ST LESION 761 10021 cpt 303462 local both 990 693 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DECLOTTING OF VASCULAR DEVICE 761 36593 cpt 303344 local both 1000 700 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH AORTA 761 36200 cpt 4400538 local both 1026.41 718.49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJECT,MYELOGRAPHY &/OR CT SCAN,SPINAL" 761 62284 cpt 4400368 local both 1051 735.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEG PRESS WND THERAPY <50CM RN DISP 761 97607 cpt 304441 local both 1060 742 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRESS/DEBRIDE LARGE 761 16030 cpt 303481 local both 1060 742 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BONE BIOPSY,TROCAR/NEEDLE SUPERF" 761 20220 cpt 4400186 local both 1061 742.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT TAL<100CM ADD25 761 15272 cpt 306806 local both 1081 756.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES INTERCOSTAL NERVE SINGLE 761 64420 cpt 304169 local both 1102 771.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-INT-SATE 2.6-7.5 CM 761 12032 cpt 304998 local both 1119 783.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPAIR-INT-SATE <2.5 CM 761 12031 cpt 304997 local both 1119 783.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG AMNIOCENTESIS,DIAGNOSTIC" 761 59000 cpt 4400127 local both 1167.08 816.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG NEEDLE BIOPSY,MUSCLE" 761 20206 cpt 4400495 local both 1173 821.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJECT CORPORA CAVERN,PHARM AGNT" 761 54235 cpt 4400358 local both 1190 833 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ SOFT TISSUE DEV PLACE 1ST GUIDE 761 10035 cpt 360933 local both 1201.6 841.12 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BIL CATH REMOVAL REQ FLUORO GDE 761 47537 cpt 360861 local both 1207.08 844.96 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA W/O US GUIDE 761 20610 cpt 4400290 local both 1227 858.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-LARGE JT/BURSA W/O US GUIDE 761 20610 cpt 310125 local both 1227 858.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH IN RT OR LT PULM ART 761 36014 cpt 4400541 local both 1243.55 870.49 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG I&D ABSCESS,COMPLICATED/MULT." 761 10061 cpt 303979 local both 1244 870.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TUBE THORACOSTOMY INCLUDES WATER SEAL 761 32551 cpt 4400637 local both 1280 896 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INTRO NEEDLE CATH UE/LE ARTERY 761 36140 cpt 4400540 local both 1296.38 907.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJECT FOR SACROILIAC JOINT 761 27096 cpt 4400361 local both 1310 917 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCHANGE PERQ NEPH CATH W RAD/GDE 761 50435 cpt 360912 local both 1311.2 917.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CONV PERQ NEPH-URET CATH W RAD/GDE 761 50434 cpt 360911 local both 1311.2 917.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ THRU KIDNEY TUBE EXIST W RGDE 761 50431 cpt 360922 local both 1311.2 917.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ THRU KIDNEY TUBE NEW W RGDE 761 50430 cpt 360921 local both 1311.2 917.84 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CORE BX LUNG MEDIASTINUM W/GUIDE 761 32408 cpt 4410621 local both 1326 928.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEEP LINE INSERTION 761 36425 cpt 303347 local both 1341.34 938.94 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE 761 49460 cpt 4400811 local both 1399.47 979.63 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,EPI LUMB/SAC SINGLE W/O IG" 761 62322 cpt 305838 local both 1405.82 984.07 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES TRIGEMINAL NERVE 761 64400 cpt 304116 local both 1408 985.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG PERCUT BIOPSY, ABDOMINAL MASS" 761 49180 cpt 4400516 local both 1428 999.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W MRI 1ST LESION 761 10011 cpt 4410580 local both 1449 1014.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W CT GUIDE 1ST LESION 761 10009 cpt 4410578 local both 1449 1014.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W FLUORO 1ST LESION 761 10007 cpt 4410576 local both 1449 1014.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,EPI CERV/THOR SINGLE W/O IG" 761 62320 cpt 305836 local both 1496.44 1047.51 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT NON-TUNNEL CV CATH < 5 Y/O 761 36555 cpt 4400385 local both 1500.48 1050.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CISTERNAL/LAT (C1-C2) CERV PUNCTURE 761 61055 cpt 4400223 local both 1519.05 1063.34 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ PARA FACET L/S 2D LVL W/IG 761 64494 cpt 306528 local both 1525 1067.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE SUBQ TISSUE 20SQCM< 761 11042 cpt 307088 local both 1530 1071 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH EA 1ST ORDER BELOW DIAPHRAGM 761 36245 cpt 4400547 local both 1538.53 1076.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PICC LINE PLACE W GUIDANCE < AGE 5 761 36572 cpt 362174 local both 1551 1085.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT FNHFG>100ADD100 761 15278 cpt 306812 local both 1590.19 1113.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT FNHFG>100 1ST100 761 15277 cpt 306811 local both 1590.19 1113.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT FNHFG<100ADD25 761 15276 cpt 306810 local both 1590.19 1113.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT TAL>100 ADD100 761 15274 cpt 306808 local both 1590.19 1113.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT TAL>100 1ST100 761 15273 cpt 306807 local both 1590.19 1113.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INCISIONAL BX OF SKIN SINGLE LESION 761 11106 cpt 503431 local both 1600 1120 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH INITIAL 2ND ORDER BELOW DIAPHRAGM 761 36246 cpt 4400549 local both 1600.81 1120.57 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION BENIGN LESION TAL 0.6-1 CM 761 11401 cpt 303714 local both 1662 1163.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SPINAL PUNCTURE,DIAGNOSTIC" 761 62270 cpt 4400608 local both 1707 1194.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PICC LINE PLACE WO GUIDANCE < AGE 5 761 36568 cpt 362172 local both 1710.75 1197.53 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC ASPIRATE PLEURA W/O IMAGING 761 32554 cpt 343204 local both 1735 1214.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE MUSC/FASCIA ADD 20 SQ CM 761 11046 cpt 338920 local both 1810.72 1267.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DEBRIDE INFECTED SKIN 761 11000 cpt 338918 local both 1810.72 1267.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PICC LINE PLACE WO GUIDANCE > AGE 5 761 36569 cpt 362173 local both 1837 1285.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE SUBQ TISSUE ADD 20 SQ CM 761 11045 cpt 338921 local both 1847 1292.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE MUSC/FASCIA FIRST 20 SQ CM 761 11043 cpt 338912 local both 1847 1292.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC DEB SUBQ TISSUE 20 SQ CM /< 761 11042 cpt 338911 local both 1847 1292.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERCUT DRAIN/INJECT RENAL CYST 761 50390 cpt 4400521 local both 1858 1300.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH INITIAL 3RD+ ORDER BELOW DIAPHRAGM 761 36247 cpt 4400551 local both 1894.27 1325.99 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERCUT DRAIN SPINAL CORD CYST 761 62268 cpt 4400520 local both 1901 1330.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT CATH PLEURA W/IG 761 32557 cpt 4400928 local both 1910 1337 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PUNC/ASPIR BREAST CYST 761 19000 cpt 4400565 local both 1910 1337 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES SUPRASCAPULAR NERVE 761 64418 cpt 304140 local both 1933 1353.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SPINAL BLOOD PATCH INJECTION 761 62273 cpt 305272 local both 1933 1353.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BIOPSY OF THYROID,PERCUT" 761 60100 cpt 4400181 local both 1948 1363.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG PUCT/ASPIR BREAST CYST,EACH A*" 761 19001 cpt 4400564 local both 1948 1363.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG FNA BIOPSY W US GUIDE 1ST LESION 761 10005 cpt 4410574 local both 1948 1363.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ(S) ANES OTHER PERIPHERAL NERVE 761 64450 cpt 304111 local both 1989 1392.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,EPI LUMB/SAC SINGLE W IG" 761 62323 cpt 305839 local both 1989 1392.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,EPI CERV/THOR SINGLE W IG" 761 62321 cpt 305837 local both 1989 1392.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ/ASPIR-INTERMED JT/BURSA WITH US GUIDE 761 20606 cpt 4400882 local both 1989 1392.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION/BGN LESN TAL <.5 CM 761 11400 cpt 303737 local both 1993.41 1395.39 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH EA 1ST ORDER ABOVE DIAPHRAGM 761 36215 cpt 4400548 local both 2069.96 1448.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BONE BIOPSY,TROCAR/NEEDLE DEEP" 761 20225 cpt 4400185 local both 2152 1506.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IDENTIFY SENTINEL NODE 761 38792 cpt 4400346 local both 2173 1521.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL 761 27040 cpt 4401628 local both 2178 1524.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVC, NON TUNNELED >AGE 5" 761 36556 cpt 303332 local both 2183 1528.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVC TUNNEL WO PORT REMOVAL 761 36589 cpt 306792 local both 2219.21 1553.45 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG THORACENTESIS WITH IMAGING GUIDANCE 761 32555 cpt 4410488 local both 2220 1554 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG SPINAL PUNCTURE,LUMBAR,DIAG." 761 62270 cpt 305273 local both 2221 1554.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,FORAMEN C/T,ADDL LEVELS" 761 64480 cpt 4400354 local both 2244.36 1571.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL TUNNELED CV CATH 761 36589 cpt 4400569 local both 2264 1584.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DX BONE MARROW BIOPSIES & ASPIRATIONS 761 38222 cpt 503414 local both 2274 1591.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,FORAMEN,L/S,ADDL LEVELS" 761 64484 cpt 4400356 local both 2285 1599.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG NEEDLE BIOPSY, LYMPH NODE(S)" 761 38505 cpt 4400494 local both 2356 1649.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPOSITION VENOUS CATHETER 761 36597 cpt 4400591 local both 2425.06 1697.54 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE CATHETER EXCHANGE 761 49423 cpt 4400292 local both 2482 1737.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH IN SVC/IVC 761 36010 cpt 4400546 local both 2506.34 1754.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MECH REMOV TUNNELED CV CATH 761 36596 cpt 4400420 local both 2512.66 1758.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BIOPSY OF KIDNEY,PERCUTANEOUS" 761 50200 cpt 4400179 local both 2513 1759.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,FORAMEN,L/S,1 LEVEL" 761 64483 cpt 4400355 local both 2570 1799 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG PARACENTESIS,ABD W/O IMAGING" 761 49082 cpt 306826 local both 2570 1799 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LUMBAR SYMP BLOCK 761 64520 cpt 304343 local both 2599 1819.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC CHANGE OF BLADDER TUBE 761 51710 cpt 308938 local both 2640.63 1848.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG EXCISION-NAIL & MATRIX 761 11750 cpt 303738 local both 2642 1849.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMAGE CATH FLUID COLXN VISC 761 49405 cpt 4410550 local both 2646 1852.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH INITIAL 2ND ORDER ABOVE DIAPHRAGM 761 36216 cpt 4400550 local both 2674.42 1872.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE BONE ADD 20 SQ CM 761 11047 cpt 338922 local both 2687.72 1881.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS 761 49451 cpt 4400584 local both 2742 1919.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DEBRIDE BONE FIRST 20 SQ CM 761 11044 cpt 338910 local both 2743 1920.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEEDLE BIOPSY LIVER 761 47000 cpt 4400490 local both 2785 1949.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INJ,FORAMEN C/T,1 LEVEL" 761 64479 cpt 4400353 local both 2798 1958.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PICC LINE PLACE W GUIDANCE > AGE 5 761 36573 cpt 362175 local both 2876 2013.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVAL TUNNELED CV CATH 761 36590 cpt 4400570 local both 2948 2063.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BALLOON DILAT URET W RAD/GDE 761 50706 cpt 360936 local both 3000 2100 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG URETERAL EMB/OCCL W RAD/GDE 761 50705 cpt 360935 local both 3000 2100 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENDOLUMINAL BX PELVIS W RAD/GDE 761 50606 cpt 360913 local both 3000 2100 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DRAINAGE OF HEMATOMA/FLUID 761 10140 cpt 4400294 local both 3015 2110.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT NON-TUNNEL CV CATH 761 36556 cpt 4400384 local both 3060 2142 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PLACE CATH INITIAL 3RD+ ORDER ABOVE DIAPHRAGM 761 36217 cpt 4400552 local both 3105.9 2174.13 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEEDLE BIOPSY OF PANCREAS 761 48102 cpt 4400492 local both 3127.15 2189.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG NEPHROURETERAL STENT CHANGE W/ FLUORO 761 50387 cpt 4400207 local both 3371.58 2360.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REM BIL CALCULI/DEBRIS W RAD/GDE 761 47544 cpt 360868 local both 3500 2450 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENDOLUML BX(S) BIL TREE W RAD/GDE 761 47543 cpt 360867 local both 3500 2450 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ DILATION BIL DUCT W RAD/GDE 761 47542 cpt 360866 local both 3500 2450 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG PARACENTESIS, ABD WITH IMAGING" 761 49083 cpt 4400855 local both 3638 2546.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BIOPSY SOFT TISSUE PELVIS&HIP AREA DEEP/SUBFSCAL 761 27041 cpt 4401629 local both 3641 2548.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ URET CATH NEW ACCESS W RAD/GDE 761 50433 cpt 360910 local both 3766.05 2636.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ NEPH CATH NEW ACCESS W RAD/GDE 761 50432 cpt 360909 local both 3766.05 2636.24 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RENAL SUPERSELECTIVE UNILATERAL W/WO AORTA 761 36253 cpt 4400860 local both 3863.31 2704.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RENAL SELECTIVE UNILATERAL W/WO AORTA 761 36251 cpt 4400858 local both 3863.31 2704.32 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMAGE CATH FLUID PERI/RETRO 761 49406 cpt 4410551 local both 3999.04 2799.33 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TENOTOMY ELBOW LATERAL OR MEDIAL 761 24357 cpt 362266 local both 4092.75 2864.93 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TUNNELED CV CATH W/O PORT OR PUMP 761 36558 cpt 4400809 local both 4093.26 2865.28 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER 761 51102 cpt 4400102 local both 4105.72 2874 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BIOPSY SOFT TISSUE NECK/CHEST 761 21550 cpt 4400183 local both 4313 3019.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TUNNELED CV CATH <5 Y/O 761 36557 cpt 4400394 local both 4566 3196.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RENAL SUPERSELECTIVE BILATERAL W/WO AORTA 761 36254 cpt 4400861 local both 4829.16 3380.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RENAL SELECTIVE BILATERAL W/WO AORTA 761 36252 cpt 4400859 local both 4829.16 3380.41 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMAGE CATH FLUID TRNS/VGNL 761 49407 cpt 4410552 local both 4910.5 3437.35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MECH REMOV TUNNELED CV CATH 761 36595 cpt 4400419 local both 4916.94 3441.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERCUT PORTAL VEIN CATH 761 36481 cpt 4400528 local both 4918.7 3443.09 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG NEEDLE BIOPSY LIVER,W OTHR PROC" 761 47001 cpt 4400491 local both 4978 3484.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS 761 49441 cpt 4400807 local both 5012.05 3508.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE PICC WO SUBQ PORT W IMAGING 761 36584 cpt 304792 local both 5022.97 3516.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE PICC WO SUBQ PORT W IMAGING 761 36584 cpt 4400587 local both 5022.97 3516.08 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CHOLECYSTOSTOMY,PERCUT" 761 47490 cpt 4400221 local both 5261.4 3682.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REMOVE PERM CANNULA/CATHETER 761 49422 cpt 4400572 local both 5338.31 3736.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT FNHFG<100 1ST25 761 15275 cpt 306809 local both 5355 3748.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG APP SKN GRAFT TAL<100CM 1ST25 761 15271 cpt 306805 local both 5366 3756.2 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ACCESS BIL TREE TO SB NEW W R/GDE 761 47541 cpt 360865 local both 5442.78 3809.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BIL CATH EX/ CV TO EXT W RAD/GDE 761 47536 cpt 360860 local both 5442.78 3809.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BILIARY EXT CATH CONV INT-EXT RS&I 761 47535 cpt 360859 local both 5442.78 3809.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ BIL CATH PLACE INT-EXT W R/GDE 761 47534 cpt 360858 local both 5442.78 3809.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ BIL CATH PLACE EXT W RAD/GDE 761 47533 cpt 360857 local both 5442.78 3809.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INJ PERQ CHOLANGIO NEW W RAD/GDE 761 47532 cpt 360856 local both 5442.78 3809.95 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ URTRL STENT NEW W CATH W RGDE 761 50695 cpt 360916 local both 5608.73 3926.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ URTRL STENT NEW WO CATH W RGDE 761 50694 cpt 360915 local both 5608.73 3926.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ URTRL STENT EXIST W RAD/GDE 761 50693 cpt 360914 local both 5608.73 3926.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG PLACEMENT, BILE DUCT STENT" 761 47801 cpt 4400558 local both 6075.45 4252.82 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RF ABLATE LIVER TUMOR(S) PERQ 761 47382 cpt 4400121 local both 6115.36 4280.75 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSVENOUS TEMP PACER SNGL CH 761 33210 cpt 305560 local both 6202 4341.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TUNNELED CV CATH 761 36563 cpt 4400890 local both 6275.94 4393.16 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERTION INDWELLING TUNNELED PLEURAL CATHETER 761 32550 cpt 4400810 local both 6295 4406.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE TUNNELED CVC WO SUBQ PORT 761 36581 cpt 4400585 local both 6297.88 4408.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE NONTUNNELED CVC WO SUBQ PORT 761 36580 cpt 4400818 local both 6297.88 4408.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE PICC W SUBQ PORT 761 36585 cpt 4400588 local both 6424 4496.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VERTEBROPLASTY ADDL INJECT 761 22512 cpt 342762 local both 6700 4690 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ LUMBOSACRAL INJECTION 761 22511 cpt 372761 local both 6700 4690 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ CERIVICOTHORACIC INJECT 761 22510 cpt 342760 local both 6700 4690 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TUNNELED CV CATH WITH PORT <5 Y/O 761 36560 cpt 4400395 local both 6820.15 4774.11 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TRANSCATHETER BIOPSY 761 37200 cpt 4400631 local both 6823.53 4776.47 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TUNNELED CV CATH 761 36571 cpt 4400393 local both 7140 4998 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT GASTROSTOMY TUBE PERCUTANEOUS 761 49440 cpt 4400808 local both 7217.34 5052.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASC EMBOLIZE/OCCLUDE BLEED 761 37244 cpt 4410548 local both 7259.4 5081.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASC EMBOLIZE/OCCLUDE ORGAN 761 37243 cpt 4410547 local both 7259.4 5081.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASC EMBOLIZE/OCCLUDE ARTERY 761 37242 cpt 4410546 local both 7259.4 5081.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VASC EMBOLIZE/OCCLUDE VENOUS 761 37241 cpt 4410545 local both 7259.4 5081.58 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG INSERT ABDOM DRAIN/CATH,PERMAN" 761 49421 cpt 4400383 local both 7265 5085.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT VENA CAVA FILTER SVC/IVC 761 37191 cpt 4400863 local both 7500 5250 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TUNNELED CV CATH 761 36561 cpt 4400391 local both 7650 5355 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ VERTEBRAL AUG EACH ADDL 761 22515 cpt 342765 local both 9000 6300 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ENDOVENOUS LASER VEIN ADDON 761 36479 cpt 4400889 local both 9205.73 6444.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG ENDOVENOUS LASER, 1ST VEIN" 761 36478 cpt 4400888 local both 9205.73 6444.01 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ BIL STENT PLACE EXIST W CATH 761 47540 cpt 360864 local both 10295.58 7206.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ BIL STENT PLACE EXIST WO CATH 761 47539 cpt 360863 local both 10295.58 7206.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ BIL STENT PLACE EXIST W R/GDE 761 47538 cpt 360862 local both 10295.58 7206.91 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG REPLACE TUNNELED CVC W SUBQ PORT 761 36582 cpt 4400586 local both 10546.25 7382.38 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENOUS STENT OPEN PERQ EA ADDL 761 37239 cpt 4410544 local both 10821.02 7574.71 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTERIAL STENT OPEN PERQ EA ADDL 761 37237 cpt 4410541 local both 10821.02 7574.71 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ANGIO FEMORAL/POPLITEAL ARTERY UNILATERAL 761 37224 cpt 4400835 local both 13230.63 9261.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT PICC W/ SUB-Q PORT <5 Y/O 761 36570 cpt 4400388 local both 14400 10080 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ VERTEBRAL AUGMENT LUMBAR 761 22514 cpt 342764 local both 15198 10638.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TIPS REVISION W IMAGING 761 37183 cpt 4400595 local both 16366.74 11456.72 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PERQ VERTEBRAL AUGMENT THORACIC 761 22513 cpt 342763 local both 19757 13829.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG RF ABLATE RENAL TUMOR(S) PERQ 761 50592 cpt 4400512 local both 20991.05 14693.74 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG VENOUS STENT OPEN PERQ INITIAL 761 37238 cpt 4410542 local both 21642.05 15149.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTERIAL STENT OPEN PERQ INITIAL 761 37236 cpt 4410539 local both 21642.05 15149.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INSERT TRANSVEN INTRAHEP PORTOSYS SHUNT 761 37182 cpt 4400390 local both 25395.69 17776.98 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ROOM/CARE - OBSERVATION HOUR * 762 G0378 HCPCS 770025 local both 121 84.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 7000 85 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 73 percent of total billed charges 81 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DIRECT ADMIT HOSPITAL OBSERV 762 G0379 HCPCS 309191 local both 297.36 208.15 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 7000 85 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 73 percent of total billed charges 81 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ROOM/CARE - OBS 1ST HR 762 G0378 HCPCS 770026 local both 313 219.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 7000 85 percent of total billed charges not to exceed 5600 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 73 percent of total billed charges 81 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PAP SMEAR OBTAIN/PREP 770 Q0091 HCPCS 306479 local both 82 57.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PNEUMOCOCCAL ADMINISTRATION 771 90471 cpt 304805 local both 51 35.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COVID SARS-COV-2 ADMINISTRATION SINGLE DOSE IM 771 90480 cpt 361073 local both 80 56 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG BMH/CVMC IMMUNIZATION ADMIN, EACH ADD" 771 90472 cpt 309027 local both 82 57.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG INFLUENZA ADMINISTRATION 771 90471 cpt 304081 local both 122 85.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IMMUNIZATION ADMINISTRATION 771 90471 cpt 306375 local both 122 85.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COVID-19 VACCINE 50 MCG 771 91322 cpt 361076 local both 291.84 204.29 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TIXAGEVIMAB/CILGAVIMAB ADMINISTRATION 771 M0220 HCPCS 304130 local both 900 630 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG TELEHEALTH ORIGINATING SITE FACILITY FEE 780 Q3014 HCPCS 309536 local both 92 64.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PSYTX COMPLEX INTERACTIVE 900 90785 cpt 310390 local both 89 62.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 70 percent of total billed charges not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PSYCHIATRIC SERVICE/THERAPY 900 90899 cpt 310092 local both 165 115.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 70 percent of total billed charges not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES 900 90792 cpt 343246 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 70 percent of total billed charges not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC PSYCH DIAGNOSTIC EVALUATION 900 90791 cpt 343249 local both 462 323.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 70 percent of total billed charges not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG IOP FAMILY THERAPY W/O PT 905 90846 cpt 304684 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 395 per diem not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 310 per diem 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 310 395
HCHG IOP GROUP THERAPY-CD 906 90853 cpt 306349 local both 305 213.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 100 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 310 per diem 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 100 310
HCHG PHP FAMILY THERAPY W/ PATIENT 912 90847 cpt 304782 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 150 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 150 150
HCHG PSYCHOTHERAPY CRISIS ADD 30 MN (AT) 914 90840 cpt 302797 local both 184 128.8 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 85 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 85 85
HCHG PSYCHOTHERAPY PT&/FAM W/E&M 30 MIN 914 90833 cpt 331004 local both 190 133 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 85 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 85 85
HCHG PRVNT MED COUNSEL/RISK FACTR 60MIN 914 99404 cpt 305185 local both 195 136.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 150 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 150 150
HCHG PSYCHOTHERAPY PT&/FAM W/E&M 45 MIN 914 90836 cpt 331009 local both 240 168 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 135 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 135 135
HCHG PSYCHOTHERAPY CRISIS 60 MIN (AT) 914 90839 cpt 302795 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 190 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 190 190
"HCHG CVMC PSYCHOTHERAPY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEM" 914 90834 cpt 343247 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 125 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 125 125
"HCHG CVMC PSYCHOTHERAPY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEM" 914 90832 cpt 343248 local both 437 305.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 85 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 85 85
"HCHG CVMC PSYCHOTHERAPY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEM" 914 90837 cpt 343250 local both 473 331.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 160 case rate not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges 160 160
HCHG PSYCH NEUR TEST AUTOMATED 918 96146 cpt 503472 local both 260 182 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges 70 percent of total billed charges not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG COGNITIVE TEST BY HC PRO 918 96125 cpt 343149 local both 357 249.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract not applicable to this contract 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG NONINVASV EXTREM EXAM, 1-2 LVLS, BILAT" 920 93922 cpt 4401005 local both 20 14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC ARTERIAL PUNCTURE FLOOR 920 36600 cpt 310111 local both 176.46 123.52 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC INJ THERAPUTIC/PROPHLACTIC/DX 920 96379 cpt 309110 local both 179.55 125.69 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC NEUROMUSCULAR JUNCTION TEST 920 95937 cpt 5200176 local both 402.66 281.86 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ANALYZE NEUROSTIMULATOR ,W/O REPROGRAMMING" 920 95970 cpt 5200180 local both 615.92 431.14 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG NONINVASV EXTREM EXAM,1LEVEL,BILAT" 920 93922 cpt 4400497 local both 725 507.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SLEEP STUDY UNATND W/ANALYSIS 920 95801 cpt 343163 local both 759 531.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX LARGE VESSEL(S),LIMITED" 920 93979 cpt 4400303 local both 771 539.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CENTAL MOTOR EVOKED POTENTIAL STUDY, LOWER LIMBS" 920 95929 cpt 5200175 local both 773.48 541.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC CENTRAL MOTOR EVOKED POTENTIAL STUDY, UPPER LIMBS" 920 95928 cpt 5200174 local both 773.48 541.44 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DUPLEX HEMODIALYSIS ACCESS 920 93990 cpt 4400301 local both 894.72 626.3 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DUPLEX UP EXTREM ART UNILAT/LTD 920 93931 cpt 4400309 local both 1035 724.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DUPLEX LO EXTREM ART UNILAT/LTD 920 93926 cpt 4400305 local both 1047 732.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG NONINVASV EXTREM EXAM,MULT,BILAT" 920 93923 cpt 4400498 local both 1087 760.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX EXTREM VENOUS,UNI OR LTD" 920 93971 cpt 4400300 local both 1150 805 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SOMATOSENSORY TESTING,TRUNK/HEAD" 920 95927 cpt 5200173 local both 1185.44 829.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SOMATOSENSORY TESTING,LOWER LIMBS" 920 95926 cpt 5200172 local both 1185.44 829.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC SOMATOSENSORY TESTING,UPPER LIMBS" 920 95925 cpt 5200171 local both 1185.44 829.81 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ANALYZE IMPLANTED NEUROSTIMULATOR, COMPLEX" 920 95972 cpt 5200182 local both 1265.24 885.67 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DUPLEX LO EXTREM ART BILAT 920 93925 cpt 4400304 local both 1288 901.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX SCAN EXTRACRANIAL,BILAT" 920 93880 cpt 4400306 local both 1380 966 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX EXTREM VENOUS,BILAT" 920 93970 cpt 4400299 local both 1461 1022.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG LE ARTERIAL STRESS EXAM 920 93924 cpt 304300 local both 1466.24 1026.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC ANALYZE NEUROSTIM, WITH REPROGRAMMING" 920 95971 cpt 5200181 local both 1584.24 1108.97 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX ABD/PEL VASC STUDY,COMPLETE" 920 93975 cpt 4400297 local both 1691 1183.7 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX LARGE VESSEL(S),COMPLETE" 920 93978 cpt 4400302 local both 2530 1771 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG DUPLEX UP EXTREM ART BILAT 920 93930 cpt 4400308 local both 2967 2076.9 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG DUPLEX SCAN EXTRACRANIAL,LIMITED" 921 93882 cpt 4400307 local both 670 469 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG ARTERIAL EXTREMITY W/STRESS 921 93924 cpt 306662 local both 1466.24 1026.37 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MUSCLE TEST, NONPARASPINAL" 922 95870 cpt 5200189 local both 269.08 188.36 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MUSCLE TEST, ONE LIMB" 922 95860 cpt 5200184 local both 519.29 363.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MUSCLE TEST CRANIAL NERVE SUPPLIED MUSCLES BILATERAL 922 95868 cpt 5200188 local both 552.09 386.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MUSCLE TEST CRANIAL NERVE SUPPLIED MUSCLE(S) UNILATERAL 922 95867 cpt 5200187 local both 552.09 386.46 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MUSCLE TEST, 2 LIMBS" 922 95861 cpt 5200185 local both 675.2 472.64 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG CVMC MUSCLE TEST, 3 LIMBS" 922 95863 cpt 5200186 local both 815.14 570.6 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG BMH/CVMC NEEDLE ELECTROMYOGRAPHY 4 EXTREMITIES W/WO PARASPINAL 922 95864 cpt 343252 local both 1027.22 719.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
"HCHG PHLEBOTOMY,THERAPEUTIC" 940 99195 cpt 304777 local both 275 192.5 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PORTABLE PUMP REFILL & MAINT 940 96521 cpt 309111 local both 643 450.1 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG CVMC MNT SUBS TX FOR CHANGE DX-MCAR 942 G0270 HCPCS 338958 local both 50 35 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG SMOKING COUNSELING VISIT > 10 MIN 942 99407 cpt 306551 local both 90.07 63.05 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MED NUT THERAPY REASSMT 15 MIN 942 97803 cpt 304369 local both 92 64.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG MED NUT THERAPY INITIAL 15 MIN 942 97802 cpt 304368 local both 102 71.4 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 70 percent of total billed charges 80 percent of total billed charges 75 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges 24 percent of total billed charges
HCHG PF ANESTHESIA SALIVARY GLANDS WITH BIOPSY 963 100 cpt 504016 local both 303.45 212.42 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA NOSE & ACCESSORY SINUSES NOS 963 160 cpt 504017 local both 303.45 212.42 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA HERNIA REPAIR UPPER ABDOMEN NOS 963 750 cpt 504018 local both 242.76 169.93 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA INTRAPERITONEAL LOWER ABD W/LAPS NOS 963 840 cpt 504019 local both 364.14 254.9 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES TRURL FRAGMNTJ MANJ&/RMVL URETERAL CALCULUS 963 918 cpt 504020 local both 303.45 212.42 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES ORCHIOPEXY UNI/BI INCL OPEN URETHRAL PX 963 930 cpt 504021 local both 242.76 169.93 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA VAGINAL HYSTERECTOMY INCL BIOPSY 963 944 cpt 504022 local both 364.14 254.9 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA CLOSED PROCEDURES UPPER 2/3 FEMUR 963 1220 cpt 504023 local both 242.76 169.93 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA OPEN PROCEDURES UPPER 2/3 FEMUR NOS 963 1230 cpt 504024 local both 364.14 254.9 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES RADICAL RESECJ INCL BELOW KNEE AMPUTATION 963 1482 cpt 504025 local both 242.76 169.93 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA OPEN TENOTOMY ELBOW TO SHOULDER 963 1712 cpt 504026 local both 303.45 212.42 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES OPEN/SURG ARTHRS REPRS NON/MALUNION HUMERUS 963 1744 cpt 504027 local both 303.45 212.42 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA VEINS FOREARM WRIST & HAND NOS 963 1850 cpt 504028 local both 182.07 127.45 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA EXTERNAL MIDDLE & INNER EAR W/BX NOS 963 120 cpt 503931 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY 963 126 cpt 503932 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA INTRAORAL WITH BIOPSY NOS 963 170 cpt 503933 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA FACIAL BONES OR SKULL NOS 963 190 cpt 503934 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES INTEG MUSC & NRV HEAD NECK&POSTERIOR TRUNK 963 300 cpt 503935 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR 963 320 cpt 503936 local both 398.16 278.71 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES INTEG EXTREMITIES ANT TRUNK & PERINEUM NOS 963 400 cpt 503937 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA RADICAL/MODIFIED RADICAL BREAST 963 404 cpt 503938 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA ESOPHAGUS 963 500 cpt 503939 local both 995.4 696.08 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA LUMBAR REGION NOS 963 630 cpt 503940 local both 530.88 371.62 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA UPPER GI ENDOSCOPIC PX NOS 963 731 cpt 503941 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS 963 790 cpt 503942 local both 464.52 325.16 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA LOWER INTST ENDOSCOPIC PX NOS 963 811 cpt 503943 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC 963 812 cpt 503944 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX 963 813 cpt 503945 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA HERNIA REPAIR LOWER ABDOMEN NOS 963 830 cpt 503946 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS 963 860 cpt 503947 local both 398.16 278.71 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA ANORECTAL PROCEDURE 963 902 cpt 503948 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES TRANSURETHRAL W/URETHROCYSTOSCOPY NOS 963 910 cpt 503949 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA VAGINAL PROCEDURE W/BIOPSY NOS 963 940 cpt 503950 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA OPEN HIP JOINT PROCEDURE NOS 963 1210 cpt 503951 local both 398.16 278.71 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA OPEN TOTAL HIP ARTHROPLASTY 963 1214 cpt 503952 local both 530.88 371.62 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES NERVE MUSC TENDON FASCIA & BURSAE UPPER LEG 963 1250 cpt 503953 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES NERVE MUSC TENDON FASCIA&BURSA KNEE&/POPLT 963 1320 cpt 503954 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA CLOSED PROCEDURES KNEE JOINT 963 1380 cpt 503955 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES OPEN PROC UPPER ENDS TIBIA FIBULA&/PATELLA 963 1392 cpt 503956 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES OPEN/SURG ARTHROSCOPIC PROC KNEE JOINT NOS 963 1400 cpt 503957 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTH OPEN/SURG ARTHRS TOTAL KNEE ARTHROPLASTY 963 1402 cpt 503958 local both 464.52 325.16 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA VEINS KNEE & POPLITEAL AREA NOS 963 1430 cpt 503959 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA ARTHROSCOPIC PROCEDURE ANKLE & FOOT 963 1464 cpt 503960 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES NRV/MUS/TND/FASC LOWER LEG/ANKLE/FOOT NOS 963 1470 cpt 503961 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES RPR RUPTURED ACHILLES TENDON W/WO GRAFT 963 1472 cpt 503962 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES OPEN PROC BONES LOWER LEG/ANKLE/FOOT NOS 963 1480 cpt 503963 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES NRV MUSC TNDN FSCIA BURSA SHOULDER & AXILLA 963 1610 cpt 503964 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES ARTHRS HUMERAL H/N STRNCLAV & SHOULDER NOS 963 1630 cpt 503965 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES ARTHROSCOPIC TOTAL SHOULDER REPLACEMENT 963 1638 cpt 503966 local both 663.6 464.52 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA TENOPLASTY ELBOW TO SHOULDER 963 1714 cpt 503967 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA BICEPS TENODESIS RUPTURE LONG TENDON 963 1716 cpt 503968 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES OPEN/SURG ARTHROSCOPIC ELBOW PROC NOS 963 1740 cpt 503969 local both 265.44 185.81 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES NERVE MUSCLE TDN FASCIA&BURSA FOREARM WRIST 963 1810 cpt 503970 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES RADIUS ULNA WRIST/HAND BONES CLOSED PX 963 1820 cpt 503971 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES ARTHRS/ENDSCPY DSTL RADIUS ULNA/WRIST/HAND 963 1830 cpt 503972 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES VENOUS/LYMPHATIC NOS THER IVNTL RAD NOS 963 1930 cpt 503973 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS 963 1991 cpt 503974 local both 199.08 139.36 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANES DX/THER NERVE BLOCK/INJECTION PRONE POS 963 1992 cpt 503975 local both 331.8 232.26 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF INJ(S) AA&/STRD BRACHIAL PLEXUS (INCLUDES IG) 963 64415 cpt 503976 local both 195.75 137.03 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION PER 15 MIN 963 532 cpt 503999 local both 255 178.5 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
HCHG PF N BLOCK INJ FEM SINGLE (INCLUDES IG) 963 64447 cpt 308980 local both 1945.56 1361.89 88 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 60 other per asa unit 60 other per asa unit 75 percent of total billed charges 115 fee schedule 160 fee schedule 79 percent of total billed charges 103 percent fee schedule 115 fee schedule 60 60
PR ECHO GUIDE FOR BIOPSY 972 76942 cpt 4400599 local both 195.33 136.73 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR ULTRASOUND BREAST LIMITED 972 76642 cpt 342759 local both 265.9 186.13 87 percent of total billed charges 115 fee schedule 420 case rate 357 case rate 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule 357 420
PR TREAT STERNUM FRACTURE 972 21820 cpt 308807 local both 375.35 262.75 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF I&D SHOULDER INFECTED BURSA 975 23031 cpt 504009 local both 685.71 480 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX 975 20660 cpt 504005 local both 746.85 522.8 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> 975 23071 cpt 504011 local both 1297.23 908.06 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF CAPSULAR CONTRACTURE RELEASE 975 23020 cpt 504007 local both 2136.03 1495.22 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG CVMC PF STRAPPING UNNA BOOT 981 29580 cpt 503370 local both 93.72 65.6 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC PF CVER PRO FEE-LEVEL I 981 99281 cpt 309133 local both 128 89.6 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC PF CVER PRO FEE-LEVEL II 981 99282 cpt 309134 local both 173 121.1 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC PF CVER PRO FEE-LEVEL III 981 99283 cpt 309135 local both 260 182 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 91.99 case rate 115 fee schedule 91.99 91.99
HCHG CVMC SWALLOW EVAL MEDI-CAL ONLY 981 X4320 HCPCS 310132 local both 333.63 233.54 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 169 case rate 115 fee schedule 169 169
PR CVMC PF CVER PRO FEE-LEVEL IV 981 99284 cpt 309136 local both 388 271.6 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 245.5 case rate 115 fee schedule 245.5 245.5
PR CVMC PF RPR FE/E/EN/L/M 12.6-20.0 CM 981 12016 cpt 308426 local both 461 322.7 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC PF CVER PRO FEE-LEVEL V 981 99285 cpt 309137 local both 578 404.6 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 245 case rate 115 fee schedule 245 245
HCHG PF REV/RMV PRPH SAC/GSTR NPG/R 981 64595 cpt 343053 local both 650.6 455.42 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC PF DRAINAGE OF SCROTUM 981 54700 cpt 308947 local both 938 656.6 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC PF TREATMENT OF TIBIA FRACTURE 981 27752 cpt 308707 local both 1098 768.6 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF TREAT HUMERUS FRACTURE CLOSED 981 23605 cpt 343147 local both 1209.82 846.87 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 245 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
"PR CVMC PF SMOKING CESSATION COUNSELING, > 10 MIN" 983 99407 cpt 309147 local both 35 24.5 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF VISIT COMPLEXITY EM W/MED SERV 983 G2211 HCPCS 503686 local both 47.64 33.35 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF PROLONGED OUTPATIENT EM 983 99417 cpt 503685 local both 96 67.2 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN 983 99307 cpt 302439 local both 134.13 93.89 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF SBSQ NURSING FACIL CARE/DAY MINOR COMPLJ 20 MIN 983 99308 cpt 302440 local both 211.17 147.82 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 97.49 case rate 115 fee schedule 97.49 97.49
HCHG PF SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 30 MIN 983 99309 cpt 302442 local both 277.71 194.4 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 128.5 case rate 115 fee schedule 128.5 128.5
HCHG PF SBSQ NURS FACIL CARE/DAY UNSTABL/NEW PROB 45 MIN 983 99310 cpt 302443 local both 411.84 288.29 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG PF EXCISION PILONIDAL CYST/SINUS COMPLICATED 983 11772 cpt 302444 local both 2463 1724.1 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR BMH/CVMC PF CARDIOVASCULAR STRESS TEST-PRO FEE 985 93016 cpt 309046 local both 46 32.2 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
PR CVMC STRESS INTERPRETATION 985 93018 cpt 330962 local both 399.03 279.32 87 percent of total billed charges 115 fee schedule 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 115 fee schedule not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 115 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 115 fee schedule
HCHG DRUG TEST PRSMV CHEM (GRANT) REF 990 80307 cpt 303099 local both 320 224 87 percent of total billed charges 24 percent of total billed charges 85 percent of total billed charges not to exceed 4150 85 percent of total billed charges up to 3550 24.72 percent of total billed charges not applicable to this contract 90 percent of total billed charges 130 fee schedule 80 percent of total billed charges 75 percent of total billed charges 24 fee schedule 85 percent of total billed charges 23.8 percent of total billed charges 79 percent of total billed charges 25.2 percent of total billed charges 81.3 percent of total billed charges