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 <AGE 12	360	42820	cpt	503638	local	both	5100	3570		87		percent of total billed charges			24		percent of total billed charges			84		percent of total billed charges	not to exceed 7000		84		percent of total billed charges	not to exceed 5600		24.72		percent of total billed charges						not applicable to this contract		90		percent of total billed charges			72		percent of total billed charges			83		percent of total billed charges			75		percent of total billed charges			24		percent of total billed charges			85		percent of total billed charges			23.8		percent of total billed charges			79		percent of 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 TARSAL BONES OTH/THN CALCANEUS/TALUS	360	28304	cpt	357612	local	both	5103.75	3572.63		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 EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN	360	24120	cpt	503807	local	both	5129.25	3590.48		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 BIOPSY BREAST OPEN INCISIONAL	360	19101	cpt	503558	local	both	5143.79	3600.65		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 EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>	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 <AGE 12	360	42830	cpt	503640	local	both	7878.39	5514.87		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 ORCHIECTOMY SIMPLE SCROTAL INGUINAL APPROACH	360	54520	cpt	5401013	local	both	7903.5	5532.45		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 HEMIARTHROPLASTY HIP PARTIAL	360	27125	cpt	503590	local	both	7905	5533.5		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 RPR 1ST INGUN HRNA AGE 5 YRS/> 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