hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|[state],"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Madison County Memorial Hospital,2/23/2024,2.0.0,Madison County Memorial Hospital,"224 NW Crane Avenue Madison, FL 32340",592319288|FL,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AETNA MEDICAL RENTAL PLAN,AETNA MEDICAL RENTAL REIMBURSEMENT METHOD,BCBS PLAN,BCBS REIMBURSEMENT METHOD,CLEAR ALLIANCE PLAN,CLEAR ALLIANCE REIMBURSEMENT METHOD,HUMANA EPO PLAN,HUMANA EPO REIMBURSEMENT METHOD,HUMANA HMO PLAN,HUMANA HMO REIMBURSEMENT METHOD,HUMANA MEDICAID ADVANTAGE HMO PLAN,HUMANA MEDICAID ADVANTAGE HMO REIMBURSEMENT METHOD,HUMANA MEDICAID ADVANTAGE TRADITIONAL PLAN,HUMANA MEDICAID ADVANTAGE TRADITIONAL REIMBURSEMENT METHOD,HUMANA POS PLAN,HUMANA POS REIMBURSEMENT METHOD,HUMANA PPO PLAN,HUMANA PPO REIMBURSEMENT METHOD,LIGHTHOUSE MEDICAID ADVANTAGE PLAN,LIGHTHOUSE MEDICAID ADVANTAGE REIMBURSEMENT METHOD,MAGELLAN PLAN,MAGELLAN REIMBURSEMENT METHOD,MOLINA FLORIDA KID CARE PLAN,MOLINA FLORIDA KID CARE REIMBURSEMENT METHOD,MOLINA MEDICAID ADVANTAGE PLAN,MOLINA MEDICAID ADVANTAGE REIMBURSEMENT METHOD,MULTIPLAN PLAN,MULTIPLAN REIMBURSEMENT METHOD,MULTIPLAN COMPLIMENTARY NETWORK PLAN,MULTIPLAN COMPLIMENTARY NETWORK REIMBURSEMENT METHOD,PRESTIGE HEALTH CHOICE PLAN,PRESTIGE HEALTH CHOICE REIMBURSEMENT METHOD,PRIME HEALTH PLAN,PRIME HEALTH REIMBURSEMENT METHOD,SIMPLY HEALTH MEDICAID ADVANTAGE PLAN,SIMPLY HEALTH MEDICAID ADVANTAGE REIMBURSEMENT METHOD,SUNSHINE HEALTHY KIDS PLAN,SUNSHINE HEALTHY KIDS REIMBURSEMENT METHOD,SUNSHINE MEDICAID ADVANTAGE PLAN,SUNSHINE MEDICAID ADVANTAGE REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICAID ADVANTAGE PLAN,UHC MEDICAID ADVANTAGE REIMBURSEMENT METHOD,WELLCARE PLAN,WELLCARE REIMBURSEMENT METHOD,YOUTH SERVICES PLAN,YOUTH SERVICES REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,AETNA MEDICARE REIMBURSEMENT METHOD,HUMANA MEDICARE HMO PLAN,HUMANA MEDICARE HMO REIMBURSEMENT METHOD,HUMANA MEDICARE PPO PLAN,HUMANA MEDICARE PPO REIMBURSEMENT METHOD,HUMANA MEDICARE POS PLAN,HUMANA MEDICARE POS REIMBURSEMENT METHOD,HUMANA MEDICARE PFFS PLAN,HUMANA MEDICARE PFFS REIMBURSEMENT METHOD,MOLINA MEDICARE PLAN,MOLINA MEDICARE REIMBURSEMENT METHOD,MULTIPLAN MEDICARE PLAN,MULTIPLAN MEDICARE REIMBURSEMENT METHOD,SUNSHINE COMMERCIAL PLAN,SUNSHINE COMMERCIAL REIMBURSEMENT METHOD,SUNSHINE MEDICARE PLAN,SUNSHINE MEDICARE REIMBURSEMENT METHOD,SUNSHINE COMMERCIAL EXCHANGE PLAN,SUNSHINE COMMERCIAL EXCHANGE REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,UHC VETERANS PLAN,UHC VETERANS REIMBURSEMENT METHOD,BCBS MEDICARE ADVANTAGE PLAN,BCBS MEDICARE ADVANTAGE REIMBURSEMENT METHOD,LIGHTHOUSE MEDICARE ADVANTAGE PLAN,LIGHTHOUSE MEDICARE ADVANTAGE REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,LAB,36415,Routine Venipuncture,300,$15.45 ,$10.04 ,65% of total billed charges,$10.51 ,68% of total billed charges,$3.00 ,100% of BCBS fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$3.09 ,20% of total billed charges,$3.09 ,20% of total billed charges,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$3.09 ,20% of total billed charges,$3.09 ,20% of total billed charges,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$10.04 ,65% of total billed charges,$10.04 ,65% of total billed charges,$2.29 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$7.73 ,50% of total billed charges,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$2.29 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$2.29 ,$15.00 ,$7.73 
Outpatient Medical Services,LAB,36430,Blood transfusion service,391,$325.48 ,$211.56 ,65% of total billed charges,$221.33 ,68% of total billed charges,N/A,Not reimbursable per contract,$425.52 ,100% of FL Medicaid fee schedule ,$65.10 ,20% of total billed charges,$65.10 ,20% of total billed charges,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$65.10 ,20% of total billed charges,$65.10 ,20% of total billed charges,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$211.56 ,65% of total billed charges,$211.56 ,65% of total billed charges,$425.52 ,100% of FL Medicaid fee schedule ,$189.60 ,Pays 100% medicare OPPS,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$425.52 ,100% of FL Medicaid fee schedule ,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$189.60 ,Pays 100% medicare OPPS,$178.00 ,$425.52 ,$162.74 
Outpatient Medical Services,LAB,80048,Basic metabolic panel,301,$77.25 ,$50.21 ,65% of total billed charges,$52.53 ,68% of total billed charges,$11.70 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$50.21 ,65% of total billed charges,$50.21 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$38.63 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$8.09 ,$50.21 ,$38.63 
Outpatient Medical Services,LAB,80051,Electrolyte panel,301,$47.59 ,$30.93 ,65% of total billed charges,$32.36 ,68% of total billed charges,$9.69 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$9.52 ,20% of total billed charges,$9.52 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$9.52 ,20% of total billed charges,$9.52 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$30.93 ,65% of total billed charges,$30.93 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$27.72 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$23.80 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$27.72 ,Pays 100% medicare OPPS,$8.09 ,$30.93 ,$23.80 
Outpatient Medical Services,LAB,80053,"Blood test, comprehensive group of blood chemicals",301,$154.50 ,$100.43 ,65% of total billed charges,$105.06 ,68% of total billed charges,$14.61 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$100.43 ,65% of total billed charges,$100.43 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$77.25 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$8.09 ,$100.43 ,$77.25 
Outpatient Medical Services,LAB,80053,Comprehensive Metabolic Panel,301,$154.50 ,$100.43 ,65% of total billed charges,$105.06 ,68% of total billed charges,$14.61 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$100.43 ,65% of total billed charges,$100.43 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$77.25 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$8.09 ,$100.43 ,$77.25 
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,309,$209.61 ,$136.25 ,65% of total billed charges,$142.53 ,68% of total billed charges,N/A,Not reimbursable per contract,$8.09 ,100% of FL Medicaid fee schedule ,$41.92 ,20% of total billed charges,$41.92 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$41.92 ,20% of total billed charges,$41.92 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$136.25 ,65% of total billed charges,$136.25 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$122.10 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$104.81 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$122.10 ,Pays 100% medicare OPPS,$8.09 ,$136.25 ,$104.81 
Outpatient Medical Services,LAB,80061,"Blood test, lipids (cholesterol and triglycerides)",301,$124.63 ,$81.01 ,65% of total billed charges,$84.75 ,68% of total billed charges,$19.01 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$24.93 ,20% of total billed charges,$24.93 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$24.93 ,20% of total billed charges,$24.93 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$81.01 ,65% of total billed charges,$81.01 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$72.60 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$62.32 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$72.60 ,Pays 100% medicare OPPS,$8.09 ,$81.01 ,$62.32 
Outpatient Medical Services,LAB,80069,Kidney function panel test,301,$154.50 ,$100.43 ,65% of total billed charges,$105.06 ,68% of total billed charges,N/A,Not reimbursable per contract,$8.09 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$100.43 ,65% of total billed charges,$100.43 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$77.25 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$8.09 ,$100.43 ,$77.25 
Outpatient Medical Services,LAB,80074,Acute Hepatitis panel,301,$224.54 ,$145.95 ,65% of total billed charges,$152.69 ,68% of total billed charges,$65.82 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$44.91 ,20% of total billed charges,$44.91 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$44.91 ,20% of total billed charges,$44.91 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$145.95 ,65% of total billed charges,$145.95 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$130.80 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$112.27 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$130.80 ,Pays 100% medicare OPPS,$8.09 ,$145.95 ,$112.27 
Outpatient Medical Services,LAB,80076,Liver function blood test panel,301,$77.25 ,$50.21 ,65% of total billed charges,$52.53 ,68% of total billed charges,$11.29 ,100% of BCBS fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$50.21 ,65% of total billed charges,$50.21 ,65% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$38.63 ,50% of total billed charges,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$8.09 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$8.09 ,$50.21 ,$38.63 
Outpatient Medical Services,LAB,80168,80168 Assay of Zarontin,301,$104.03 ,$67.62 ,65% of total billed charges,$70.74 ,68% of total billed charges,$23.19 ,100% of BCBS fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$20.81 ,20% of total billed charges,$20.81 ,20% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$20.81 ,20% of total billed charges,$20.81 ,20% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$67.62 ,65% of total billed charges,$67.62 ,65% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$60.60 ,Pays 100% medicare OPPS,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$52.02 ,50% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$10.27 ,$67.62 ,$52.02 
Outpatient Medical Services,LAB,80197,80197 Assay of tacrolimus,301,$175.10 ,$113.82 ,65% of total billed charges,$119.07 ,68% of total billed charges,N/A,Not reimbursable per contract,$10.27 ,100% of FL Medicaid fee schedule ,$35.02 ,20% of total billed charges,$35.02 ,20% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$35.02 ,20% of total billed charges,$35.02 ,20% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$113.82 ,65% of total billed charges,$113.82 ,65% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$102.00 ,Pays 100% medicare OPPS,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$87.55 ,50% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$102.00 ,Pays 100% medicare OPPS,$10.27 ,$113.82 ,$87.55 
Outpatient Medical Services,LAB,80202,80202 Assay of vancomycin,301,$133.90 ,$87.04 ,65% of total billed charges,$91.05 ,68% of total billed charges,$19.23 ,100% of BCBS fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$26.78 ,20% of total billed charges,$26.78 ,20% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$26.78 ,20% of total billed charges,$26.78 ,20% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$87.04 ,65% of total billed charges,$87.04 ,65% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$78.00 ,Pays 100% medicare OPPS,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$66.95 ,50% of total billed charges,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$10.27 ,100% of FL Medicaid fee schedule ,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$78.00 ,Pays 100% medicare OPPS,$10.27 ,$87.04 ,$66.95 
Outpatient Medical Services,LAB,80307,80307 Drug test prsmv chem anlyzr,301,$152.44 ,$99.09 ,65% of total billed charges,$103.66 ,68% of total billed charges,$19.58 ,100% of BCBS fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$30.49 ,20% of total billed charges,$30.49 ,20% of total billed charges,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$30.49 ,20% of total billed charges,$30.49 ,20% of total billed charges,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$99.09 ,65% of total billed charges,$99.09 ,65% of total billed charges,$62.86 ,100% of FL Medicaid fee schedule ,$88.80 ,Pays 100% medicare OPPS,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$76.22 ,50% of total billed charges,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$62.86 ,100% of FL Medicaid fee schedule ,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$88.80 ,Pays 100% medicare OPPS,$62.86 ,$99.09 ,$76.22 
Outpatient Medical Services,LAB,81000,"81000 Urinalysis, Manual, Microscope Exam",307,$42.23 ,$27.45 ,65% of total billed charges,$28.72 ,68% of total billed charges,$4.49 ,100% of BCBS fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$8.45 ,20% of total billed charges,$8.45 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$8.45 ,20% of total billed charges,$8.45 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$27.45 ,65% of total billed charges,$27.45 ,65% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$24.60 ,Pays 100% medicare OPPS,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$21.12 ,50% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$2.72 ,$27.45 ,$21.12 
Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination using microscope,301,$42.23 ,$27.45 ,65% of total billed charges,$28.72 ,68% of total billed charges,$4.49 ,100% of BCBS fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$8.45 ,20% of total billed charges,$8.45 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$8.45 ,20% of total billed charges,$8.45 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$27.45 ,65% of total billed charges,$27.45 ,65% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$9.00 ,Pays 100% medicare OPPS,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$21.12 ,50% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$2.72 ,$27.45 ,$21.12 
Outpatient Medical Services,LAB,81002,"81002 Urinalysis, Automated",307,$20.60 ,$13.39 ,65% of total billed charges,$14.01 ,68% of total billed charges,$3.63 ,100% of BCBS fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$4.12 ,20% of total billed charges,$4.12 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$4.12 ,20% of total billed charges,$4.12 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$13.39 ,65% of total billed charges,$13.39 ,65% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$10.30 ,50% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,$2.72 ,$13.39 ,$10.30 
Outpatient Medical Services,LAB,81003,"81003 Urinalysis, Automated",307,$17.00 ,$11.05 ,65% of total billed charges,$11.56 ,68% of total billed charges,$3.18 ,100% of BCBS fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$3.40 ,20% of total billed charges,$3.40 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$3.40 ,20% of total billed charges,$3.40 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$11.05 ,65% of total billed charges,$11.05 ,65% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$9.90 ,Pays 100% medicare OPPS,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$8.50 ,50% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$2.72 ,$11.05 ,$8.50 
Outpatient Medical Services,LAB,81003,Automated urinalysis test,307,$17.00 ,$11.05 ,65% of total billed charges,$11.56 ,68% of total billed charges,$3.18 ,100% of BCBS fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$3.40 ,20% of total billed charges,$3.40 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$3.40 ,20% of total billed charges,$3.40 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$11.05 ,65% of total billed charges,$11.05 ,65% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$9.90 ,Pays 100% medicare OPPS,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$8.50 ,50% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$9.90 ,Pays 100% medicare OPPS,$2.72 ,$11.05 ,$8.50 
Outpatient Medical Services,LAB,82040,82040 Assay of serum albumin,301,$28.33 ,$18.41 ,65% of total billed charges,$19.26 ,68% of total billed charges,$5.67 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$18.41 ,65% of total billed charges,$18.41 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$14.17 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$4.89 ,$18.41 ,$14.17 
Outpatient Medical Services,LAB,82043,82043 Microalbumin quantitative,301,$87.55 ,$56.91 ,65% of total billed charges,$59.53 ,68% of total billed charges,$2.43 ,100% of BCBS fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$17.51 ,20% of total billed charges,$17.51 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$17.51 ,20% of total billed charges,$17.51 ,20% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$56.91 ,65% of total billed charges,$56.91 ,65% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$51.00 ,Pays 100% medicare OPPS,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$43.78 ,50% of total billed charges,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$2.72 ,100% of FL Medicaid fee schedule ,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$2.72 ,$56.91 ,$43.78 
Outpatient Medical Services,LAB,82140,82140 Assay of ammonia,301,$92.70 ,$60.26 ,65% of total billed charges,$63.04 ,68% of total billed charges,$20.68 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$60.26 ,65% of total billed charges,$60.26 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$46.35 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$10.57 ,$60.26 ,$46.35 
Outpatient Medical Services,LAB,82150,82150 Assay of amylase,301,$52.53 ,$34.14 ,65% of total billed charges,$35.72 ,68% of total billed charges,$9.20 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.51 ,20% of total billed charges,$10.51 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.51 ,20% of total billed charges,$10.51 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$34.14 ,65% of total billed charges,$34.14 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$26.27 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$4.89 ,$34.14 ,$26.27 
Outpatient Medical Services,LAB,82247,82247 Bilirubin total,301,$26.78 ,$17.41 ,65% of total billed charges,$18.21 ,68% of total billed charges,$6.94 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.36 ,20% of total billed charges,$5.36 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.36 ,20% of total billed charges,$5.36 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$17.41 ,65% of total billed charges,$17.41 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.60 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$13.39 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$15.60 ,Pays 100% medicare OPPS,$4.89 ,$17.41 ,$13.39 
Outpatient Medical Services,LAB,82248,82248 Bilirubin direct,301,$82.40 ,$53.56 ,65% of total billed charges,$56.03 ,68% of total billed charges,$6.94 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$53.56 ,65% of total billed charges,$53.56 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$48.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$41.20 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$4.89 ,$53.56 ,$41.20 
Outpatient Medical Services,LAB,82306,Vitamin d 25 hydroxy,301,$100.94 ,$65.61 ,65% of total billed charges,$68.64 ,68% of total billed charges,$42.01 ,100% of BCBS fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$20.19 ,20% of total billed charges,$20.19 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$20.19 ,20% of total billed charges,$20.19 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$65.61 ,65% of total billed charges,$65.61 ,65% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$58.80 ,Pays 100% medicare OPPS,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$50.47 ,50% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$58.80 ,Pays 100% medicare OPPS,$26.57 ,$65.61 ,$50.47 
Outpatient Medical Services,LAB,82310,82310 Assay of calcium,301,$30.90 ,$20.09 ,65% of total billed charges,$21.01 ,68% of total billed charges,$7.31 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.18 ,20% of total billed charges,$6.18 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.18 ,20% of total billed charges,$6.18 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$20.09 ,65% of total billed charges,$20.09 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$18.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$4.89 ,$20.09 ,$15.45 
Outpatient Medical Services,LAB,82330,82330 Assay of calcium,301,$69.01 ,$44.86 ,65% of total billed charges,$46.93 ,68% of total billed charges,$19.40 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$13.80 ,20% of total billed charges,$13.80 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$13.80 ,20% of total billed charges,$13.80 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$44.86 ,65% of total billed charges,$44.86 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$40.20 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$34.51 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$10.57 ,$44.86 ,$34.51 
Outpatient Medical Services,LAB,82378,82378 Carcinoembryonic antigen,301,$87.55 ,$56.91 ,65% of total billed charges,$59.53 ,68% of total billed charges,$26.93 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$17.51 ,20% of total billed charges,$17.51 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$17.51 ,20% of total billed charges,$17.51 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$56.91 ,65% of total billed charges,$56.91 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$51.00 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$43.78 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$10.57 ,$56.91 ,$43.78 
Outpatient Medical Services,LAB,82533,82533 Total cortisol,301,$107.12 ,$69.63 ,65% of total billed charges,$72.84 ,68% of total billed charges,$23.14 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$21.42 ,20% of total billed charges,$21.42 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$21.42 ,20% of total billed charges,$21.42 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$69.63 ,65% of total billed charges,$69.63 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$49.80 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$53.56 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$12.02 ,$69.63 ,$53.56 
Outpatient Medical Services,LAB,82550,82550 Assay of ck (cpk),301,$22.66 ,$14.73 ,65% of total billed charges,$15.41 ,68% of total billed charges,$9.25 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.53 ,20% of total billed charges,$4.53 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.53 ,20% of total billed charges,$4.53 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$14.73 ,65% of total billed charges,$14.73 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$13.20 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$11.33 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$13.20 ,Pays 100% medicare OPPS,$4.89 ,$14.73 ,$11.33 
Outpatient Medical Services,LAB,82565,82565 Assay of creatinine,301,$30.90 ,$20.09 ,65% of total billed charges,$21.01 ,68% of total billed charges,$7.27 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.18 ,20% of total billed charges,$6.18 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.18 ,20% of total billed charges,$6.18 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$20.09 ,65% of total billed charges,$20.09 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$18.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$4.89 ,$20.09 ,$15.45 
Outpatient Medical Services,LAB,82570,82570 Assay of urine creatinine,301,$53.56 ,$34.81 ,65% of total billed charges,$36.42 ,68% of total billed charges,$7.34 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.71 ,20% of total billed charges,$10.71 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.71 ,20% of total billed charges,$10.71 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$34.81 ,65% of total billed charges,$34.81 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$31.20 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$26.78 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$4.89 ,$34.81 ,$26.78 
Outpatient Medical Services,LAB,82607,82607 Vitamin b-12,301,$72.10 ,$46.87 ,65% of total billed charges,$49.03 ,68% of total billed charges,$21.39 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$14.42 ,20% of total billed charges,$14.42 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$14.42 ,20% of total billed charges,$14.42 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$46.87 ,65% of total billed charges,$46.87 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$42.00 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$36.05 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$42.00 ,Pays 100% medicare OPPS,$12.02 ,$46.87 ,$36.05 
Outpatient Medical Services,LAB,82728,82728 Assay of ferritin,301,$82.40 ,$53.56 ,65% of total billed charges,$56.03 ,68% of total billed charges,$19.33 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$53.56 ,65% of total billed charges,$53.56 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$48.00 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$41.20 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$10.57 ,$53.56 ,$41.20 
Outpatient Medical Services,LAB,82746,82746 Assay of folic acid serum,301,$71.38 ,$46.40 ,65% of total billed charges,$48.54 ,68% of total billed charges,$20.87 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$14.28 ,20% of total billed charges,$14.28 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$14.28 ,20% of total billed charges,$14.28 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$46.40 ,65% of total billed charges,$46.40 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$41.58 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$35.69 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$41.58 ,Pays 100% medicare OPPS,$10.57 ,$46.40 ,$35.69 
Outpatient Medical Services,LAB,82784,82784 Assay iga/igd/igg/igm each,301,$59.74 ,$38.83 ,65% of total billed charges,$40.62 ,68% of total billed charges,$13.20 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$11.95 ,20% of total billed charges,$11.95 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$11.95 ,20% of total billed charges,$11.95 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$38.83 ,65% of total billed charges,$38.83 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$34.80 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$29.87 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$4.89 ,$38.83 ,$29.87 
Outpatient Medical Services,LAB,82803,82803 Blood gases any combination,301,$298.70 ,$194.16 ,65% of total billed charges,$203.12 ,68% of total billed charges,$27.47 ,100% of BCBS fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$59.74 ,20% of total billed charges,$59.74 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$59.74 ,20% of total billed charges,$59.74 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$194.16 ,65% of total billed charges,$194.16 ,65% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$174.00 ,Pays 100% medicare OPPS,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$149.35 ,50% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$26.57 ,$194.16 ,$149.35 
Outpatient Medical Services,LAB,82945,82945 Glucose other fluid,301,$46.35 ,$30.13 ,65% of total billed charges,$31.52 ,68% of total billed charges,N/A,Not reimbursable per contract,$4.89 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$30.13 ,65% of total billed charges,$30.13 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$23.18 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$4.89 ,$30.13 ,$23.18 
Outpatient Medical Services,LAB,82947,82947 Assay glucose blood quant,301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$5.57 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,82948,82948 Reagent strip/blood glucose,301,$10.30 ,$6.70 ,65% of total billed charges,$7.00 ,68% of total billed charges,$4.49 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$2.06 ,20% of total billed charges,$2.06 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$2.06 ,20% of total billed charges,$2.06 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.70 ,65% of total billed charges,$6.70 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$6.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$6.00 ,Pays 100% medicare OPPS,$4.89 ,$6.70 ,$5.15 
Outpatient Medical Services,LAB,83010,83010 Assay of haptoglobin quant,301,$58.71 ,$38.16 ,65% of total billed charges,$39.92 ,68% of total billed charges,$17.85 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$11.74 ,20% of total billed charges,$11.74 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$11.74 ,20% of total billed charges,$11.74 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$38.16 ,65% of total billed charges,$38.16 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$29.36 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$10.57 ,$38.16 ,$29.36 
Outpatient Medical Services,LAB,83020,83020 Hemoglobin electrophoresis,301,$82.40 ,$53.56 ,65% of total billed charges,$56.03 ,68% of total billed charges,$18.28 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$53.56 ,65% of total billed charges,$53.56 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$45.24 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$41.20 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$45.24 ,Pays 100% medicare OPPS,$10.57 ,$53.56 ,$41.20 
Outpatient Medical Services,LAB,83036,83036 Glycosylated hemoglobin test,301,$77.25 ,$50.21 ,65% of total billed charges,$52.53 ,68% of total billed charges,$13.78 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$50.21 ,65% of total billed charges,$50.21 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$38.63 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$4.89 ,$50.21 ,$38.63 
Outpatient Medical Services,LAB,83540,83540 Assay of iron,301,$33.99 ,$22.09 ,65% of total billed charges,$23.11 ,68% of total billed charges,$9.20 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.80 ,20% of total billed charges,$6.80 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.80 ,20% of total billed charges,$6.80 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$22.09 ,65% of total billed charges,$22.09 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$19.80 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$17.00 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$19.80 ,Pays 100% medicare OPPS,$4.89 ,$22.09 ,$17.00 
Outpatient Medical Services,LAB,83550,83550 Iron binding test,301,$51.50 ,$33.48 ,65% of total billed charges,$35.02 ,68% of total billed charges,$12.40 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.30 ,20% of total billed charges,$10.30 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.30 ,20% of total billed charges,$10.30 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$33.48 ,65% of total billed charges,$33.48 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$28.20 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$25.75 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$28.20 ,Pays 100% medicare OPPS,$4.89 ,$33.48 ,$25.75 
Outpatient Medical Services,LAB,83605,83605 Assay of lactic acid,302,$96.82 ,$62.93 ,65% of total billed charges,$65.84 ,68% of total billed charges,$15.15 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$19.36 ,20% of total billed charges,$19.36 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$19.36 ,20% of total billed charges,$19.36 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$62.93 ,65% of total billed charges,$62.93 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$56.40 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$48.41 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$56.40 ,Pays 100% medicare OPPS,$10.57 ,$62.93 ,$48.41 
Outpatient Medical Services,LAB,83615,83615 Lactate (ld) (ldh) enzyme,301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$8.57 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,83690,83690 Assay of lipase,301,$39.66 ,$25.78 ,65% of total billed charges,$26.97 ,68% of total billed charges,$9.77 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$7.93 ,20% of total billed charges,$7.93 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$7.93 ,20% of total billed charges,$7.93 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$25.78 ,65% of total billed charges,$25.78 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$23.10 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$19.83 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$23.10 ,Pays 100% medicare OPPS,$4.89 ,$25.78 ,$19.83 
Outpatient Medical Services,LAB,83735,83735 Assay of magnesium,301,$51.50 ,$33.48 ,65% of total billed charges,$35.02 ,68% of total billed charges,$9.51 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.30 ,20% of total billed charges,$10.30 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.30 ,20% of total billed charges,$10.30 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$33.48 ,65% of total billed charges,$33.48 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$30.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$25.75 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$30.00 ,Pays 100% medicare OPPS,$4.89 ,$33.48 ,$25.75 
Outpatient Medical Services,LAB,83880,83880 Assay of natriuretic peptide,301,$245.14 ,$159.34 ,65% of total billed charges,$166.70 ,68% of total billed charges,N/A,Not reimbursable per contract,$26.57 ,100% of FL Medicaid fee schedule ,$49.03 ,20% of total billed charges,$49.03 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$49.03 ,20% of total billed charges,$49.03 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$159.34 ,65% of total billed charges,$159.34 ,65% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$142.80 ,Pays 100% medicare OPPS,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$122.57 ,50% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$142.80 ,Pays 100% medicare OPPS,$26.57 ,$159.34 ,$122.57 
Outpatient Medical Services,LAB,83930,83930 Assay of blood osmolality,301,$60.77 ,$39.50 ,65% of total billed charges,$41.32 ,68% of total billed charges,$9.38 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.15 ,20% of total billed charges,$12.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.15 ,20% of total billed charges,$12.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$39.50 ,65% of total billed charges,$39.50 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$35.40 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$30.39 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$35.40 ,Pays 100% medicare OPPS,$4.89 ,$39.50 ,$30.39 
Outpatient Medical Services,LAB,83935,83935 Assay of urine osmolality,301,$59.74 ,$38.83 ,65% of total billed charges,$40.62 ,68% of total billed charges,$9.67 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$11.95 ,20% of total billed charges,$11.95 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$11.95 ,20% of total billed charges,$11.95 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$38.83 ,65% of total billed charges,$38.83 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$34.80 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$29.87 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$34.80 ,Pays 100% medicare OPPS,$4.89 ,$38.83 ,$29.87 
Outpatient Medical Services,LAB,83970,83970 Assay of parathormone,301,$307.97 ,$200.18 ,65% of total billed charges,$209.42 ,68% of total billed charges,$58.58 ,100% of BCBS fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$61.59 ,20% of total billed charges,$61.59 ,20% of total billed charges,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$61.59 ,20% of total billed charges,$61.59 ,20% of total billed charges,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$200.18 ,65% of total billed charges,$200.18 ,65% of total billed charges,$28.62 ,100% of FL Medicaid fee schedule ,$179.40 ,Pays 100% medicare OPPS,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$153.99 ,50% of total billed charges,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$28.62 ,100% of FL Medicaid fee schedule ,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$179.40 ,Pays 100% medicare OPPS,$28.62 ,$200.18 ,$153.99 
Outpatient Medical Services,LAB,84030,84030 Assay of blood pku,301,$127.98 ,$83.19 ,65% of total billed charges,$87.03 ,68% of total billed charges,$7.81 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$25.60 ,20% of total billed charges,$25.60 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$25.60 ,20% of total billed charges,$25.60 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$83.19 ,65% of total billed charges,$83.19 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$74.55 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$63.99 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$74.55 ,Pays 100% medicare OPPS,$4.89 ,$83.19 ,$63.99 
Outpatient Medical Services,LAB,84075,84075 Assay alkaline phosphatase,301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$7.34 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,84100,84100 Assay of phosphorus,301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$6.73 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,84132,84132 Assay of serum potassium,301,$23.69 ,$15.40 ,65% of total billed charges,$16.11 ,68% of total billed charges,$6.52 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.74 ,20% of total billed charges,$4.74 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.74 ,20% of total billed charges,$4.74 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.40 ,65% of total billed charges,$15.40 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$13.80 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$11.85 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$13.80 ,Pays 100% medicare OPPS,$4.89 ,$15.40 ,$11.85 
Outpatient Medical Services,LAB,84134,84134 Assay of prealbumin,301,$50.68 ,$32.94 ,65% of total billed charges,$34.46 ,68% of total billed charges,$20.70 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.14 ,20% of total billed charges,$10.14 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.14 ,20% of total billed charges,$10.14 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$32.94 ,65% of total billed charges,$32.94 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$29.52 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$25.34 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$29.52 ,Pays 100% medicare OPPS,$10.57 ,$32.94 ,$25.34 
Outpatient Medical Services,LAB,84145,84145 Procalcitonin (pct),300,$353.81 ,$229.98 ,65% of total billed charges,$240.59 ,68% of total billed charges,N/A,Not reimbursable per contract,$12.02 ,100% of FL Medicaid fee schedule ,$70.76 ,20% of total billed charges,$70.76 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$70.76 ,20% of total billed charges,$70.76 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$229.98 ,65% of total billed charges,$229.98 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$206.10 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$176.91 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$206.10 ,Pays 100% medicare OPPS,$12.02 ,$229.98 ,$176.91 
Outpatient Medical Services,LAB,84153,84153 PSA (Prostate Specific Antigen),301,$83.43 ,$54.23 ,65% of total billed charges,$56.73 ,68% of total billed charges,$26.11 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$16.69 ,20% of total billed charges,$16.69 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$16.69 ,20% of total billed charges,$16.69 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$54.23 ,65% of total billed charges,$54.23 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$48.60 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$41.72 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$48.60 ,Pays 100% medicare OPPS,$10.57 ,$54.23 ,$41.72 
Outpatient Medical Services,LAB,84154,84154 PSA (Prostate Specific Antigen),301,$99.91 ,$64.94 ,65% of total billed charges,$67.94 ,68% of total billed charges,$25.42 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$19.98 ,20% of total billed charges,$19.98 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$19.98 ,20% of total billed charges,$19.98 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$64.94 ,65% of total billed charges,$64.94 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$58.20 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$49.96 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$10.57 ,$64.94 ,$49.96 
Outpatient Medical Services,LAB,84154,PSA (prostate specific antigen),301,$99.91 ,$64.94 ,65% of total billed charges,$67.94 ,68% of total billed charges,$25.42 ,100% of BCBS fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$19.98 ,20% of total billed charges,$19.98 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$19.98 ,20% of total billed charges,$19.98 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$64.94 ,65% of total billed charges,$64.94 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$58.20 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$49.96 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$10.57 ,$64.94 ,$49.96 
Outpatient Medical Services,LAB,84155,84155 Assay of protein serum,301,$30.90 ,$20.09 ,65% of total billed charges,$21.01 ,68% of total billed charges,$5.20 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.18 ,20% of total billed charges,$6.18 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$6.18 ,20% of total billed charges,$6.18 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$20.09 ,65% of total billed charges,$20.09 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$18.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$18.00 ,Pays 100% medicare OPPS,$4.89 ,$20.09 ,$15.45 
Outpatient Medical Services,LAB,84156,84156 Assay of protein urine,301,$53.56 ,$34.81 ,65% of total billed charges,$36.42 ,68% of total billed charges,N/A,Not reimbursable per contract,$4.89 ,100% of FL Medicaid fee schedule ,$10.71 ,20% of total billed charges,$10.71 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.71 ,20% of total billed charges,$10.71 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$34.81 ,65% of total billed charges,$34.81 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$19.20 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$26.78 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$19.20 ,Pays 100% medicare OPPS,$4.89 ,$34.81 ,$26.78 
Outpatient Medical Services,LAB,84157,84157 Assay of protein other,301,$46.35 ,$30.13 ,65% of total billed charges,$31.52 ,68% of total billed charges,N/A,Not reimbursable per contract,$4.89 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$30.13 ,65% of total billed charges,$30.13 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$23.18 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$4.89 ,$30.13 ,$23.18 
Outpatient Medical Services,LAB,84165,84165 Protein e-phoresis serum,301,$77.25 ,$50.21 ,65% of total billed charges,$52.53 ,68% of total billed charges,$15.25 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$50.21 ,65% of total billed charges,$50.21 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$38.63 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$4.89 ,$50.21 ,$38.63 
Outpatient Medical Services,LAB,84295,84295 Assay of serum sodium,301,$21.63 ,$14.06 ,65% of total billed charges,$14.71 ,68% of total billed charges,$6.82 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.33 ,20% of total billed charges,$4.33 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.33 ,20% of total billed charges,$4.33 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$14.06 ,65% of total billed charges,$14.06 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$12.60 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.82 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$12.60 ,Pays 100% medicare OPPS,$4.89 ,$14.06 ,$10.82 
Outpatient Medical Services,LAB,84300,84300 Assay of urine sodium,301,$53.56 ,$34.81 ,65% of total billed charges,$36.42 ,68% of total billed charges,$6.90 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.71 ,20% of total billed charges,$10.71 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$10.71 ,20% of total billed charges,$10.71 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$34.81 ,65% of total billed charges,$34.81 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$31.20 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$26.78 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$31.20 ,Pays 100% medicare OPPS,$4.89 ,$34.81 ,$26.78 
Outpatient Medical Services,LAB,84403,84403 Assay of total testosterone,301,$118.45 ,$76.99 ,65% of total billed charges,$80.55 ,68% of total billed charges,$36.64 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$23.69 ,20% of total billed charges,$23.69 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$23.69 ,20% of total billed charges,$23.69 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$76.99 ,65% of total billed charges,$76.99 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$69.00 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$59.23 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$69.00 ,Pays 100% medicare OPPS,$12.02 ,$76.99 ,$59.23 
Outpatient Medical Services,LAB,84436,84436 Assay of total thyroxine,301,$12.36 ,$8.03 ,65% of total billed charges,$8.40 ,68% of total billed charges,$9.76 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$2.47 ,20% of total billed charges,$2.47 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$2.47 ,20% of total billed charges,$2.47 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$8.03 ,65% of total billed charges,$8.03 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$7.20 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$6.18 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$7.20 ,Pays 100% medicare OPPS,$6.18 ,$12.02 ,$6.18 
Outpatient Medical Services,LAB,84439,84439 Assay of free thyroxine,301,$91.67 ,$59.59 ,65% of total billed charges,$62.34 ,68% of total billed charges,$12.80 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$18.33 ,20% of total billed charges,$18.33 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$18.33 ,20% of total billed charges,$18.33 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$59.59 ,65% of total billed charges,$59.59 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$53.40 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$45.84 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$53.40 ,Pays 100% medicare OPPS,$12.02 ,$59.59 ,$45.84 
Outpatient Medical Services,LAB,84443,84443 Thyroid Simulating Hormone (TSH) Blood Test,301,$92.70 ,$60.26 ,65% of total billed charges,$63.04 ,68% of total billed charges,$23.84 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$60.26 ,65% of total billed charges,$60.26 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$46.35 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$12.02 ,$60.26 ,$46.35 
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone (TSH)",301,$92.70 ,$60.26 ,65% of total billed charges,$63.04 ,68% of total billed charges,$23.84 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$60.26 ,65% of total billed charges,$60.26 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$46.35 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$12.02 ,$60.26 ,$46.35 
Outpatient Medical Services,LAB,84450,84450 Transferase (ast) (sgot),301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$7.33 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,84460,84460 Alanine amino (alt) (sgpt),301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$7.52 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,84478,84478 Assay of triglycerides,301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$8.16 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,84484,84484 Assay of troponin quant,301,$66.95 ,$43.52 ,65% of total billed charges,$45.53 ,68% of total billed charges,N/A,Not reimbursable per contract,$10.57 ,100% of FL Medicaid fee schedule ,$13.39 ,20% of total billed charges,$13.39 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$13.39 ,20% of total billed charges,$13.39 ,20% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$43.52 ,65% of total billed charges,$43.52 ,65% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$39.00 ,Pays 100% medicare OPPS,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$33.48 ,50% of total billed charges,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$10.57 ,100% of FL Medicaid fee schedule ,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$39.00 ,Pays 100% medicare OPPS,$10.57 ,$43.52 ,$33.48 
Outpatient Medical Services,LAB,84520,84520 Assay of urea nitrogen,301,$25.75 ,$16.74 ,65% of total billed charges,$17.51 ,68% of total billed charges,$5.60 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.15 ,20% of total billed charges,$5.15 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.74 ,65% of total billed charges,$16.74 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$12.88 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$15.00 ,Pays 100% medicare OPPS,$4.89 ,$16.74 ,$12.88 
Outpatient Medical Services,LAB,84550,84550 Assay of blood/uric acid,301,$28.33 ,$18.41 ,65% of total billed charges,$19.26 ,68% of total billed charges,$6.41 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$18.41 ,65% of total billed charges,$18.41 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$14.17 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$4.89 ,$18.41 ,$14.17 
Outpatient Medical Services,LAB,84630,84630 Assay of zinc,301,$78.28 ,$50.88 ,65% of total billed charges,$53.23 ,68% of total billed charges,$16.17 ,100% of BCBS fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$15.66 ,20% of total billed charges,$15.66 ,20% of total billed charges,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$15.66 ,20% of total billed charges,$15.66 ,20% of total billed charges,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$50.88 ,65% of total billed charges,$50.88 ,65% of total billed charges,$10.63 ,100% of FL Medicaid fee schedule ,$45.60 ,Pays 100% medicare OPPS,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$39.14 ,50% of total billed charges,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$10.63 ,100% of FL Medicaid fee schedule ,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$45.60 ,Pays 100% medicare OPPS,$10.63 ,$50.88 ,$39.14 
Outpatient Medical Services,LAB,84702,84702 Chorionic gonadotropin test,301,$85.49 ,$55.57 ,65% of total billed charges,$58.13 ,68% of total billed charges,$21.36 ,100% of BCBS fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$17.10 ,20% of total billed charges,$17.10 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$17.10 ,20% of total billed charges,$17.10 ,20% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$55.57 ,65% of total billed charges,$55.57 ,65% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$49.80 ,Pays 100% medicare OPPS,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$42.75 ,50% of total billed charges,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$12.02 ,100% of FL Medicaid fee schedule ,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$12.02 ,$55.57 ,$42.75 
Outpatient Medical Services,LAB,84703,84703 Chorionic gonadotropin assay,301,$42.23 ,$27.45 ,65% of total billed charges,$28.72 ,68% of total billed charges,$10.66 ,100% of BCBS fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$8.45 ,20% of total billed charges,$8.45 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$8.45 ,20% of total billed charges,$8.45 ,20% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$27.45 ,65% of total billed charges,$27.45 ,65% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$24.60 ,Pays 100% medicare OPPS,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$21.12 ,50% of total billed charges,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$4.89 ,100% of FL Medicaid fee schedule ,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$24.60 ,Pays 100% medicare OPPS,$4.89 ,$27.45 ,$21.12 
Outpatient Medical Services,LAB,85014,85014 Hematocrit,305,$15.45 ,$10.04 ,65% of total billed charges,$10.51 ,68% of total billed charges,$3.36 ,100% of BCBS fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$3.09 ,20% of total billed charges,$3.09 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$3.09 ,20% of total billed charges,$3.09 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$10.04 ,65% of total billed charges,$10.04 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$9.00 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$7.73 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$5.49 ,$10.04 ,$7.73 
Outpatient Medical Services,LAB,85018,85018 Hemoglobin,305,$15.45 ,$10.04 ,65% of total billed charges,$10.51 ,68% of total billed charges,$3.35 ,100% of BCBS fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$3.09 ,20% of total billed charges,$3.09 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$3.09 ,20% of total billed charges,$3.09 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$10.04 ,65% of total billed charges,$10.04 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$9.00 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$7.73 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$9.00 ,Pays 100% medicare OPPS,$5.49 ,$10.04 ,$7.73 
Outpatient Medical Services,LAB,85025,"85025 Complete Blood Count (CBC), With Differential, Automated",305,$46.35 ,$30.13 ,65% of total billed charges,$31.52 ,68% of total billed charges,$11.04 ,100% of BCBS fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$30.13 ,65% of total billed charges,$30.13 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$23.18 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$5.49 ,$30.13 ,$23.18 
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",305,$46.35 ,$30.13 ,65% of total billed charges,$31.52 ,68% of total billed charges,$11.04 ,100% of BCBS fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$9.27 ,20% of total billed charges,$9.27 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$30.13 ,65% of total billed charges,$30.13 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$23.18 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$27.00 ,Pays 100% medicare OPPS,$5.49 ,$30.13 ,$23.18 
Outpatient Medical Services,LAB,85027,"85027 Complete Blood Count (CBC), Automated",305,$28.33 ,$18.41 ,65% of total billed charges,$19.26 ,68% of total billed charges,$9.19 ,100% of BCBS fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$18.41 ,65% of total billed charges,$18.41 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$14.17 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$5.49 ,$18.41 ,$14.17 
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",305,$28.33 ,$18.41 ,65% of total billed charges,$19.26 ,68% of total billed charges,$9.19 ,100% of BCBS fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.67 ,20% of total billed charges,$5.67 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$18.41 ,65% of total billed charges,$18.41 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$14.17 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$16.50 ,Pays 100% medicare OPPS,$5.49 ,$18.41 ,$14.17 
Outpatient Medical Services,LAB,85049,85049 Automated platelet count,305,$20.60 ,$13.39 ,65% of total billed charges,$14.01 ,68% of total billed charges,N/A,Not reimbursable per contract,$5.49 ,100% of FL Medicaid fee schedule ,$4.12 ,20% of total billed charges,$4.12 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$4.12 ,20% of total billed charges,$4.12 ,20% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$13.39 ,65% of total billed charges,$13.39 ,65% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$12.00 ,Pays 100% medicare OPPS,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$10.30 ,50% of total billed charges,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$5.49 ,100% of FL Medicaid fee schedule ,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$12.00 ,Pays 100% medicare OPPS,$5.49 ,$13.39 ,$10.30 
Outpatient Medical Services,LAB,85378,85378 D-Dimer Quant,305,$128.75 ,$83.69 ,65% of total billed charges,$87.55 ,68% of total billed charges,$10.12 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$25.75 ,20% of total billed charges,$25.75 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$25.75 ,20% of total billed charges,$25.75 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$83.69 ,65% of total billed charges,$83.69 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$75.00 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$64.38 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$3.62 ,$83.69 ,$64.38 
Outpatient Medical Services,LAB,85384,85384 Fibrinogen activity,305,$69.01 ,$44.86 ,65% of total billed charges,$46.93 ,68% of total billed charges,$12.05 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$13.80 ,20% of total billed charges,$13.80 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$13.80 ,20% of total billed charges,$13.80 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$44.86 ,65% of total billed charges,$44.86 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$40.20 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$34.51 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$40.20 ,Pays 100% medicare OPPS,$3.62 ,$44.86 ,$34.51 
Outpatient Medical Services,LAB,85610,85610 Clotting Time Blood Test,305,$61.80 ,$40.17 ,65% of total billed charges,$42.02 ,68% of total billed charges,$5.58 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$40.17 ,65% of total billed charges,$40.17 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$30.90 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$3.62 ,$40.17 ,$30.90 
Outpatient Medical Services,LAB,85610,"Blood test, clotting time",305,$61.80 ,$40.17 ,65% of total billed charges,$42.02 ,68% of total billed charges,$5.58 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$40.17 ,65% of total billed charges,$40.17 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$30.90 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$3.62 ,$40.17 ,$30.90 
Outpatient Medical Services,LAB,85670,85670 Thrombin time plasma,305,$70.04 ,$45.53 ,65% of total billed charges,$47.63 ,68% of total billed charges,$8.03 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$14.01 ,20% of total billed charges,$14.01 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$14.01 ,20% of total billed charges,$14.01 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$45.53 ,65% of total billed charges,$45.53 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$40.80 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$35.02 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$40.80 ,Pays 100% medicare OPPS,$3.62 ,$45.53 ,$35.02 
Outpatient Medical Services,LAB,85730,85730 Coagulation Assessment Blood Test,305,$61.80 ,$40.17 ,65% of total billed charges,$42.02 ,68% of total billed charges,$8.52 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$40.17 ,65% of total billed charges,$40.17 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$30.90 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$3.62 ,$40.17 ,$30.90 
Outpatient Medical Services,LAB,85730,Coagulation assessment blood test,305,$61.80 ,$40.17 ,65% of total billed charges,$42.02 ,68% of total billed charges,$8.52 ,100% of BCBS fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$40.17 ,65% of total billed charges,$40.17 ,65% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$30.90 ,50% of total billed charges,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$3.62 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$3.62 ,$40.17 ,$30.90 
Outpatient Medical Services,LAB,86003,86003 Allergen specific ige,302,$27.81 ,$18.08 ,65% of total billed charges,$18.91 ,68% of total billed charges,$7.41 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$5.56 ,20% of total billed charges,$5.56 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$5.56 ,20% of total billed charges,$5.56 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$18.08 ,65% of total billed charges,$18.08 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$16.20 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$13.91 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$16.20 ,Pays 100% medicare OPPS,$9.90 ,$18.08 ,$13.91 
Outpatient Medical Services,LAB,86038,86038 Antinuclear antibodies,302,$61.80 ,$40.17 ,65% of total billed charges,$42.02 ,68% of total billed charges,$17.15 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$12.36 ,20% of total billed charges,$12.36 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$40.17 ,65% of total billed charges,$40.17 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$30.90 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$36.00 ,Pays 100% medicare OPPS,$9.90 ,$40.17 ,$30.90 
Outpatient Medical Services,LAB,86140,86140 C-reactive protein,302,$82.40 ,$53.56 ,65% of total billed charges,$56.03 ,68% of total billed charges,$7.34 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$53.56 ,65% of total billed charges,$53.56 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$33.00 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$41.20 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$33.00 ,Pays 100% medicare OPPS,$9.90 ,$53.56 ,$41.20 
Outpatient Medical Services,LAB,86160,86160 Complement antigen,302,$73.13 ,$47.53 ,65% of total billed charges,$49.73 ,68% of total billed charges,$17.04 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$14.63 ,20% of total billed charges,$14.63 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$14.63 ,20% of total billed charges,$14.63 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$47.53 ,65% of total billed charges,$47.53 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$42.60 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$36.57 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$42.60 ,Pays 100% medicare OPPS,$9.90 ,$47.53 ,$36.57 
Outpatient Medical Services,LAB,86235,86235 Nuclear antigen antibody,302,$115.36 ,$74.98 ,65% of total billed charges,$78.44 ,68% of total billed charges,$25.45 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$23.07 ,20% of total billed charges,$23.07 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$23.07 ,20% of total billed charges,$23.07 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$74.98 ,65% of total billed charges,$74.98 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$67.20 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$57.68 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$67.20 ,Pays 100% medicare OPPS,$9.90 ,$74.98 ,$57.68 
Outpatient Medical Services,LAB,86300,86300 Immunoassay tumor ca 15-3,302,$164.80 ,$107.12 ,65% of total billed charges,$112.06 ,68% of total billed charges,N/A,Not reimbursable per contract,$9.90 ,100% of FL Medicaid fee schedule ,$32.96 ,20% of total billed charges,$32.96 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$32.96 ,20% of total billed charges,$32.96 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$107.12 ,65% of total billed charges,$107.12 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$96.00 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$82.40 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$96.00 ,Pays 100% medicare OPPS,$9.90 ,$107.12 ,$82.40 
Outpatient Medical Services,LAB,86317,86317 Immunoassay infectious agent,302,$87.55 ,$56.91 ,65% of total billed charges,$59.53 ,68% of total billed charges,$21.28 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$17.51 ,20% of total billed charges,$17.51 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$17.51 ,20% of total billed charges,$17.51 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$56.91 ,65% of total billed charges,$56.91 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$51.00 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$43.78 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$51.00 ,Pays 100% medicare OPPS,$9.90 ,$56.91 ,$43.78 
Outpatient Medical Services,LAB,86334,86334 Immunofix e-phoresis serum,302,$43.26 ,$28.12 ,65% of total billed charges,$29.42 ,68% of total billed charges,$31.71 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$8.65 ,20% of total billed charges,$8.65 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$8.65 ,20% of total billed charges,$8.65 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$28.12 ,65% of total billed charges,$28.12 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$25.20 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$21.63 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$25.20 ,Pays 100% medicare OPPS,$9.90 ,$28.12 ,$21.63 
Outpatient Medical Services,LAB,86360,86360 T cell absolute count/ratio,302,$174.07 ,$113.15 ,65% of total billed charges,$118.37 ,68% of total billed charges,$9.66 ,100% of BCBS fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$34.81 ,20% of total billed charges,$34.81 ,20% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$34.81 ,20% of total billed charges,$34.81 ,20% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$113.15 ,65% of total billed charges,$113.15 ,65% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$101.40 ,Pays 100% medicare OPPS,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$87.04 ,50% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$32.91 ,$113.15 ,$87.04 
Outpatient Medical Services,LAB,86480,86480 Tb test cell immun measure,301,$123.60 ,$80.34 ,65% of total billed charges,$84.05 ,68% of total billed charges,N/A,Not reimbursable per contract,$32.91 ,100% of FL Medicaid fee schedule ,$24.72 ,20% of total billed charges,$24.72 ,20% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$24.72 ,20% of total billed charges,$24.72 ,20% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$80.34 ,65% of total billed charges,$80.34 ,65% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$72.00 ,Pays 100% medicare OPPS,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$61.80 ,50% of total billed charges,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$32.91 ,100% of FL Medicaid fee schedule ,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$32.91 ,$80.34 ,$61.80 
Outpatient Medical Services,LAB,86592,86592 Syphilis test non-trep qual,302,$36.05 ,$23.43 ,65% of total billed charges,$24.51 ,68% of total billed charges,$6.06 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$7.21 ,20% of total billed charges,$7.21 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$7.21 ,20% of total billed charges,$7.21 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$23.43 ,65% of total billed charges,$23.43 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$21.00 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$18.03 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$21.00 ,Pays 100% medicare OPPS,$9.90 ,$23.43 ,$18.03 
Outpatient Medical Services,LAB,86618,86618 Lyme disease antibody,302,$140.08 ,$91.05 ,65% of total billed charges,$95.25 ,68% of total billed charges,$20.82 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$28.02 ,20% of total billed charges,$28.02 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$28.02 ,20% of total billed charges,$28.02 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$91.05 ,65% of total billed charges,$91.05 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$81.60 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$70.04 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$81.60 ,Pays 100% medicare OPPS,$9.90 ,$91.05 ,$70.04 
Outpatient Medical Services,LAB,86704,86704 Hep b core antibody total,302,$58.71 ,$38.16 ,65% of total billed charges,$39.92 ,68% of total billed charges,$16.66 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$11.74 ,20% of total billed charges,$11.74 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$11.74 ,20% of total billed charges,$11.74 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$38.16 ,65% of total billed charges,$38.16 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$29.36 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$9.90 ,$38.16 ,$29.36 
Outpatient Medical Services,LAB,86706,86706 Hep b surface antibody,302,$64.89 ,$42.18 ,65% of total billed charges,$44.13 ,68% of total billed charges,$14.84 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$12.98 ,20% of total billed charges,$12.98 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$12.98 ,20% of total billed charges,$12.98 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$42.18 ,65% of total billed charges,$42.18 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$32.45 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$9.90 ,$42.18 ,$32.45 
Outpatient Medical Services,LAB,86762,86762 Rubella antibody,302,$57.68 ,$37.49 ,65% of total billed charges,$39.22 ,68% of total billed charges,$20.43 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$11.54 ,20% of total billed charges,$11.54 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$11.54 ,20% of total billed charges,$11.54 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$37.49 ,65% of total billed charges,$37.49 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$33.60 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$28.84 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$33.60 ,Pays 100% medicare OPPS,$9.90 ,$37.49 ,$28.84 
Outpatient Medical Services,LAB,86787,86787 Varicella-zoster antibody,302,$103.00 ,$66.95 ,65% of total billed charges,$70.04 ,68% of total billed charges,$18.29 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$20.60 ,20% of total billed charges,$20.60 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$20.60 ,20% of total billed charges,$20.60 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$66.95 ,65% of total billed charges,$66.95 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$22.80 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$51.50 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$22.80 ,Pays 100% medicare OPPS,$9.90 ,$66.95 ,$51.50 
Outpatient Medical Services,LAB,86803,86803 Hepatitis c ab test,302,$93.73 ,$60.92 ,65% of total billed charges,$63.74 ,68% of total billed charges,$19.73 ,100% of BCBS fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$18.75 ,20% of total billed charges,$18.75 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$18.75 ,20% of total billed charges,$18.75 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$60.92 ,65% of total billed charges,$60.92 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$54.60 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$46.87 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$54.60 ,Pays 100% medicare OPPS,$9.90 ,$60.92 ,$46.87 
Outpatient Medical Services,LAB,86870,86870 Rbc antibody identification,309,$195.70 ,$127.21 ,65% of total billed charges,$133.08 ,68% of total billed charges,N/A,Not reimbursable per contract,$138.34 ,100% of FL Medicaid fee schedule ,$39.14 ,20% of total billed charges,$39.14 ,20% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$39.14 ,20% of total billed charges,$39.14 ,20% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$127.21 ,65% of total billed charges,$127.21 ,65% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$114.00 ,Pays 100% medicare OPPS,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$97.85 ,50% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$114.00 ,Pays 100% medicare OPPS,$97.85 ,$138.34 ,$97.85 
Outpatient Medical Services,LAB,86880,86880 Coombs test direct,309,$52.53 ,$34.14 ,65% of total billed charges,$35.72 ,68% of total billed charges,$7.62 ,100% of BCBS fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$10.51 ,20% of total billed charges,$10.51 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$10.51 ,20% of total billed charges,$10.51 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$34.14 ,65% of total billed charges,$34.14 ,65% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$30.60 ,Pays 100% medicare OPPS,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$26.27 ,50% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$3.99 ,$34.14 ,$26.27 
Outpatient Medical Services,LAB,86900,86900 Blood typing serologic abo,309,$52.53 ,$34.14 ,65% of total billed charges,$35.72 ,68% of total billed charges,$4.23 ,100% of BCBS fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$10.51 ,20% of total billed charges,$10.51 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$10.51 ,20% of total billed charges,$10.51 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$34.14 ,65% of total billed charges,$34.14 ,65% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$30.60 ,Pays 100% medicare OPPS,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$26.27 ,50% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$30.60 ,Pays 100% medicare OPPS,$3.99 ,$34.14 ,$26.27 
Outpatient Medical Services,LAB,86901,86901 Blood typing serologic rh(d),309,$28.84 ,$18.75 ,65% of total billed charges,$19.61 ,68% of total billed charges,N/A,Not reimbursable per contract,$3.99 ,100% of FL Medicaid fee schedule ,$5.77 ,20% of total billed charges,$5.77 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$5.77 ,20% of total billed charges,$5.77 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$18.75 ,65% of total billed charges,$18.75 ,65% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$16.80 ,Pays 100% medicare OPPS,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$14.42 ,50% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$16.80 ,Pays 100% medicare OPPS,$3.99 ,$18.75 ,$14.42 
Outpatient Medical Services,LAB,86902,86902 Blood type antigen donor ea,309,$95.79 ,$62.26 ,65% of total billed charges,$65.14 ,68% of total billed charges,$8.37 ,100% of BCBS fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$19.16 ,20% of total billed charges,$19.16 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$19.16 ,20% of total billed charges,$19.16 ,20% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$62.26 ,65% of total billed charges,$62.26 ,65% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$55.80 ,Pays 100% medicare OPPS,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$47.90 ,50% of total billed charges,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$3.99 ,100% of FL Medicaid fee schedule ,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$55.80 ,Pays 100% medicare OPPS,$3.99 ,$62.26 ,$47.90 
Outpatient Medical Services,LAB,86922,86922 Compatibility test antiglob,390,$97.85 ,$63.60 ,65% of total billed charges,$66.54 ,68% of total billed charges,N/A,Not reimbursable per contract,$138.34 ,100% of FL Medicaid fee schedule ,$19.57 ,20% of total billed charges,$19.57 ,20% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$19.57 ,20% of total billed charges,$19.57 ,20% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$63.60 ,65% of total billed charges,$63.60 ,65% of total billed charges,$138.34 ,100% of FL Medicaid fee schedule ,$57.00 ,Pays 100% medicare OPPS,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,N/A,100% of case rate fee,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$138.34 ,100% of FL Medicaid fee schedule ,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,$138.34 ,$48.93 
Outpatient Medical Services,LAB,87040,87040 Blood culture for bacteria,306,$92.70 ,$60.26 ,65% of total billed charges,$63.04 ,68% of total billed charges,$14.65 ,100% of BCBS fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$18.54 ,20% of total billed charges,$18.54 ,20% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$60.26 ,65% of total billed charges,$60.26 ,65% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$46.35 ,50% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$54.00 ,Pays 100% medicare OPPS,$7.13 ,$60.26 ,$46.35 
Outpatient Medical Services,LAB,87070,87070 Culture othr specimn aerobic,306,$58.71 ,$38.16 ,65% of total billed charges,$39.92 ,68% of total billed charges,$12.22 ,100% of BCBS fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$11.74 ,20% of total billed charges,$11.74 ,20% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$11.74 ,20% of total billed charges,$11.74 ,20% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$38.16 ,65% of total billed charges,$38.16 ,65% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$29.36 ,50% of total billed charges,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$7.13 ,100% of FL Medicaid fee schedule ,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$34.20 ,Pays 100% medicare OPPS,$7.13 ,$38.16 ,$29.36 
Outpatient Medical Services,LAB,G0103,PSA screening,309,$82.40 ,$53.56 ,65% of total billed charges,$56.03 ,68% of total billed charges,N/A,Not reimbursable per contract,$9.90 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$16.48 ,20% of total billed charges,$16.48 ,20% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$53.56 ,65% of total billed charges,$53.56 ,65% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$48.00 ,Pays 100% medicare OPPS,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$41.20 ,50% of total billed charges,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$9.90 ,100% of FL Medicaid fee schedule ,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$48.00 ,Pays 100% medicare OPPS,$9.90 ,$53.56 ,$41.20 
Outpatient Medical Services,RADIOLOGY,70450,"CT scan, head or brain, without contrast",351,"$1,133.00 ",$736.45 ,65% of total billed charges,$770.44 ,68% of total billed charges,$157.68 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$226.60 ,20% of total billed charges,$226.60 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$226.60 ,20% of total billed charges,$226.60 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$736.45 ,65% of total billed charges,$736.45 ,65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$135.85 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,Pays 100% medicare OPPS,$135.85 ,$736.45 ,$566.50 
Outpatient Medical Services,RADIOLOGY,70486,"CT, Maxillofacial without contrast GLR",351,$824.00 ,$535.60 ,65% of total billed charges,$560.32 ,68% of total billed charges,$157.68 ,100% of BCBS fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$164.80 ,20% of total billed charges,$164.80 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$164.80 ,20% of total billed charges,$164.80 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$535.60 ,65% of total billed charges,$535.60 ,65% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$480.00 ,Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$116.42 ,$535.60 ,$412.00 
Outpatient Medical Services,RADIOLOGY,70486,"CT, Maxillofacial without contrast PFR",972,$246.17 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$142.31 ,110% of physician fee schedule,$142.31 ,110% of physician fee schedule,$116.42 ,100% of FL Medicaid fee schedule ,$480.00 ,Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$547.64 ,115% of physician fee schedule,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$480.00 ,Pays 100% medicare OPPS,$116.42 ,$547.64 ,$123.09 
Outpatient Medical Services,RADIOLOGY,70491,CT scan soft tissue Neck with contrast,351,"$1,236.00 ",$803.40 ,65% of total billed charges,$840.48 ,68% of total billed charges,$189.00 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$247.20 ,20% of total billed charges,$247.20 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$247.20 ,20% of total billed charges,$247.20 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$803.40 ,65% of total billed charges,$803.40 ,65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$236.81 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,Pays 100% medicare OPPS,$236.81 ,$803.40 ,$618.00 
Outpatient Medical Services,RADIOLOGY,70496,"CT, Angiography Head GLR",351,"$2,107.38 ","$1,369.80 ",65% of total billed charges,"$1,433.02 ",68% of total billed charges,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$421.48 ,20% of total billed charges,$421.48 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$421.48 ,20% of total billed charges,$421.48 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,369.80 ",65% of total billed charges,"$1,369.80 ",65% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,"$1,369.80 ","$1,053.69 "
Outpatient Medical Services,RADIOLOGY,70496,"CT, Angiography Head PFR",972,$597.40 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$307.56 ,110% of physician fee schedule,$307.56 ,110% of physician fee schedule,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$720.40 ,115% of physician fee schedule,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,$307.56 ,"$1,227.60 ",$298.70 
Outpatient Medical Services,RADIOLOGY,70498,"CT, Angiography Neck GLR",351,"$2,107.38 ","$1,369.80 ",65% of total billed charges,"$1,433.02 ",68% of total billed charges,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$421.48 ,20% of total billed charges,$421.48 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$421.48 ,20% of total billed charges,$421.48 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,369.80 ",65% of total billed charges,"$1,369.80 ",65% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,"$1,369.80 ","$1,053.69 "
Outpatient Medical Services,RADIOLOGY,70498,"CT, Angiography Neck PFR",972,$597.40 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$307.21 ,110% of physician fee schedule,$307.21 ,110% of physician fee schedule,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$720.03 ,115% of physician fee schedule,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,$307.21 ,"$1,227.60 ",$298.70 
Outpatient Medical Services,RADIOLOGY,71045,"XRAY, Chest, Single View, Frontal GLR",324,$77.25 ,$50.21 ,65% of total billed charges,$52.53 ,68% of total billed charges,$15.82 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$50.21 ,65% of total billed charges,$50.21 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,$180.00 ,$38.63 
Outpatient Medical Services,RADIOLOGY,71045,"XRAY, Chest, Single View, Frontal PFR",972,$43.26 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$28.11 ,110% of physician fee schedule,$28.11 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$205.78 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$28.11 ,$205.78 ,$21.63 
Outpatient Medical Services,RADIOLOGY,71046,"XRAY, Chest 2 Views GLR",324,$77.25 ,$50.21 ,65% of total billed charges,$52.53 ,68% of total billed charges,$20.37 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$15.45 ,20% of total billed charges,$15.45 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$50.21 ,65% of total billed charges,$50.21 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,$180.00 ,$38.63 
Outpatient Medical Services,RADIOLOGY,71046,"XRAY, Chest 2 Views PFR",972,$53.56 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.26 ,110% of physician fee schedule,$36.26 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$214.30 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$45.00 ,Pays 100% medicare OPPS,$36.26 ,$214.30 ,$26.78 
Outpatient Medical Services,RADIOLOGY,71250,"CT, Thorax without contrast GLR",352,"$2,678.00 ","$1,740.70 ",65% of total billed charges,"$1,821.04 ",68% of total billed charges,$197.14 ,100% of BCBS fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$535.60 ,20% of total billed charges,$535.60 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$535.60 ,20% of total billed charges,$535.60 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,"$1,740.70 ",65% of total billed charges,"$1,740.70 ",65% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,"$1,560.00 ",Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,$116.42 ,"$1,740.70 ","$1,339.00 "
Outpatient Medical Services,RADIOLOGY,71250,"CT, Thorax without contrast PFR",972,$314.97 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$148.46 ,110% of physician fee schedule,$148.46 ,110% of physician fee schedule,$116.42 ,100% of FL Medicaid fee schedule ,"$1,560.00 ",Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$554.06 ,115% of physician fee schedule,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,"$1,560.00 ",Pays 100% medicare OPPS,$116.42 ,"$1,560.00 ",$157.49 
Outpatient Medical Services,RADIOLOGY,71260,"CT, Thorax with contrast GLR",352,"$1,931.25 ","$1,255.31 ",65% of total billed charges,"$1,313.25 ",68% of total billed charges,$235.97 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$386.25 ,20% of total billed charges,$386.25 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$386.25 ,20% of total billed charges,$386.25 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,255.31 ",65% of total billed charges,"$1,255.31 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$213.46 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,"$1,255.31 ",$965.63 
Outpatient Medical Services,RADIOLOGY,71260,"CT, Thorax with contrast PFR",972,$343.30 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$185.61 ,110% of physician fee schedule,$185.61 ,110% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,$213.46 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$592.91 ,115% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$213.46 ,Pays 100% medicare OPPS,$185.61 ,$592.91 ,$171.65 
Outpatient Medical Services,RADIOLOGY,71270,"CT, Chest with and without contrast",352,"$3,296.00 ","$2,142.40 ",65% of total billed charges,"$2,241.28 ",68% of total billed charges,$294.28 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$659.20 ,20% of total billed charges,$659.20 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$659.20 ,20% of total billed charges,$659.20 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$2,142.40 ",65% of total billed charges,"$2,142.40 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,"$1,920.00 ",Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,"$1,920.00 ",Pays 100% medicare OPPS,$319.79 ,"$2,142.40 ","$1,648.00 "
Outpatient Medical Services,RADIOLOGY,71275,"CTA, Chest",352,"$1,081.50 ",$702.98 ,65% of total billed charges,$735.42 ,68% of total billed charges,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$216.30 ,20% of total billed charges,$216.30 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$216.30 ,20% of total billed charges,$216.30 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$702.98 ,65% of total billed charges,$702.98 ,65% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$630.00 ,Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$630.00 ,Pays 100% medicare OPPS,$395.21 ,$702.98 ,$540.75 
Outpatient Medical Services,RADIOLOGY,72040,"XRAY, Neck Spine 2-3 Views GLR",320,$334.75 ,$217.59 ,65% of total billed charges,$227.63 ,68% of total billed charges,$20.13 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$66.95 ,20% of total billed charges,$66.95 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$66.95 ,20% of total billed charges,$66.95 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$217.59 ,65% of total billed charges,$217.59 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$195.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$56.10 ,$217.59 ,$167.38 
Outpatient Medical Services,RADIOLOGY,72040,"XRAY, Neck Spine 2-3 Views PFR",972,$60.05 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$42.56 ,110% of physician fee schedule,$42.56 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$195.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$220.89 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$42.56 ,$220.89 ,$30.03 
Outpatient Medical Services,RADIOLOGY,72100,"XRAY, Lumbar Spine 2-3 Views GLR",320,$206.00 ,$133.90 ,65% of total billed charges,$140.08 ,68% of total billed charges,$22.37 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$133.90 ,65% of total billed charges,$133.90 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$120.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$56.10 ,$180.00 ,$103.00 
Outpatient Medical Services,RADIOLOGY,72100,"XRAY, Lumbar Spine 2-3 Views PFR",972,$64.58 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$42.91 ,110% of physician fee schedule,$42.91 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$120.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$221.26 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$42.91 ,$221.26 ,$32.29 
Outpatient Medical Services,RADIOLOGY,72110,"X-Ray, lower back, minimum four views",320,$249.26 ,$162.02 ,65% of total billed charges,$169.50 ,68% of total billed charges,$30.67 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$49.85 ,20% of total billed charges,$49.85 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$49.85 ,20% of total billed charges,$49.85 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$162.02 ,65% of total billed charges,$162.02 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$63.16 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$63.16 ,Pays 100% medicare OPPS,$56.10 ,$180.00 ,$124.63 
Outpatient Medical Services,RADIOLOGY,72125,"CT, Neck Spine without contrast GLR",352,$721.00 ,$468.65 ,65% of total billed charges,$490.28 ,68% of total billed charges,$197.14 ,100% of BCBS fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$144.20 ,20% of total billed charges,$144.20 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$144.20 ,20% of total billed charges,$144.20 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$468.65 ,65% of total billed charges,$468.65 ,65% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$420.00 ,Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$116.42 ,$468.65 ,$360.50 
Outpatient Medical Services,RADIOLOGY,72125,"CT, Neck Spine without contrast PFR",972,$284.28 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$144.05 ,110% of physician fee schedule,$144.05 ,110% of physician fee schedule,$116.42 ,100% of FL Medicaid fee schedule ,$420.00 ,Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$549.45 ,115% of physician fee schedule,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$420.00 ,Pays 100% medicare OPPS,$116.42 ,$549.45 ,$142.14 
Outpatient Medical Services,RADIOLOGY,72131,"CT, Lumbar Spine without contrast",352,"$1,611.95 ","$1,047.77 ",65% of total billed charges,"$1,096.13 ",68% of total billed charges,$197.14 ,100% of BCBS fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$322.39 ,20% of total billed charges,$322.39 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$322.39 ,20% of total billed charges,$322.39 ,20% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,"$1,047.77 ",65% of total billed charges,"$1,047.77 ",65% of total billed charges,$116.42 ,100% of FL Medicaid fee schedule ,$164.84 ,Pays 100% medicare OPPS,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$116.42 ,100% of FL Medicaid fee schedule ,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$164.84 ,Pays 100% medicare OPPS,$116.42 ,"$1,047.77 ",$805.98 
Outpatient Medical Services,RADIOLOGY,72132,"CT, Lumbar Spine with contrast",352,"$1,103.13 ",$717.03 ,65% of total billed charges,$750.13 ,68% of total billed charges,$235.97 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$220.63 ,20% of total billed charges,$220.63 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$220.63 ,20% of total billed charges,$220.63 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$717.03 ,65% of total billed charges,$717.03 ,65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$216.43 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,Pays 100% medicare OPPS,$216.43 ,$717.03 ,$551.57 
Outpatient Medical Services,RADIOLOGY,72170,"XRAY, Pelvis GLR",320,$218.36 ,$141.93 ,65% of total billed charges,$148.48 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.67 ,20% of total billed charges,$43.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.67 ,20% of total billed charges,$43.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$141.93 ,65% of total billed charges,$141.93 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$34.71 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,$180.00 ,$109.18 
Outpatient Medical Services,RADIOLOGY,72170,"XRAY, Pelvis PFR",972,$49.85 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$30.18 ,110% of physician fee schedule,$30.18 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$34.71 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$207.96 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$34.71 ,Pays 100% medicare OPPS,$30.18 ,$207.96 ,$24.93 
Outpatient Medical Services,RADIOLOGY,72193,"CT, Pelvis with contrast GLR",352,"$1,596.50 ","$1,037.73 ",65% of total billed charges,"$1,085.62 ",68% of total billed charges,$227.98 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.30 ,20% of total billed charges,$319.30 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.30 ,20% of total billed charges,$319.30 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,037.73 ",65% of total billed charges,"$1,037.73 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$930.00 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$319.79 ,"$1,037.73 ",$798.25 
Outpatient Medical Services,RADIOLOGY,72193,"CT, Pelvis with contrast PFR",972,$283.25 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$256.05 ,110% of physician fee schedule,$256.05 ,110% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,$930.00 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$666.55 ,115% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$256.05 ,$930.00 ,$141.63 
Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",352,"$1,596.50 ","$1,037.73 ",65% of total billed charges,"$1,085.62 ",68% of total billed charges,$227.98 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.30 ,20% of total billed charges,$319.30 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.30 ,20% of total billed charges,$319.30 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,037.73 ",65% of total billed charges,"$1,037.73 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$930.00 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$930.00 ,Pays 100% medicare OPPS,$319.79 ,"$1,037.73 ",$798.25 
Outpatient Medical Services,RADIOLOGY,73000,"XRAY, Clavicle  GLR",320,$218.36 ,$141.93 ,65% of total billed charges,$148.48 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.67 ,20% of total billed charges,$43.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.67 ,20% of total billed charges,$43.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$141.93 ,65% of total billed charges,$141.93 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,$180.00 ,$109.18 
Outpatient Medical Services,RADIOLOGY,73000,"XRAY, Clavicle PFR",972,$72.10 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$34.72 ,110% of physician fee schedule,$34.72 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$212.69 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$34.72 ,$212.69 ,$36.05 
Outpatient Medical Services,RADIOLOGY,73030,"XRAY, Shoulder GLR",320,$206.00 ,$133.90 ,65% of total billed charges,$140.08 ,68% of total billed charges,$19.17 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$133.90 ,65% of total billed charges,$133.90 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$42.81 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,$180.00 ,$103.00 
Outpatient Medical Services,RADIOLOGY,73030,"XRAY, Shoulder PFR",972,$91.77 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$37.22 ,110% of physician fee schedule,$37.22 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$42.81 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$215.32 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$42.81 ,Pays 100% medicare OPPS,$37.22 ,$215.32 ,$45.89 
Outpatient Medical Services,RADIOLOGY,73060,"XRAY, Humerus GLR",320,$206.00 ,$133.90 ,65% of total billed charges,$140.08 ,68% of total billed charges,$19.17 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$133.90 ,65% of total billed charges,$133.90 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,$180.00 ,$103.00 
Outpatient Medical Services,RADIOLOGY,73060,"XRAY, Humerus PFR",972,$81.37 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$34.72 ,110% of physician fee schedule,$34.72 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$212.69 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$39.92 ,Pays 100% medicare OPPS,$34.72 ,$212.69 ,$40.69 
Outpatient Medical Services,RADIOLOGY,73070,"XRAY, Elbow 2 Views GLR",324,$162.74 ,$105.78 ,65% of total billed charges,$110.66 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$32.55 ,20% of total billed charges,$32.55 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$32.55 ,20% of total billed charges,$32.55 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$105.78 ,65% of total billed charges,$105.78 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,$180.00 ,$81.37 
Outpatient Medical Services,RADIOLOGY,73070,"XRAY, Elbow 2 Views PFR",972,$89.51 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$31.57 ,110% of physician fee schedule,$31.57 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$209.41 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$31.57 ,$209.41 ,$44.76 
Outpatient Medical Services,RADIOLOGY,73090,"XRAY, Forearm 2 Views GLR",320,$206.00 ,$133.90 ,65% of total billed charges,$140.08 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$133.90 ,65% of total billed charges,$133.90 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,$180.00 ,$103.00 
Outpatient Medical Services,RADIOLOGY,73090,"XRAY, Forearm 2 Views PFR",972,$75.19 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$31.57 ,110% of physician fee schedule,$31.57 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$209.41 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$36.31 ,Pays 100% medicare OPPS,$31.57 ,$209.41 ,$37.60 
Outpatient Medical Services,RADIOLOGY,73110,"XRAY, Wrist 3 Views GLR",320,$164.29 ,$106.79 ,65% of total billed charges,$111.72 ,68% of total billed charges,$17.73 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$32.86 ,20% of total billed charges,$32.86 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$32.86 ,20% of total billed charges,$32.86 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$106.79 ,65% of total billed charges,$106.79 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$50.44 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,$180.00 ,$82.15 
Outpatient Medical Services,RADIOLOGY,73110,"XRAY, Wrist 3 Views PFR",972,$84.98 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.86 ,110% of physician fee schedule,$43.86 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$50.44 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$222.25 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$50.44 ,Pays 100% medicare OPPS,$43.86 ,$222.25 ,$42.49 
Outpatient Medical Services,RADIOLOGY,73130,"XRAY, Hand 3 Views GLR",320,$234.84 ,$152.65 ,65% of total billed charges,$159.69 ,68% of total billed charges,$17.73 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$46.97 ,20% of total billed charges,$46.97 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$46.97 ,20% of total billed charges,$46.97 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$152.65 ,65% of total billed charges,$152.65 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,$180.00 ,$117.42 
Outpatient Medical Services,RADIOLOGY,73130,"XRAY, Hand 3 Views PFR",972,$84.98 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.64 ,110% of physician fee schedule,$39.64 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$217.85 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$39.64 ,$217.85 ,$42.49 
Outpatient Medical Services,RADIOLOGY,73140,"XRAY, Fingers GLR",320,$183.34 ,$119.17 ,65% of total billed charges,$124.67 ,68% of total billed charges,$14.22 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.67 ,20% of total billed charges,$36.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.67 ,20% of total billed charges,$36.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$119.17 ,65% of total billed charges,$119.17 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$46.70 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,$180.00 ,$91.67 
Outpatient Medical Services,RADIOLOGY,73140,"XRAY, Fingers PFR",972,$62.32 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$40.61 ,110% of physician fee schedule,$40.61 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$46.70 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$218.86 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$46.70 ,Pays 100% medicare OPPS,$40.61 ,$218.86 ,$31.16 
Outpatient Medical Services,RADIOLOGY,73552,"XRAY, Femur 2 Views GLR",320,$218.36 ,$141.93 ,65% of total billed charges,$148.48 ,68% of total billed charges,$19.17 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.67 ,20% of total billed charges,$43.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.67 ,20% of total billed charges,$43.67 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$141.93 ,65% of total billed charges,$141.93 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$44.01 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,$180.00 ,$109.18 
Outpatient Medical Services,RADIOLOGY,73552,"XRAY, Femur 2 Views PFR",972,$89.51 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$38.27 ,110% of physician fee schedule,$38.27 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$44.01 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$216.41 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$44.01 ,Pays 100% medicare OPPS,$38.27 ,$216.41 ,$44.76 
Outpatient Medical Services,RADIOLOGY,73560,"XRAY, Knee 1 or 2 Views GLR",320,$226.60 ,$147.29 ,65% of total billed charges,$154.09 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.32 ,20% of total billed charges,$45.32 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.32 ,20% of total billed charges,$45.32 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$147.29 ,65% of total billed charges,$147.29 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$132.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$56.10 ,$180.00 ,$113.30 
Outpatient Medical Services,RADIOLOGY,73560,"XRAY, Knee 1 or 2 Views PFR",972,$82.71 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.83 ,110% of physician fee schedule,$36.83 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$132.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$214.90 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$36.83 ,$214.90 ,$41.36 
Outpatient Medical Services,RADIOLOGY,73590,"XRAY, Tibia Fibula 2 Views GLR",320,$216.30 ,$140.60 ,65% of total billed charges,$147.08 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.26 ,20% of total billed charges,$43.26 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$43.26 ,20% of total billed charges,$43.26 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$140.60 ,65% of total billed charges,$140.60 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$39.13 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,$180.00 ,$108.15 
Outpatient Medical Services,RADIOLOGY,73590,"XRAY, Tibia Fibula 2 Views PFR",972,$82.71 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$34.02 ,110% of physician fee schedule,$34.02 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$39.13 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$211.97 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$39.13 ,Pays 100% medicare OPPS,$34.02 ,$211.97 ,$41.36 
Outpatient Medical Services,RADIOLOGY,73600,"XRAY, Ankle 2 Views GLR",320,$179.22 ,$116.49 ,65% of total billed charges,$121.87 ,68% of total billed charges,$16.46 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$35.84 ,20% of total billed charges,$35.84 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$35.84 ,20% of total billed charges,$35.84 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$116.49 ,65% of total billed charges,$116.49 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$104.40 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$56.10 ,$180.00 ,$89.61 
Outpatient Medical Services,RADIOLOGY,73600,"XRAY, Ankle 2 Views PFR",972,$57.78 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$35.07 ,110% of physician fee schedule,$35.07 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$104.40 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$213.06 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$104.40 ,Pays 100% medicare OPPS,$35.07 ,$213.06 ,$28.89 
Outpatient Medical Services,RADIOLOGY,73610,"XRAY, Ankle, Complete, => 3 Views GLR",320,$181.28 ,$117.83 ,65% of total billed charges,$123.27 ,68% of total billed charges,$17.73 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.26 ,20% of total billed charges,$36.26 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.26 ,20% of total billed charges,$36.26 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$117.83 ,65% of total billed charges,$117.83 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,$180.00 ,$90.64 
Outpatient Medical Services,RADIOLOGY,73610,"XRAY, Ankle, Complete, => 3 Views PFR",972,$84.98 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$39.64 ,110% of physician fee schedule,$39.64 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$217.85 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$45.59 ,Pays 100% medicare OPPS,$39.64 ,$217.85 ,$42.49 
Outpatient Medical Services,RADIOLOGY,73630,"XRAY, Foot, Complete, => 3 Views GLR",320,$180.25 ,$117.16 ,65% of total billed charges,$122.57 ,68% of total billed charges,$17.73 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.05 ,20% of total billed charges,$36.05 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.05 ,20% of total billed charges,$36.05 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$117.16 ,65% of total billed charges,$117.16 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$42.38 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,$180.00 ,$90.13 
Outpatient Medical Services,RADIOLOGY,73630,"XRAY, Foot, Complete, => 3 Views PFR",972,$89.51 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$36.85 ,110% of physician fee schedule,$36.85 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$42.38 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$214.93 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$42.38 ,Pays 100% medicare OPPS,$36.85 ,$214.93 ,$44.76 
Outpatient Medical Services,RADIOLOGY,74018,"XRAY, Abdomen 1 View GLR",320,$309.00 ,$200.85 ,65% of total billed charges,$210.12 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$200.85 ,65% of total billed charges,$200.85 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$56.10 ,$200.85 ,$154.50 
Outpatient Medical Services,RADIOLOGY,74018,"XRAY, Abdomen 1 View PFR",972,$50.99 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$32.32 ,110% of physician fee schedule,$32.32 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$210.19 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$32.32 ,$210.19 ,$25.50 
Outpatient Medical Services,RADIOLOGY,74022,Abdominal Series,320,$226.60 ,$147.29 ,65% of total billed charges,$154.09 ,68% of total billed charges,$24.76 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.32 ,20% of total billed charges,$45.32 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$45.32 ,20% of total billed charges,$45.32 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$147.29 ,65% of total billed charges,$147.29 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$132.00 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$132.00 ,Pays 100% medicare OPPS,$56.10 ,$180.00 ,$113.30 
Outpatient Medical Services,RADIOLOGY,74175,"CTA, Abdomen with and without contrast GLR",350,"$2,107.38 ","$1,369.80 ",65% of total billed charges,"$1,433.02 ",68% of total billed charges,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$421.48 ,20% of total billed charges,$421.48 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$421.48 ,20% of total billed charges,$421.48 ,20% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,369.80 ",65% of total billed charges,"$1,369.80 ",65% of total billed charges,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,"$1,369.80 ","$1,053.69 "
Outpatient Medical Services,RADIOLOGY,74175,"CTA, Abdomen with and without contrast PFR",972,$597.40 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$341.70 ,110% of physician fee schedule,$341.70 ,110% of physician fee schedule,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$756.10 ,115% of physician fee schedule,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,$395.21 ,100% of FL Medicaid fee schedule ,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,"$1,227.60 ",Pays 100% medicare OPPS,$341.70 ,"$1,227.60 ",$298.70 
Outpatient Medical Services,RADIOLOGY,74176,"CTA, Abdomen and Pelvis without contrast GLR",352,"$2,775.85 ","$1,804.30 ",65% of total billed charges,"$1,887.58 ",68% of total billed charges,$386.14 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$555.17 ,20% of total billed charges,$555.17 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$555.17 ,20% of total billed charges,$555.17 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,804.30 ",65% of total billed charges,"$1,804.30 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,"$1,617.00 ",Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,$319.79 ,"$1,804.30 ","$1,387.93 "
Outpatient Medical Services,RADIOLOGY,74176,"CTA, Abdomen and Pelvis without contrast PFR",972,$598.22 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$205.19 ,110% of physician fee schedule,$205.19 ,110% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,"$1,617.00 ",Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$613.38 ,115% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,"$1,617.00 ",Pays 100% medicare OPPS,$205.19 ,"$1,617.00 ",$299.11 
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,352,"$3,453.38 ","$2,244.70 ",65% of total billed charges,"$2,348.30 ",68% of total billed charges,$455.96 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$690.68 ,20% of total billed charges,$690.68 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$690.68 ,20% of total billed charges,$690.68 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$2,244.70 ",65% of total billed charges,"$2,244.70 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$390.91 ,Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$390.91 ,Pays 100% medicare OPPS,$319.79 ,"$2,244.70 ","$1,726.69 "
Outpatient Medical Services,RADIOLOGY,74178,CT Abdomen and Pelvis 1 or more Regions GLR,352,"$4,192.10 ","$2,724.87 ",65% of total billed charges,"$2,850.63 ",68% of total billed charges,$564.92 ,100% of BCBS fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$838.42 ,20% of total billed charges,$838.42 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$838.42 ,20% of total billed charges,$838.42 ,20% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$2,724.87 ",65% of total billed charges,"$2,724.87 ",65% of total billed charges,$319.79 ,100% of FL Medicaid fee schedule ,"$2,442.00 ",Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$407.00 ,100% of case rate fee,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,$319.79 ,"$2,724.87 ","$2,096.05 "
Outpatient Medical Services,RADIOLOGY,74178,CT Abdomen and Pelvis 1 or more Regions PFR,972,$733.05 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$380.29 ,110% of physician fee schedule,$380.29 ,110% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,"$2,442.00 ",Pays 100% medicare OPPS,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$796.44 ,115% of physician fee schedule,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,$319.79 ,100% of FL Medicaid fee schedule ,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,"$2,442.00 ",Pays 100% medicare OPPS,$319.79 ,"$2,442.00 ",$366.53 
Outpatient Medical Services,RADIOLOGY,74270,"XRAY, Barium enema GLR",320,$414.06 ,$269.14 ,65% of total billed charges,$281.56 ,68% of total billed charges,$57.03 ,100% of BCBS fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$82.81 ,20% of total billed charges,$82.81 ,20% of total billed charges,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$82.81 ,20% of total billed charges,$82.81 ,20% of total billed charges,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$269.14 ,65% of total billed charges,$269.14 ,65% of total billed charges,$120.77 ,100% of FL Medicaid fee schedule ,$241.20 ,Pays 100% medicare OPPS,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$120.77 ,$269.14 ,$207.03 
Outpatient Medical Services,RADIOLOGY,74270,"XRAY, Barium enema PFR",972,$147.29 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$120.77 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$162.02 ,110% of physician fee schedule,$162.02 ,110% of physician fee schedule,$120.77 ,100% of FL Medicaid fee schedule ,$241.20 ,Pays 100% medicare OPPS,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$345.78 ,115% of physician fee schedule,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$241.20 ,Pays 100% medicare OPPS,$120.77 ,$345.78 ,$73.65 
Outpatient Medical Services,RADIOLOGY,74280,"XRAY, Barium enema w/air contrast GLR",320,$501.61 ,$326.05 ,65% of total billed charges,$341.09 ,68% of total billed charges,$74.77 ,100% of BCBS fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$100.32 ,20% of total billed charges,$100.32 ,20% of total billed charges,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$100.32 ,20% of total billed charges,$100.32 ,20% of total billed charges,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$326.05 ,65% of total billed charges,$326.05 ,65% of total billed charges,$120.77 ,100% of FL Medicaid fee schedule ,$292.20 ,Pays 100% medicare OPPS,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$120.77 ,$326.05 ,$250.81 
Outpatient Medical Services,RADIOLOGY,74280,"XRAY, Barium enema w/air contrast PFR",972,$198.28 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$120.77 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$218.11 ,110% of physician fee schedule,$218.11 ,110% of physician fee schedule,$120.77 ,100% of FL Medicaid fee schedule ,$292.20 ,Pays 100% medicare OPPS,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$404.42 ,115% of physician fee schedule,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$120.77 ,100% of FL Medicaid fee schedule ,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$292.20 ,Pays 100% medicare OPPS,$120.77 ,$404.42 ,$99.14 
Outpatient Medical Services,RADIOLOGY,76536,"US, Head and Neck GLR",402,$355.76 ,$231.24 ,65% of total billed charges,$241.92 ,68% of total billed charges,$47.45 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$71.15 ,20% of total billed charges,$71.15 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$71.15 ,20% of total billed charges,$71.15 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$231.24 ,65% of total billed charges,$231.24 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$207.24 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$107.90 ,$231.24 ,$177.88 
Outpatient Medical Services,RADIOLOGY,76536,"US, Head and Neck PFR",972,$157.49 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$119.58 ,110% of physician fee schedule,$119.58 ,110% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$207.24 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$301.42 ,115% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$207.24 ,Pays 100% medicare OPPS,$107.90 ,$301.42 ,$78.75 
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen,402,$254.93 ,$165.70 ,65% of total billed charges,$173.35 ,68% of total billed charges,$65.82 ,100% of BCBS fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$50.99 ,20% of total billed charges,$50.99 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$50.99 ,20% of total billed charges,$50.99 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$165.70 ,65% of total billed charges,$165.70 ,65% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$144.61 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,Pays 100% medicare OPPS,$144.61 ,$180.00 ,$127.47 
Outpatient Medical Services,RADIOLOGY,76705,"US, Abdomen Limited GLR",402,$379.56 ,$246.71 ,65% of total billed charges,$258.10 ,68% of total billed charges,$47.45 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$75.91 ,20% of total billed charges,$75.91 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$75.91 ,20% of total billed charges,$75.91 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$246.71 ,65% of total billed charges,$246.71 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$221.10 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$107.90 ,$246.71 ,$189.78 
Outpatient Medical Services,RADIOLOGY,76705,"US, Abdomen Limited PFR",972,$143.89 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$95.12 ,110% of physician fee schedule,$95.12 ,110% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$221.10 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$275.84 ,115% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$221.10 ,Pays 100% medicare OPPS,$95.12 ,$275.84 ,$71.95 
Outpatient Medical Services,RADIOLOGY,76770,"US, Retroperitoneal Complete GLR",402,$597.40 ,$388.31 ,65% of total billed charges,$406.23 ,68% of total billed charges,$65.82 ,100% of BCBS fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$119.48 ,20% of total billed charges,$119.48 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$119.48 ,20% of total billed charges,$119.48 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$388.31 ,65% of total billed charges,$388.31 ,65% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$510.00 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$167.44 ,$510.00 ,$298.70 
Outpatient Medical Services,RADIOLOGY,76770,"US, Retroperitoneal Complete PFR",972,$336.50 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$167.44 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$117.18 ,110% of physician fee schedule,$117.18 ,110% of physician fee schedule,$167.44 ,100% of FL Medicaid fee schedule ,$510.00 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$298.91 ,115% of physician fee schedule,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$510.00 ,Pays 100% medicare OPPS,$117.18 ,$510.00 ,$168.25 
Outpatient Medical Services,RADIOLOGY,76801,"US, Pregnant, 1st Trimest, 1st Gestation GLR",402,$429.51 ,$279.18 ,65% of total billed charges,$292.07 ,68% of total billed charges,$70.13 ,100% of BCBS fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$85.90 ,20% of total billed charges,$85.90 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$85.90 ,20% of total billed charges,$85.90 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$279.18 ,65% of total billed charges,$279.18 ,65% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$146.28 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$101.20 ,$279.18 ,$214.76 
Outpatient Medical Services,RADIOLOGY,76801,"US, Pregnant, 1st Trimest, 1st Gestation PFR",972,$186.95 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$127.20 ,110% of physician fee schedule,$127.20 ,110% of physician fee schedule,$101.20 ,100% of FL Medicaid fee schedule ,$146.28 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$309.39 ,115% of physician fee schedule,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$146.28 ,Pays 100% medicare OPPS,$101.20 ,$309.39 ,$93.48 
Outpatient Medical Services,RADIOLOGY,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,402,$303.85 ,$197.50 ,65% of total billed charges,$206.62 ,68% of total billed charges,$70.13 ,100% of BCBS fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$60.77 ,20% of total billed charges,$60.77 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$60.77 ,20% of total billed charges,$60.77 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$197.50 ,65% of total billed charges,$197.50 ,65% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$177.00 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$177.00 ,Pays 100% medicare OPPS,$101.20 ,$197.50 ,$151.93 
Outpatient Medical Services,RADIOLOGY,76815,"US, Pregnant, Limited GLR",402,$252.35 ,$164.03 ,65% of total billed charges,$171.60 ,68% of total billed charges,$47.45 ,100% of BCBS fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$50.47 ,20% of total billed charges,$50.47 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$50.47 ,20% of total billed charges,$50.47 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$164.03 ,65% of total billed charges,$164.03 ,65% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$147.00 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$101.20 ,$180.00 ,$126.18 
Outpatient Medical Services,RADIOLOGY,76815,"US, Pregnant, Limited PFR",972,$120.10 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$88.24 ,110% of physician fee schedule,$88.24 ,110% of physician fee schedule,$101.20 ,100% of FL Medicaid fee schedule ,$147.00 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$268.65 ,115% of physician fee schedule,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$147.00 ,Pays 100% medicare OPPS,$88.24 ,$268.65 ,$60.05 
Outpatient Medical Services,RADIOLOGY,76817,"US, Pregnant, Transvaginal GLR",402,$424.36 ,$275.83 ,65% of total billed charges,$288.56 ,68% of total billed charges,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$84.87 ,20% of total billed charges,$84.87 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$84.87 ,20% of total billed charges,$84.87 ,20% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$275.83 ,65% of total billed charges,$275.83 ,65% of total billed charges,$101.20 ,100% of FL Medicaid fee schedule ,$115.44 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$101.20 ,$275.83 ,$212.18 
Outpatient Medical Services,RADIOLOGY,76817,"US, Pregnant, Transvaginal PFR",972,$163.15 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$100.39 ,110% of physician fee schedule,$100.39 ,110% of physician fee schedule,$101.20 ,100% of FL Medicaid fee schedule ,$115.44 ,Pays 100% medicare OPPS,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$281.35 ,115% of physician fee schedule,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$101.20 ,100% of FL Medicaid fee schedule ,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$115.44 ,Pays 100% medicare OPPS,$100.39 ,$281.35 ,$81.58 
Outpatient Medical Services,RADIOLOGY,76830,"US, Transvaginal Non-OB GLR",402,$309.00 ,$200.85 ,65% of total billed charges,$210.12 ,68% of total billed charges,$51.12 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$200.85 ,65% of total billed charges,$200.85 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$107.90 ,$200.85 ,$154.50 
Outpatient Medical Services,RADIOLOGY,76830,"US, Transvaginal Non-OB PFR",972,$164.29 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$128.99 ,110% of physician fee schedule,$128.99 ,110% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$311.25 ,115% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$107.90 ,$311.25 ,$82.15 
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound pelvis through vagina,402,$309.00 ,$200.85 ,65% of total billed charges,$210.12 ,68% of total billed charges,$51.12 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$200.85 ,65% of total billed charges,$200.85 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$107.90 ,$200.85 ,$154.50 
Outpatient Medical Services,RADIOLOGY,76856,"US, Pelvic Complete GLR",402,$360.50 ,$234.33 ,65% of total billed charges,$245.14 ,68% of total billed charges,$51.12 ,100% of BCBS fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$72.10 ,20% of total billed charges,$72.10 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$72.10 ,20% of total billed charges,$72.10 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$234.33 ,65% of total billed charges,$234.33 ,65% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$131.00 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,$234.33 ,$180.25 
Outpatient Medical Services,RADIOLOGY,76856,"US, Pelvic Complete PFR",972,$150.69 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$167.44 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$113.92 ,110% of physician fee schedule,$113.92 ,110% of physician fee schedule,$167.44 ,100% of FL Medicaid fee schedule ,$131.00 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$295.49 ,115% of physician fee schedule,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$131.00 ,Pays 100% medicare OPPS,$113.92 ,$295.49 ,$75.35 
Outpatient Medical Services,RADIOLOGY,76870,"US, Scrotum and Contents, Limited GLR",402,$434.66 ,$282.53 ,65% of total billed charges,$295.57 ,68% of total billed charges,$51.12 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$86.93 ,20% of total billed charges,$86.93 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$86.93 ,20% of total billed charges,$86.93 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$282.53 ,65% of total billed charges,$282.53 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$125.24 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$107.90 ,$282.53 ,$217.33 
Outpatient Medical Services,RADIOLOGY,76870,"US, Scrotum and Contents, Limited PFR",972,$156.35 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$108.90 ,110% of physician fee schedule,$108.90 ,110% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$125.24 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$113.85 ,115% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$125.24 ,Pays 100% medicare OPPS,$107.90 ,$125.24 ,$78.18 
Outpatient Medical Services,RADIOLOGY,76882,"US, Extremity, Non-Vascular, Limited GLR",402,$154.50 ,$100.43 ,65% of total billed charges,$105.06 ,68% of total billed charges,$47.45 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$30.90 ,20% of total billed charges,$30.90 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$100.43 ,65% of total billed charges,$100.43 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,$180.00 ,$77.25 
Outpatient Medical Services,RADIOLOGY,76882,"US, Extremity, Non-Vascular, Limited PFR",972,$65.92 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$46.64 ,110% of physician fee schedule,$46.64 ,110% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$225.16 ,115% of physician fee schedule,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$90.00 ,Pays 100% medicare OPPS,$46.64 ,$225.16 ,$32.96 
Outpatient Medical Services,RADIOLOGY,76937,"US Guidance, Vascular Access",402,$595.34 ,$386.97 ,65% of total billed charges,$404.83 ,68% of total billed charges,N/A,Not reimbursable per contract,$113.16 ,100% of FL Medicaid fee schedule ,$119.07 ,20% of total billed charges,$119.07 ,20% of total billed charges,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$119.07 ,20% of total billed charges,$119.07 ,20% of total billed charges,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$386.97 ,65% of total billed charges,$386.97 ,65% of total billed charges,$113.16 ,100% of FL Medicaid fee schedule ,$346.80 ,Pays 100% medicare OPPS,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$113.16 ,100% of FL Medicaid fee schedule ,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$346.80 ,Pays 100% medicare OPPS,$113.16 ,$386.97 ,$297.67 
Outpatient Medical Services,RADIOLOGY,77052,CAD screening,403,$123.60 ,$80.34 ,65% of total billed charges,$84.05 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$24.72 ,20% of total billed charges,$24.72 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$24.72 ,20% of total billed charges,$24.72 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$80.34 ,65% of total billed charges,$80.34 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$72.00 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$91.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,$91.00 ,$61.80 
Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,401,$159.65 ,$103.77 ,65% of total billed charges,$108.56 ,68% of total billed charges,N/A,Not reimbursable per contract,$49.09 ,100% of FL Medicaid fee schedule ,$31.93 ,20% of total billed charges,$31.93 ,20% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$31.93 ,20% of total billed charges,$31.93 ,20% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$103.77 ,65% of total billed charges,$103.77 ,65% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$75.00 ,Pays 100% medicare OPPS,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$91.00 ,100% of case rate fee,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$75.00 ,Pays 100% medicare OPPS,$49.09 ,$103.77 ,$79.83 
Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,401,$252.35 ,$164.03 ,65% of total billed charges,$171.60 ,68% of total billed charges,N/A,Not reimbursable per contract,$49.09 ,100% of FL Medicaid fee schedule ,$50.47 ,20% of total billed charges,$50.47 ,20% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$50.47 ,20% of total billed charges,$50.47 ,20% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$164.03 ,65% of total billed charges,$164.03 ,65% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$101.20 ,Pays 100% medicare OPPS,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$91.00 ,100% of case rate fee,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$101.20 ,Pays 100% medicare OPPS,$49.09 ,$164.03 ,$126.18 
Outpatient Medical Services,RADIOLOGY,77067,"Mammography, screening, bilateral",401,$247.20 ,$160.68 ,65% of total billed charges,$168.10 ,68% of total billed charges,N/A,Not reimbursable per contract,$49.09 ,100% of FL Medicaid fee schedule ,$49.44 ,20% of total billed charges,$49.44 ,20% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.44 ,20% of total billed charges,$49.44 ,20% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$160.68 ,65% of total billed charges,$160.68 ,65% of total billed charges,$49.09 ,100% of FL Medicaid fee schedule ,$99.60 ,Pays 100% medicare OPPS,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$91.00 ,100% of case rate fee,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$49.09 ,100% of FL Medicaid fee schedule ,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$99.60 ,Pays 100% medicare OPPS,$49.09 ,$160.68 ,$123.60 
Outpatient Medical Services,RADIOLOGY,77072,"XRAY, Bone Age GLR",320,$138.02 ,$89.71 ,65% of total billed charges,$93.85 ,68% of total billed charges,$17.41 ,100% of BCBS fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$27.60 ,20% of total billed charges,$27.60 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$27.60 ,20% of total billed charges,$27.60 ,20% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$89.71 ,65% of total billed charges,$89.71 ,65% of total billed charges,$56.10 ,100% of FL Medicaid fee schedule ,$80.40 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$180.00 ,100% of case rate fee,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$56.10 ,$180.00 ,$69.01 
Outpatient Medical Services,RADIOLOGY,77072,"XRAY, Bone Age PFR",972,$53.56 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$28.13 ,110% of physician fee schedule,$28.13 ,110% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$80.40 ,Pays 100% medicare OPPS,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$29.41 ,115% of physician fee schedule,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$56.10 ,100% of FL Medicaid fee schedule ,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$80.40 ,Pays 100% medicare OPPS,$28.13 ,$80.40 ,$26.78 
Outpatient Medical Services,RADIOLOGY,93307,Ultasound echocardiograham complete,480,"$1,854.00 ","$1,205.10 ",65% of total billed charges,"$1,260.72 ",68% of total billed charges,$130.53 ,100% of BCBS fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$370.80 ,20% of total billed charges,$370.80 ,20% of total billed charges,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$370.80 ,20% of total billed charges,$370.80 ,20% of total billed charges,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,"$1,205.10 ",65% of total billed charges,"$1,205.10 ",65% of total billed charges,$464.10 ,100% of FL Medicaid fee schedule ,$168.49 ,Pays 100% medicare OPPS,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$591.00 ,100% of case rate fee,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,Pays 100% medicare OPPS,$168.49 ,"$1,205.10 ",$927.00 
Outpatient Medical Services,RADIOLOGY,93880,Extracranial bilat study,921,"$1,545.00 ","$1,004.25 ",65% of total billed charges,"$1,050.60 ",68% of total billed charges,$132.61 ,100% of BCBS fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$309.00 ,20% of total billed charges,$309.00 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$309.00 ,20% of total billed charges,$309.00 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,"$1,004.25 ",65% of total billed charges,"$1,004.25 ",65% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$235.35 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$97.00 ,100% of asc tier grouper rate,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$97.00 ,"$1,004.25 ",$772.50 
Outpatient Medical Services,MEDICINE AND SURGERY,17250,Chemical cauterization gran tissue,360,$978.50 ,$636.03 ,65% of total billed charges,$665.38 ,68% of total billed charges,N/A,Not reimbursable per contract,$168.89 ,100% of FL Medicaid fee schedule ,$195.70 ,20% of total billed charges,$195.70 ,20% of total billed charges,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$195.70 ,20% of total billed charges,$195.70 ,20% of total billed charges,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$636.03 ,65% of total billed charges,$636.03 ,65% of total billed charges,$168.89 ,100% of FL Medicaid fee schedule ,$570.00 ,Pays 100% medicare OPPS,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$168.89 ,100% of FL Medicaid fee schedule ,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$570.00 ,Pays 100% medicare OPPS,$168.89 ,$636.03 ,$489.25 
Outpatient Medical Services,MEDICINE AND SURGERY,27590,Amputation leg at thigh,982,"$1,130.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$3,620.45 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,$907.81 ,110% of physician fee schedule,$907.81 ,110% of physician fee schedule,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$1,043.98 ",Pays 100% medicare OPPS,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,$949.07 ,115% of physician fee schedule,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$3,620.45 ",100% of FL Medicaid fee schedule ,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,"$1,043.98 ",Pays 100% medicare OPPS,$907.81 ,"$3,620.45 ",$565.00 
Outpatient Medical Services,MEDICINE AND SURGERY,27880,Amputation of lower leg,982,"$1,292.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$7,447.22 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$1,039.68 ",110% of physician fee schedule,"$1,039.68 ",110% of physician fee schedule,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$1,195.63 ",Pays 100% medicare OPPS,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$1,086.93 ",115% of physician fee schedule,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$7,447.22 ",100% of FL Medicaid fee schedule ,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,195.63 ",Pays 100% medicare OPPS,"$1,039.68 ","$7,447.22 ",$646.00 
Outpatient Medical Services,MEDICINE AND SURGERY,28805,Amputation thru metatarsal,982,"$1,002.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$5,422.70 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,$795.42 ,110% of physician fee schedule,$795.42 ,110% of physician fee schedule,"$5,422.70 ",100% of FL Medicaid fee schedule ,$914.73 ,Pays 100% medicare OPPS,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,$831.58 ,115% of physician fee schedule,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$914.73 ,Pays 100% medicare OPPS,$795.42 ,"$5,422.70 ",$501.00 
Outpatient Medical Services,MEDICINE AND SURGERY,28810,Amputation toe metatarsal,982,$594.00 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$5,422.70 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,$474.66 ,110% of physician fee schedule,$474.66 ,110% of physician fee schedule,"$5,422.70 ",100% of FL Medicaid fee schedule ,$545.86 ,Pays 100% medicare OPPS,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,$496.24 ,115% of physician fee schedule,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,"$5,422.70 ",100% of FL Medicaid fee schedule ,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$545.86 ,Pays 100% medicare OPPS,$474.66 ,"$5,422.70 ",$297.00 
Outpatient Medical Services,MEDICINE AND SURGERY,32555,Aspirate pleura with imaging,360,$734.00 ,$477.10 ,65% of total billed charges,$499.12 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,$979.53 ,100% of FL Medicaid fee schedule ,$146.80 ,20% of total billed charges,$146.80 ,20% of total billed charges,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$146.80 ,20% of total billed charges,$146.80 ,20% of total billed charges,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$477.10 ,65% of total billed charges,$477.10 ,65% of total billed charges,$979.53 ,100% of FL Medicaid fee schedule ,$139.55 ,Pays 100% medicare OPPS,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$979.53 ,100% of FL Medicaid fee schedule ,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,Pays 100% medicare OPPS,$139.55 ,$979.53 ,$367.00 
Outpatient Medical Services,MEDICINE AND SURGERY,36556,insert non-tunnel CV cath,360,"$1,180.50 ",$767.33 ,65% of total billed charges,$802.74 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,"$1,117.81 ",100% of FL Medicaid fee schedule ,$236.10 ,20% of total billed charges,$236.10 ,20% of total billed charges,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$236.10 ,20% of total billed charges,$236.10 ,20% of total billed charges,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$767.33 ,65% of total billed charges,$767.33 ,65% of total billed charges,"$1,117.81 ",100% of FL Medicaid fee schedule ,$708.30 ,Pays 100% medicare OPPS,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$708.30 ,Pays 100% medicare OPPS,$296.00 ,"$1,117.81 ",$590.25 
Outpatient Medical Services,MEDICINE AND SURGERY,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",750,"$1,221.00 ",$793.65 ,65% of total billed charges,$830.28 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,$986.84 ,100% of FL Medicaid fee schedule ,$244.20 ,20% of total billed charges,$244.20 ,20% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$244.20 ,20% of total billed charges,$244.20 ,20% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$793.65 ,65% of total billed charges,$793.65 ,65% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$732.60 ,Pays 100% medicare OPPS,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$732.60 ,Pays 100% medicare OPPS,$665.00 ,$986.84 ,$610.50 
Outpatient Medical Services,MEDICINE AND SURGERY,43246,EGD gtube placement,360,"$1,054.00 ",$685.10 ,65% of total billed charges,$716.72 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,$986.84 ,100% of FL Medicaid fee schedule ,$210.80 ,20% of total billed charges,$210.80 ,20% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$210.80 ,20% of total billed charges,$210.80 ,20% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$685.10 ,65% of total billed charges,$685.10 ,65% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$258.31 ,Pays 100% medicare OPPS,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,Pays 100% medicare OPPS,$258.31 ,$986.84 ,$527.00 
Outpatient Medical Services,MEDICINE AND SURGERY,44388,Colonoscopy thru stoma spx,750,"$1,457.00 ",$947.05 ,65% of total billed charges,$990.76 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$291.40 ,20% of total billed charges,$291.40 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$291.40 ,20% of total billed charges,$291.40 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$947.05 ,65% of total billed charges,$947.05 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$874.20 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$874.20 ,Pays 100% medicare OPPS,$665.00 ,"$1,004.47 ",$728.50 
Outpatient Medical Services,MEDICINE AND SURGERY,44392,Colonoscopy polypectomy,750,"$1,377.00 ",$895.05 ,65% of total billed charges,$936.36 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$275.40 ,20% of total billed charges,$275.40 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$275.40 ,20% of total billed charges,$275.40 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$895.05 ,65% of total billed charges,$895.05 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$826.20 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$826.20 ,Pays 100% medicare OPPS,$665.00 ,"$1,004.47 ",$688.50 
Outpatient Medical Services,MEDICINE AND SURGERY,45331,Sigmoidoscopy and biopsy,750,"$1,269.00 ",$824.85 ,65% of total billed charges,$862.92 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$253.80 ,20% of total billed charges,$253.80 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$253.80 ,20% of total billed charges,$253.80 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$824.85 ,65% of total billed charges,$824.85 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$761.40 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$296.00 ,"$1,004.47 ",$634.50 
Outpatient Medical Services,MEDICINE AND SURGERY,45380,Biopsy of large bowel using an endoscope,750,"$1,267.00 ",$823.55 ,65% of total billed charges,$861.56 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$253.40 ,20% of total billed charges,$253.40 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$253.40 ,20% of total billed charges,$253.40 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$823.55 ,65% of total billed charges,$823.55 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$256.12 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,"$1,004.47 ",$633.50 
Outpatient Medical Services,MEDICINE AND SURGERY,45382,Colonoscopy w/control bleed,750,"$1,430.00 ",$929.50 ,65% of total billed charges,$972.40 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$286.00 ,20% of total billed charges,$286.00 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$286.00 ,20% of total billed charges,$286.00 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$929.50 ,65% of total billed charges,$929.50 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$858.00 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$858.00 ,Pays 100% medicare OPPS,$665.00 ,"$1,004.47 ",$715.00 
Outpatient Medical Services,MEDICINE AND SURGERY,46083,Incise external hemorrhoid,360,$755.00 ,$490.75 ,65% of total billed charges,$513.40 ,68% of total billed charges,N/A,Not reimbursable per contract,"$1,494.48 ",100% of FL Medicaid fee schedule ,$151.00 ,20% of total billed charges,$151.00 ,20% of total billed charges,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,$151.00 ,20% of total billed charges,$151.00 ,20% of total billed charges,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,$490.75 ,65% of total billed charges,$490.75 ,65% of total billed charges,"$1,494.48 ",100% of FL Medicaid fee schedule ,$453.00 ,Pays 100% medicare OPPS,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,"$1,494.48 ",100% of FL Medicaid fee schedule ,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$453.00 ,Pays 100% medicare OPPS,$178.00 ,"$1,494.48 ",$377.50 
Outpatient Medical Services,MEDICINE AND SURGERY,93005,EKG,730,$347.00 ,$225.55 ,65% of total billed charges,$235.96 ,68% of total billed charges,$36.14 ,100% of BCBS fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$69.40 ,20% of total billed charges,$69.40 ,20% of total billed charges,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$69.40 ,20% of total billed charges,$69.40 ,20% of total billed charges,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$225.55 ,65% of total billed charges,$225.55 ,65% of total billed charges,$26.39 ,100% of FL Medicaid fee schedule ,$208.20 ,Pays 100% medicare OPPS,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$148.00 ,100% of case rate fee,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$26.39 ,100% of FL Medicaid fee schedule ,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$208.20 ,Pays 100% medicare OPPS,$26.39 ,$225.55 ,$173.50 
Outpatient Medical Services,MEDICINE AND SURGERY,97110,"Physical therapy, therapeutic exercise",430,$106.00 ,$68.90 ,65% of total billed charges,$72.08 ,68% of total billed charges,N/A,Not reimbursable per contract,$38.10 ,100% of FL Medicaid fee schedule ,$21.20 ,20% of total billed charges,$21.20 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$21.20 ,20% of total billed charges,$21.20 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$68.90 ,65% of total billed charges,$68.90 ,65% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$37.80 ,Pays 100% medicare OPPS,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,Pays 100% medicare OPPS,$37.80 ,$82.00 ,$53.00 
Outpatient Medical Services,MEDICINE AND SURGERY,97161,PT eval low complex 20 min,420,$291.00 ,$189.15 ,65% of total billed charges,$197.88 ,68% of total billed charges,N/A,Not reimbursable per contract,$241.83 ,100% of FL Medicaid fee schedule ,$58.20 ,20% of total billed charges,$58.20 ,20% of total billed charges,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$58.20 ,20% of total billed charges,$58.20 ,20% of total billed charges,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$189.15 ,65% of total billed charges,$189.15 ,65% of total billed charges,$241.83 ,100% of FL Medicaid fee schedule ,$174.60 ,Pays 100% medicare OPPS,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$174.60 ,Pays 100% medicare OPPS,$82.00 ,$241.83 ,$145.50 
Outpatient Medical Services,MEDICINE AND SURGERY,97162,PT eval mod complex 45 min,420,$341.00 ,$221.65 ,65% of total billed charges,$231.88 ,68% of total billed charges,N/A,Not reimbursable per contract,$241.83 ,100% of FL Medicaid fee schedule ,$68.20 ,20% of total billed charges,$68.20 ,20% of total billed charges,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$68.20 ,20% of total billed charges,$68.20 ,20% of total billed charges,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$221.65 ,65% of total billed charges,$221.65 ,65% of total billed charges,$241.83 ,100% of FL Medicaid fee schedule ,$204.60 ,Pays 100% medicare OPPS,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$241.83 ,100% of FL Medicaid fee schedule ,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$204.60 ,Pays 100% medicare OPPS,$82.00 ,$241.83 ,$170.50 
Outpatient Medical Services,MEDICINE AND SURGERY,G0105,Colorectal screening high risk,750,"$1,320.00 ",$858.00 ,65% of total billed charges,$897.60 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$264.00 ,20% of total billed charges,$264.00 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$264.00 ,20% of total billed charges,$264.00 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$858.00 ,65% of total billed charges,$858.00 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$792.00 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$792.00 ,Pays 100% medicare OPPS,$296.00 ,"$1,004.47 ",$660.00 
Outpatient Medical Services,MEDICINE AND SURGERY,G0121,Colon CA screening not high risk,750,"$1,269.00 ",$824.85 ,65% of total billed charges,$862.92 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$253.80 ,20% of total billed charges,$253.80 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$253.80 ,20% of total billed charges,$253.80 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$824.85 ,65% of total billed charges,$824.85 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$761.40 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$761.40 ,Pays 100% medicare OPPS,$296.00 ,"$1,004.47 ",$634.50 
Outpatient Medical Services,MEDICINE AND SURGERY,45378,Colonoscopy,750,"$2,174.75 ","$1,413.59 ",65% of total billed charges,"$1,478.83 ",68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$434.95 ,20% of total billed charges,$434.95 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$434.95 ,20% of total billed charges,$434.95 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,413.59 ",65% of total billed charges,"$1,413.59 ",65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$462.00 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,Pays 100% medicare OPPS,$462.00 ,"$1,413.59 ","$1,087.38 "
Outpatient Medical Services,MEDICINE AND SURGERY,45380,Colonoscopy with Biopsy,750,"$2,532.75 ","$1,646.29 ",65% of total billed charges,"$1,722.27 ",68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$506.55 ,20% of total billed charges,$506.55 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$506.55 ,20% of total billed charges,$506.55 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,646.29 ",65% of total billed charges,"$1,646.29 ",65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$256.12 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,Pays 100% medicare OPPS,$256.12 ,"$1,646.29 ","$1,266.38 "
Outpatient Medical Services,MEDICINE AND SURGERY,43239,EGD with biopsy,750,"$2,296.25 ","$1,492.56 ",65% of total billed charges,"$1,561.45 ",68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,$986.84 ,100% of FL Medicaid fee schedule ,$459.25 ,20% of total billed charges,$459.25 ,20% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$459.25 ,20% of total billed charges,$459.25 ,20% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,"$1,492.56 ",65% of total billed charges,"$1,492.56 ",65% of total billed charges,$986.84 ,100% of FL Medicaid fee schedule ,$176.09 ,Pays 100% medicare OPPS,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$986.84 ,100% of FL Medicaid fee schedule ,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,Pays 100% medicare OPPS,$176.09 ,"$1,492.56 ","$1,148.13 "
Outpatient Medical Services,MEDICINE AND SURGERY,45385,Colonoscopy with Polpectomy,750,"$3,389.50 ","$2,203.18 ",65% of total billed charges,"$2,304.86 ",68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$677.90 ,20% of total billed charges,$677.90 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$677.90 ,20% of total billed charges,$677.90 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$2,203.18 ",65% of total billed charges,"$2,203.18 ",65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,$907.80 ,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$907.80 ,Pays 100% medicare OPPS,$665.00 ,"$2,203.18 ","$1,694.75 "
Outpatient Medical Services,MEDICINE AND SURGERY,45330,SIGMOIDSCOPY FLEXIABLE,750,"$1,307.07 ",$849.60 ,65% of total billed charges,$888.81 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,$261.41 ,20% of total billed charges,$261.41 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$261.41 ,20% of total billed charges,$261.41 ,20% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$849.60 ,65% of total billed charges,$849.60 ,65% of total billed charges,"$1,004.47 ",100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,"$1,004.47 ",100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,$296.00 ,"$1,004.47 ",$653.54 
Outpatient Medical Services,MEDICINE AND SURGERY,47562,LAPS CHOLECYSTECOMY W/O CDE and without MCC/CC,982,"$7,950.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$3,510.85 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,$764.56 ,110% of physician fee schedule,$764.56 ,110% of physician fee schedule,"$3,510.85 ",100% of FL Medicaid fee schedule ,$879.24 ,Pays 100% medicare OPPS,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,$799.31 ,115% of physician fee schedule,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$879.24 ,Pays 100% medicare OPPS,$764.56 ,"$3,510.85 ","$3,975.00 "
Outpatient Medical Services,MEDICINE AND SURGERY,47563,Gallbladder removal with CDE and without MCC/CC,982,"$5,035.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$3,510.85 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,$834.31 ,110% of physician fee schedule,$834.31 ,110% of physician fee schedule,"$3,510.85 ",100% of FL Medicaid fee schedule ,$959.45 ,Pays 100% medicare OPPS,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,$872.23 ,115% of physician fee schedule,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,"$3,510.85 ",100% of FL Medicaid fee schedule ,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$959.45 ,Pays 100% medicare OPPS,$834.31 ,"$3,510.85 ","$2,517.50 "
Outpatient Medical Services,MEDICINE AND SURGERY,49505,RPR 1ST INGUN HRNA 5YRS /> REDUCIBLE,982,"$7,605.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$3,549.62 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,$605.79 ,110% of physician fee schedule,$605.79 ,110% of physician fee schedule,"$3,549.62 ",100% of FL Medicaid fee schedule ,$696.66 ,Pays 100% medicare OPPS,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,$633.33 ,115% of physician fee schedule,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,"$3,549.62 ",100% of FL Medicaid fee schedule ,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$696.66 ,Pays 100% medicare OPPS,$605.79 ,"$3,549.62 ","$3,802.50 "
Outpatient Medical Services,MEDICINE AND SURGERY,44970,LAPAROSCOPIC APPENDECTOMY,982,"$5,082.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract,"$4,542.62 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,Not reimbursable per contract,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,$697.57 ,110% of physician fee schedule,$697.57 ,110% of physician fee schedule,"$4,542.62 ",100% of FL Medicaid fee schedule ,$802.20 ,Pays 100% medicare OPPS,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,$729.27 ,115% of physician fee schedule,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,"$4,542.62 ",100% of FL Medicaid fee schedule ,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$802.20 ,Pays 100% medicare OPPS,$697.57 ,"$4,542.62 ","$2,541.00 "
Outpatient Medical Services,MEDICINE AND SURGERY,,,360,$310.00 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$62.00 ,20% of total billed charges,$62.00 ,20% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$62.00 ,20% of total billed charges,$62.00 ,20% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$201.50 ,65% of total billed charges,$201.50 ,65% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$108.50 ,100% of asc tier grouper rate,$53.67 ,100% case rate,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$53.67 ,$201.50 ,$155.00 
Outpatient Medical Services,MEDICINE AND SURGERY,,,361,$622.00 ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$124.40 ,20% of total billed charges,$124.40 ,20% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$124.40 ,20% of total billed charges,$124.40 ,20% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$404.30 ,65% of total billed charges,$404.30 ,65% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$217.70 ,100% of asc tier grouper rate,$53.67 ,100% case rate,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$53.67 ,$404.30 ,$311.00 
Outpatient Medical Services,MEDICINE AND SURGERY,,,361,"$1,243.00 ",N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$248.60 ,20% of total billed charges,$248.60 ,20% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$248.60 ,20% of total billed charges,$248.60 ,20% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$807.95 ,65% of total billed charges,$807.95 ,65% of total billed charges,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$435.05 ,100% of asc tier grouper rate,$53.67 ,100% case rate,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,N/A,Not reimbursable per contract ,$53.67 ,$807.95 ,$621.50 
Outpatient Medical Services,AMBULATORY,36569,Insertion PICC Line,450,$804.43 ,$522.88 ,65% of total billed charges,$547.01 ,68% of total billed charges,$312.00 ,100% of BCBS asc grouper rate,"$1,117.81 ",100% of FL Medicaid fee schedule ,$160.89 ,20% of total billed charges,$160.89 ,20% of total billed charges,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$160.89 ,20% of total billed charges,$160.89 ,20% of total billed charges,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$522.88 ,65% of total billed charges,$522.88 ,65% of total billed charges,"$1,117.81 ",100% of FL Medicaid fee schedule ,$468.60 ,Pays 100% medicare OPPS,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$296.00 ,100% of asc tier grouper rate,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,"$1,117.81 ",100% of FL Medicaid fee schedule ,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$468.60 ,Pays 100% medicare OPPS,$296.00 ,"$1,117.81 ",$402.22 
Outpatient Medical Services,AMBULATORY,36600,Withdrawal of Arterial Blood,301,$85.49 ,$55.57 ,65% of total billed charges,$58.13 ,68% of total billed charges,N/A,Not reimbursable per contract,$67.63 ,100% of FL Medicaid fee schedule ,$17.10 ,20% of total billed charges,$17.10 ,20% of total billed charges,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$17.10 ,20% of total billed charges,$17.10 ,20% of total billed charges,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$55.57 ,65% of total billed charges,$55.57 ,65% of total billed charges,$67.63 ,100% of FL Medicaid fee schedule ,$49.80 ,Pays 100% medicare OPPS,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$67.63 ,100% of FL Medicaid fee schedule ,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,Pays 100% medicare OPPS,$49.80 ,$178.00 ,$42.75 
Outpatient Medical Services,AMBULATORY,49083,Abdominal Paracentesis w/Imaging,450,$450.11 ,$292.57 ,65% of total billed charges,$306.07 ,68% of total billed charges,$419.00 ,100% of BCBS asc grouper rate,$736.49 ,100% of FL Medicaid fee schedule ,$90.02 ,20% of total billed charges,$90.02 ,20% of total billed charges,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$90.02 ,20% of total billed charges,$90.02 ,20% of total billed charges,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$292.57 ,65% of total billed charges,$292.57 ,65% of total billed charges,$736.49 ,100% of FL Medicaid fee schedule ,$262.20 ,Pays 100% medicare OPPS,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$665.00 ,100% of asc tier grouper rate,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$736.49 ,100% of FL Medicaid fee schedule ,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,Pays 100% medicare OPPS,$262.20 ,$736.49 ,$225.06 
Outpatient Medical Services,AMBULATORY,51798,Us urine capacity measure,402,$203.80 ,$132.47 ,65% of total billed charges,$138.58 ,68% of total billed charges,N/A,Not reimbursable per contract,$79.95 ,100% of FL Medicaid fee schedule ,$40.76 ,20% of total billed charges,$40.76 ,20% of total billed charges,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$40.76 ,20% of total billed charges,$40.76 ,20% of total billed charges,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$132.47 ,65% of total billed charges,$132.47 ,65% of total billed charges,$79.95 ,100% of FL Medicaid fee schedule ,$118.72 ,Pays 100% medicare OPPS,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$79.95 ,100% of FL Medicaid fee schedule ,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$118.72 ,Pays 100% medicare OPPS,$79.95 ,$178.00 ,$101.90 
Outpatient Medical Services,RESPIRATORY,31500,Insert emergency airway,450,$515.00 ,$334.75 ,65% of total billed charges,$350.20 ,68% of total billed charges,N/A,Not reimbursable per contract,$729.43 ,100% of FL Medicaid fee schedule ,$103.00 ,20% of total billed charges,$103.00 ,20% of total billed charges,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$103.00 ,20% of total billed charges,$103.00 ,20% of total billed charges,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$334.75 ,65% of total billed charges,$334.75 ,65% of total billed charges,$729.43 ,100% of FL Medicaid fee schedule ,$300.00 ,Pays 100% medicare OPPS,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$300.00 ,Pays 100% medicare OPPS,$178.00 ,$729.43 ,$257.50 
Outpatient Medical Services,RESPIRATORY,82803,ABG Analysis,301,$298.70 ,$194.16 ,65% of total billed charges,$203.12 ,68% of total billed charges,$27.47 ,100% of BCBS fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$59.74 ,20% of total billed charges,$59.74 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$59.74 ,20% of total billed charges,$59.74 ,20% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$194.16 ,65% of total billed charges,$194.16 ,65% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$174.00 ,Pays 100% medicare OPPS,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$149.35 ,50% of total billed charges,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$26.57 ,100% of FL Medicaid fee schedule ,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$174.00 ,Pays 100% medicare OPPS,$26.57 ,$194.16 ,$149.35 
Outpatient Medical Services,RESPIRATORY,92950,CPR,480,$546.98 ,$355.54 ,65% of total billed charges,$371.95 ,68% of total billed charges,N/A,Not reimbursable per contract,$729.43 ,100% of FL Medicaid fee schedule ,$109.40 ,20% of total billed charges,$109.40 ,20% of total billed charges,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$109.40 ,20% of total billed charges,$109.40 ,20% of total billed charges,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$355.54 ,65% of total billed charges,$355.54 ,65% of total billed charges,$729.43 ,100% of FL Medicaid fee schedule ,$318.63 ,Pays 100% medicare OPPS,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$178.00 ,100% of asc tier grouper rate,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$729.43 ,100% of FL Medicaid fee schedule ,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$318.63 ,Pays 100% medicare OPPS,$178.00 ,$729.43 ,$273.49 
Outpatient Medical Services,RESPIRATORY,94010,PFT Simple,460,$334.75 ,$217.59 ,65% of total billed charges,$227.63 ,68% of total billed charges,$14.22 ,100% of BCBS fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$66.95 ,20% of total billed charges,$66.95 ,20% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$66.95 ,20% of total billed charges,$66.95 ,20% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$217.59 ,65% of total billed charges,$217.59 ,65% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$195.00 ,Pays 100% medicare OPPS,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$207.00 ,100% of case rate fee,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$195.00 ,Pays 100% medicare OPPS,$54.95 ,$217.59 ,$167.38 
Outpatient Medical Services,RESPIRATORY,94060,Evaluation of wheezing,460,$437.75 ,$284.54 ,65% of total billed charges,$297.67 ,68% of total billed charges,$31.31 ,100% of BCBS fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$87.55 ,20% of total billed charges,$87.55 ,20% of total billed charges,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$87.55 ,20% of total billed charges,$87.55 ,20% of total billed charges,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$284.54 ,65% of total billed charges,$284.54 ,65% of total billed charges,$101.56 ,100% of FL Medicaid fee schedule ,$255.00 ,Pays 100% medicare OPPS,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$207.00 ,100% of case rate fee,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$101.56 ,$284.54 ,$218.88 
Outpatient Medical Services,RESPIRATORY,94060,PFT Total,460,$437.75 ,$284.54 ,65% of total billed charges,$297.67 ,68% of total billed charges,$31.31 ,100% of BCBS fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$87.55 ,20% of total billed charges,$87.55 ,20% of total billed charges,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$87.55 ,20% of total billed charges,$87.55 ,20% of total billed charges,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$284.54 ,65% of total billed charges,$284.54 ,65% of total billed charges,$101.56 ,100% of FL Medicaid fee schedule ,$255.00 ,Pays 100% medicare OPPS,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$207.00 ,100% of case rate fee,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$101.56 ,100% of FL Medicaid fee schedule ,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$255.00 ,Pays 100% medicare OPPS,$101.56 ,$284.54 ,$218.88 
Outpatient Medical Services,RESPIRATORY,94618,Pulmonary stress testing,460,$206.00 ,$133.90 ,65% of total billed charges,$140.08 ,68% of total billed charges,$47.93 ,100% of BCBS fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$41.20 ,20% of total billed charges,$41.20 ,20% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$133.90 ,65% of total billed charges,$133.90 ,65% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$120.00 ,Pays 100% medicare OPPS,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$207.00 ,100% of case rate fee,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$120.00 ,Pays 100% medicare OPPS,$54.95 ,$207.00 ,$103.00 
Outpatient Medical Services,RESPIRATORY,94770,Exhaled CO2,460,$205.39 ,$133.50 ,65% of total billed charges,$139.67 ,68% of total billed charges,$13.10 ,100% of BCBS fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$41.08 ,20% of total billed charges,$41.08 ,20% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$41.08 ,20% of total billed charges,$41.08 ,20% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$133.50 ,65% of total billed charges,$133.50 ,65% of total billed charges,$54.95 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$207.00 ,100% of case rate fee,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,$54.95 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,$54.95 ,$207.00 ,$102.70 
Outpatient Medical Services,CARDIAC,93325,Doppler color flow add-on,480,$254.41 ,$165.37 ,65% of total billed charges,$173.00 ,68% of total billed charges,$99.69 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$50.88 ,20% of total billed charges,$50.88 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$50.88 ,20% of total billed charges,$50.88 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$165.37 ,65% of total billed charges,$165.37 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$591.00 ,100% of case rate fee,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,$107.90 ,$591.00 ,$127.21 
Outpatient Medical Services,CARDIAC,93320,Doppler echo exam heart,480,$355.35 ,$230.98 ,65% of total billed charges,$241.64 ,68% of total billed charges,$58.31 ,100% of BCBS fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$71.07 ,20% of total billed charges,$71.07 ,20% of total billed charges,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$71.07 ,20% of total billed charges,$71.07 ,20% of total billed charges,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$230.98 ,65% of total billed charges,$230.98 ,65% of total billed charges,$464.10 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$591.00 ,100% of case rate fee,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,$464.10 ,100% of FL Medicaid fee schedule ,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,N/A,Pays 100% medicare OPPS,$230.98 ,$591.00 ,$177.68 
Outpatient Medical Services,CARDIAC,93880,Extracranial bilat study,921,"$1,545.00 ","$1,004.25 ",65% of total billed charges,"$1,050.60 ",68% of total billed charges,$132.61 ,100% of BCBS fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$309.00 ,20% of total billed charges,$309.00 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$309.00 ,20% of total billed charges,$309.00 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,"$1,004.25 ",65% of total billed charges,"$1,004.25 ",65% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$235.35 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$97.00 ,100% of asc tier grouper rate,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$235.35 ,Pays 100% medicare OPPS,$97.00 ,"$1,004.25 ",$772.50 
Outpatient Medical Services,CARDIAC,93970,Extremity study,921,"$1,055.75 ",$686.24 ,65% of total billed charges,$717.91 ,68% of total billed charges,$147.62 ,100% of BCBS fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$211.15 ,20% of total billed charges,$211.15 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$211.15 ,20% of total billed charges,$211.15 ,20% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$686.24 ,65% of total billed charges,$686.24 ,65% of total billed charges,$167.44 ,100% of FL Medicaid fee schedule ,$231.65 ,Pays 100% medicare OPPS,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$97.00 ,100% of asc tier grouper rate,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$167.44 ,100% of FL Medicaid fee schedule ,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$231.65 ,Pays 100% medicare OPPS,$97.00 ,$686.24 ,$527.88 
Outpatient Medical Services,CARDIAC,93971,Extremity study,921,"$1,004.25 ",$652.76 ,65% of total billed charges,$682.89 ,68% of total billed charges,$98.58 ,100% of BCBS fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$200.85 ,20% of total billed charges,$200.85 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$200.85 ,20% of total billed charges,$200.85 ,20% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$652.76 ,65% of total billed charges,$652.76 ,65% of total billed charges,$107.90 ,100% of FL Medicaid fee schedule ,$585.00 ,Pays 100% medicare OPPS,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$97.00 ,100% of asc tier grouper rate,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$107.90 ,100% of FL Medicaid fee schedule ,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$585.00 ,Pays 100% medicare OPPS,$97.00 ,$652.76 ,$502.13 
Outpatient Medical Services,THERAPY,G0283,Elec stim other than wound,420,$99.91 ,$64.94 ,65% of total billed charges,$67.94 ,68% of total billed charges,N/A,Not reimbursable per contract,$32.67 ,100% of FL Medicaid fee schedule ,$19.98 ,20% of total billed charges,$19.98 ,20% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$19.98 ,20% of total billed charges,$19.98 ,20% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$64.94 ,65% of total billed charges,$64.94 ,65% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$58.20 ,Pays 100% medicare OPPS,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$58.20 ,Pays 100% medicare OPPS,$32.67 ,$82.00 ,$49.96 
Outpatient Medical Services,THERAPY,92610,Evaluate swallowing function,440,$123.60 ,$80.34 ,65% of total billed charges,$84.05 ,68% of total billed charges,N/A,Not reimbursable per contract,$233.44 ,100% of FL Medicaid fee schedule ,$24.72 ,20% of total billed charges,$24.72 ,20% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$24.72 ,20% of total billed charges,$24.72 ,20% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$80.34 ,65% of total billed charges,$80.34 ,65% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$72.00 ,Pays 100% medicare OPPS,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,Pays 100% medicare OPPS,$72.00 ,$233.44 ,$61.80 
Outpatient Medical Services,THERAPY,97116,Gait training therapy,420,$98.88 ,$64.27 ,65% of total billed charges,$67.24 ,68% of total billed charges,N/A,Not reimbursable per contract,$32.67 ,100% of FL Medicaid fee schedule ,$19.78 ,20% of total billed charges,$19.78 ,20% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$19.78 ,20% of total billed charges,$19.78 ,20% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$64.27 ,65% of total billed charges,$64.27 ,65% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$57.60 ,Pays 100% medicare OPPS,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$32.67 ,$82.00 ,$49.44 
Outpatient Medical Services,THERAPY,97140,Manual therapy 1/> regions,420,$121.54 ,$79.00 ,65% of total billed charges,$82.65 ,68% of total billed charges,N/A,Not reimbursable per contract,$38.10 ,100% of FL Medicaid fee schedule ,$24.31 ,20% of total billed charges,$24.31 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$24.31 ,20% of total billed charges,$24.31 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$79.00 ,65% of total billed charges,$79.00 ,65% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$66.00 ,Pays 100% medicare OPPS,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$66.00 ,Pays 100% medicare OPPS,$38.10 ,$82.00 ,$60.77 
Outpatient Medical Services,THERAPY,97112,Neuromuscular reeducation,420,$109.18 ,$70.97 ,65% of total billed charges,$74.24 ,68% of total billed charges,N/A,Not reimbursable per contract,$38.10 ,100% of FL Medicaid fee schedule ,$21.84 ,20% of total billed charges,$21.84 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$21.84 ,20% of total billed charges,$21.84 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$70.97 ,65% of total billed charges,$70.97 ,65% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$63.60 ,Pays 100% medicare OPPS,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$63.60 ,Pays 100% medicare OPPS,$38.10 ,$82.00 ,$54.59 
Outpatient Medical Services,THERAPY,92526,Oral function therapy,440,$98.88 ,$64.27 ,65% of total billed charges,$67.24 ,68% of total billed charges,N/A,Not reimbursable per contract,$38.10 ,100% of FL Medicaid fee schedule ,$19.78 ,20% of total billed charges,$19.78 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$19.78 ,20% of total billed charges,$19.78 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$64.27 ,65% of total billed charges,$64.27 ,65% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$57.60 ,Pays 100% medicare OPPS,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$57.60 ,Pays 100% medicare OPPS,$38.10 ,$82.00 ,$49.44 
Outpatient Medical Services,THERAPY,97165,Ot eval low complex 30 min,430,$210.12 ,$136.58 ,65% of total billed charges,$142.88 ,68% of total billed charges,N/A,Not reimbursable per contract,$186.58 ,100% of FL Medicaid fee schedule ,$42.02 ,20% of total billed charges,$42.02 ,20% of total billed charges,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$42.02 ,20% of total billed charges,$42.02 ,20% of total billed charges,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$136.58 ,65% of total billed charges,$136.58 ,65% of total billed charges,$186.58 ,100% of FL Medicaid fee schedule ,$122.40 ,Pays 100% medicare OPPS,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$122.40 ,Pays 100% medicare OPPS,$82.00 ,$186.58 ,$105.06 
Outpatient Medical Services,THERAPY,97166,Ot eval mod complex 45 min,430,$261.62 ,$170.05 ,65% of total billed charges,$177.90 ,68% of total billed charges,N/A,Not reimbursable per contract,$186.58 ,100% of FL Medicaid fee schedule ,$52.32 ,20% of total billed charges,$52.32 ,20% of total billed charges,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$52.32 ,20% of total billed charges,$52.32 ,20% of total billed charges,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$170.05 ,65% of total billed charges,$170.05 ,65% of total billed charges,$186.58 ,100% of FL Medicaid fee schedule ,$152.40 ,Pays 100% medicare OPPS,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$186.58 ,100% of FL Medicaid fee schedule ,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$152.40 ,Pays 100% medicare OPPS,$82.00 ,$186.58 ,$130.81 
Outpatient Medical Services,THERAPY,97535,Self care mngment training,430,$103.00 ,$66.95 ,65% of total billed charges,$70.04 ,68% of total billed charges,N/A,Not reimbursable per contract,$32.67 ,100% of FL Medicaid fee schedule ,$20.60 ,20% of total billed charges,$20.60 ,20% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$20.60 ,20% of total billed charges,$20.60 ,20% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$66.95 ,65% of total billed charges,$66.95 ,65% of total billed charges,$32.67 ,100% of FL Medicaid fee schedule ,$60.00 ,Pays 100% medicare OPPS,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$32.67 ,100% of FL Medicaid fee schedule ,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$60.00 ,Pays 100% medicare OPPS,$32.67 ,$82.00 ,$51.50 
Outpatient Medical Services,THERAPY,92523,Speech sound lang comprehen,440,$174.07 ,$113.15 ,65% of total billed charges,$118.37 ,68% of total billed charges,N/A,Not reimbursable per contract,$233.44 ,100% of FL Medicaid fee schedule ,$34.81 ,20% of total billed charges,$34.81 ,20% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$34.81 ,20% of total billed charges,$34.81 ,20% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$113.15 ,65% of total billed charges,$113.15 ,65% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$101.40 ,Pays 100% medicare OPPS,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$101.40 ,Pays 100% medicare OPPS,$82.00 ,$233.44 ,$87.04 
Outpatient Medical Services,THERAPY,92507,Speech/hearing therapy,440,$108.15 ,$70.30 ,65% of total billed charges,$73.54 ,68% of total billed charges,N/A,Not reimbursable per contract,$233.44 ,100% of FL Medicaid fee schedule ,$21.63 ,20% of total billed charges,$21.63 ,20% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$21.63 ,20% of total billed charges,$21.63 ,20% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$70.30 ,65% of total billed charges,$70.30 ,65% of total billed charges,$233.44 ,100% of FL Medicaid fee schedule ,$63.00 ,Pays 100% medicare OPPS,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$233.44 ,100% of FL Medicaid fee schedule ,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,Pays 100% medicare OPPS,$63.00 ,$233.44 ,$54.08 
Outpatient Medical Services,THERAPY,97530,Therapeutic activities,420,$104.03 ,$67.62 ,65% of total billed charges,$70.74 ,68% of total billed charges,N/A,Not reimbursable per contract,$38.10 ,100% of FL Medicaid fee schedule ,$20.81 ,20% of total billed charges,$20.81 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$20.81 ,20% of total billed charges,$20.81 ,20% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$67.62 ,65% of total billed charges,$67.62 ,65% of total billed charges,$38.10 ,100% of FL Medicaid fee schedule ,$57.00 ,Pays 100% medicare OPPS,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$82.00 ,100% of case rate fee,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$38.10 ,100% of FL Medicaid fee schedule ,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$57.00 ,Pays 100% medicare OPPS,$38.10 ,$82.00 ,$52.02 
Outpatient Medical Services,VISIT,99215,"Established Patient Office Visit, Complex",510,$488.22 ,$317.34 ,65% of total billed charges,$331.99 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$97.64 ,20% of total billed charges,$97.64 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$97.64 ,20% of total billed charges,$97.64 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$317.34 ,65% of total billed charges,$317.34 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$284.40 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,Pays 100% medicare OPPS,$284.40 ,$317.34 ,$244.11 
Outpatient Medical Services,VISIT,99214,"Established Patient Office Visit, Detailed",510,$362.56 ,$235.66 ,65% of total billed charges,$246.54 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$72.51 ,20% of total billed charges,$72.51 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$72.51 ,20% of total billed charges,$72.51 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$235.66 ,65% of total billed charges,$235.66 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$211.20 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,Pays 100% medicare OPPS,$211.20 ,$235.66 ,$181.28 
Outpatient Medical Services,VISIT,99213,"Established Patient Office Visit, Expanded Focused",510,$309.00 ,$200.85 ,65% of total billed charges,$210.12 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$61.80 ,20% of total billed charges,$61.80 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$200.85 ,65% of total billed charges,$200.85 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,Pays 100% medicare OPPS,$180.00 ,$200.85 ,$154.50 
Outpatient Medical Services,VISIT,99212,"Established Patient Office Visit, Focused",510,$150.38 ,$97.75 ,65% of total billed charges,$102.26 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$30.08 ,20% of total billed charges,$30.08 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$30.08 ,20% of total billed charges,$30.08 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$97.75 ,65% of total billed charges,$97.75 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$87.60 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,Pays 100% medicare OPPS,$87.60 ,$97.75 ,$75.19 
Outpatient Medical Services,VISIT,99211,"Established Patient Office Visit, Minimal",510,$104.03 ,$67.62 ,65% of total billed charges,$70.74 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$20.81 ,20% of total billed charges,$20.81 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$20.81 ,20% of total billed charges,$20.81 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$67.62 ,65% of total billed charges,$67.62 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$60.60 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,Pays 100% medicare OPPS,$60.60 ,$67.62 ,$52.02 
Outpatient Medical Services,VISIT,99385,"Preventive Medicine Evaluation, Initial, 18-39 Years Old",521,$132.87 ,$86.37 ,65% of total billed charges,$90.35 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$26.57 ,20% of total billed charges,$26.57 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$26.57 ,20% of total billed charges,$26.57 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$86.37 ,65% of total billed charges,$86.37 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$77.40 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$66.44 ,50% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$66.44 ,$86.37 ,$66.44 
Outpatient Medical Services,VISIT,99386,"Preventive Medicine Evaluation, Initial, 40-64 Years Old",521,$132.87 ,$86.37 ,65% of total billed charges,$90.35 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$26.57 ,20% of total billed charges,$26.57 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$26.57 ,20% of total billed charges,$26.57 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$86.37 ,65% of total billed charges,$86.37 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$77.40 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$66.44 ,50% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$77.40 ,Pays 100% medicare OPPS,$66.44 ,$86.37 ,$66.44 
Outpatient Medical Services,VISIT,99202,"New patient office or other outpatient visit, expanded history",510,$253.38 ,$164.70 ,65% of total billed charges,$172.30 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$50.68 ,20% of total billed charges,$50.68 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$50.68 ,20% of total billed charges,$50.68 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$164.70 ,65% of total billed charges,$164.70 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$61.35 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,Pays 100% medicare OPPS,$61.35 ,$164.70 ,$126.69 
Outpatient Medical Services,VISIT,99203,"New patient office or other outpatient visit, typically 30 min",510,$359.47 ,$233.66 ,65% of total billed charges,$244.44 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$71.89 ,20% of total billed charges,$71.89 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$71.89 ,20% of total billed charges,$71.89 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$233.66 ,65% of total billed charges,$233.66 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$209.40 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,Pays 100% medicare OPPS,$209.40 ,$233.66 ,$179.74 
Outpatient Medical Services,VISIT,99204,"New patient office of other outpatient visit, typically 45 min",510,$553.11 ,$359.52 ,65% of total billed charges,$376.11 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$110.62 ,20% of total billed charges,$110.62 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$110.62 ,20% of total billed charges,$110.62 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$359.52 ,65% of total billed charges,$359.52 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$322.20 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,Pays 100% medicare OPPS,$322.20 ,$359.52 ,$276.56 
Outpatient Medical Services,VISIT,99205,"New patient office of other outpatient visit, typically 60 min",510,$698.34 ,$453.92 ,65% of total billed charges,$474.87 ,68% of total billed charges,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$139.67 ,20% of total billed charges,$139.67 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$139.67 ,20% of total billed charges,$139.67 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$453.92 ,65% of total billed charges,$453.92 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$406.80 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,Pays 100% medicare OPPS,$406.80 ,$453.92 ,$349.17 
Outpatient Medical Services,EMERGENCY ROOM,99291,Critical care first hour-Emergency Services,450,$621.09 ,$700.00 ,700 case rate for ER,$735.00 ,735 case rate for ER,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$124.22 ,20% of total billed charges,$124.22 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$124.22 ,20% of total billed charges,$124.22 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$403.71 ,65% of total billed charges,$403.71 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$361.80 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$510.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,Pays 100% medicare OPPS,$361.80 ,$510.00 ,$310.55 
Outpatient Medical Services,EMERGENCY ROOM,99281,Emergency dept visit Level 1,450,$98.88 ,$700.00 ,700 case rate for ER,$735.00 ,735 case rate for ER,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$19.78 ,20% of total billed charges,$19.78 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$19.78 ,20% of total billed charges,$19.78 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$64.27 ,65% of total billed charges,$64.27 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$15.61 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$510.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,Pays 100% medicare OPPS,$15.61 ,$510.00 ,$49.44 
Outpatient Medical Services,EMERGENCY ROOM,99282,Emergency dept visit Level 2,450,$126.69 ,$700.00 ,700 case rate for ER,$735.00 ,735 case rate for ER,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$25.34 ,20% of total billed charges,$25.34 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$25.34 ,20% of total billed charges,$25.34 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$82.35 ,65% of total billed charges,$82.35 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$54.55 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$510.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,Pays 100% medicare OPPS,$54.55 ,$510.00 ,$63.35 
Outpatient Medical Services,EMERGENCY ROOM,99283,Emergency dept visit Level 3,450,$190.55 ,$700.00 ,700 case rate for ER,$735.00 ,735 case rate for ER,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$38.11 ,20% of total billed charges,$38.11 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$38.11 ,20% of total billed charges,$38.11 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$123.86 ,65% of total billed charges,$123.86 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$93.88 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$510.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,Pays 100% medicare OPPS,$93.88 ,$510.00 ,$95.28 
Outpatient Medical Services,EMERGENCY ROOM,99284,Emergency dept visit Level 4,450,$304.88 ,$700.00 ,700 case rate for ER,$735.00 ,735 case rate for ER,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$60.98 ,20% of total billed charges,$60.98 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$60.98 ,20% of total billed charges,$60.98 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$198.17 ,65% of total billed charges,$198.17 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$157.21 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$510.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,Pays 100% medicare OPPS,$157.21 ,$510.00 ,$152.44 
Outpatient Medical Services,EMERGENCY ROOM,99285,Emergency dept visit Level 5,450,$453.20 ,$700.00 ,700 case rate for ER,$735.00 ,735 case rate for ER,N/A,Not reimbursable per contract,N/A,100% of FL Medicaid fee schedule ,$90.64 ,20% of total billed charges,$90.64 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$90.64 ,20% of total billed charges,$90.64 ,20% of total billed charges,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$294.58 ,65% of total billed charges,$294.58 ,65% of total billed charges,N/A,100% of FL Medicaid fee schedule ,$229.42 ,Pays 100% medicare OPPS,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$510.00 ,100% of case rate fee,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,N/A,100% of FL Medicaid fee schedule ,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,Pays 100% medicare OPPS,$229.42 ,$510.00 ,$226.60 
Outpatient Medical Services,OFFICE VISIT,99203,"New patient office or other outpatient visit, typically 30 min",761,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99204,"New patient office of other outpatient visit, typically 45 min",761,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99205,"New patient office of other outpatient visit, typically 60 min",761,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99385,"Initial new patient preventive medicine evaluation, for those ages 18 to 39",761,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OFFICE VISIT,99386,"Initial new patient preventive medicine evaluation, for those ages 40 to 64",761,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,80048,Basic metabolic panel,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,80053,"Blood test, comprehensive group of blood chemicals",300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,80061,"Blood test, lipids",300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,80069,Kidney function panel tes,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,80076,Liver function blood test panel,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,81001,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,81003,Prostate specific antigen,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,84443,"Blood test, thyroid stimulating hormone",300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,85025,"Complete blood cell count, with differential white blood cells, automated",300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,85027,"Complete blood count, automated",300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,85610,"Blood test, clotting time",300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,LAB,85730,Coagulation assessment blood test,300,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,70450,"CT scan, head or brain, without contrast",350,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72110,"X-Ray, lower back, minimum four views",320,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,72193,"CT scan, pelvis, with contrast",350,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,74177,CT scan of abdomen and pelvis with contrast,320,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,76700,Ultrasound of abdomen,402,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,76805,"Abdominal ultrasound of pregnant uterus, greater or equal to 14 weeks 0 days, single or first fetus",402,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,76830,Ultrasound pelvis through vagina,402,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77065,Mammography of one breast,403,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77066,Mammography of both breasts,403,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,RADIOLOGY,77067,"Mammography, screening, bilateral",403,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscop",360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45378,Diagnostic examination of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45380,Biopsy of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,45385,Removal of polyps or growths of large bowel using an endoscope,360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A
Outpatient Medical Services,PHYSICAL THERAPY,97110,"Physical therapy, therapeutic exercise",420,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,SERVICE NOT OFFERED,N/A,N/A,N/A